Deep Gluteal Syndrome: Cause, Symptoms, Treatment, Exercise

What is a Deep Gluteal Syndrome?

Deep Gluteal Syndrome (DGS) is a condition characterized by pain in the buttocks region, caused by compression or irritation of the sciatic nerve and/or other nerves, vessels, or muscles that pass through the deep gluteal region. The deep gluteal region is the area located in the buttocks between the iliac crest, the greater trochanter, and the ischial tuberosity.

DGS is caused by a variety of factors, including anatomical variations, trauma, repetitive motions, muscle imbalances, and compression due to sitting for prolonged periods. Common symptoms include deep pain in the buttocks, numbness or tingling in the legs or feet, difficulty walking, and difficulty sitting or standing for prolonged periods.

Treatment options for DGS include physical therapy, medication, and in some cases, surgery. The goal of treatment is to alleviate pain, restore normal function, and improve quality of life.

Related Anatomy

To understand Deep Gluteal Syndrome, it is essential to have a basic understanding of the anatomy of the deep gluteal region.

The deep gluteal region is a complex area that contains many important structures, including nerves, vessels, muscles, and bones. The region is bordered by the iliac crest superiorly, the greater trochanter of the femur laterally, and the ischial tuberosity posteriorly.

Some of the major structures that pass through the deep gluteal region include:

Sciatic Nerve: The sciatic nerve is the largest nerve in the body and is responsible for transmitting signals from the lower limb to the spinal cord. It passes through the deep gluteal region and can be compressed or irritated in cases of DGS.

Piriformis Muscle: The piriformis muscle is a small muscle that runs from the sacrum to the greater trochanter of the femur. It is responsible for rotating the hip and stabilizing the pelvis.

Superior Gluteal Artery and Nerve: The superior gluteal artery and nerve pass through the deep gluteal region and are responsible for supplying blood and innervation to the gluteus medius and minimus muscles.

Inferior Gluteal Artery and Nerve: The inferior gluteal artery and nerve pass through the deep gluteal region and are responsible for supplying blood and innervation to the gluteus maximus muscle.

Other structures that pass through the deep gluteal region include the pudendal nerve, the obturator internus muscle, and the gemellus muscles. Dysfunction of any of these structures can contribute to the development of DGS.

Causes of Deep Gluteal Syndrome

There are several possible causes of Deep Gluteal Syndrome (DGS). Some of the most common causes include:

• Anatomical variations: In some people, the structures in the deep gluteal region may be arranged in a way that increases the risk of compression or irritation of the nerves and blood vessels that pass through the region.
• Trauma: A direct blow to the buttocks or pelvis can cause damage to the nerves or muscles in the deep gluteal region, leading to DGS.
• Repetitive motions: Certain activities or occupations that involve repetitive motions of the hips, such as running or cycling, can increase the risk of DGS.
• Muscle imbalances: Weakness or tightness in certain muscles, such as the gluteus maximus or piriformis muscles, can contribute to DGS.
• Compression due to sitting: Sitting for prolonged periods of time can put pressure on the nerves and blood vessels in the deep gluteal region, leading to DGS.
• Structural problems: Conditions such as herniated discs, spinal stenosis, or tumors in the lower back or pelvic region can cause compression of the nerves that pass through the deep gluteal region, leading to DGS.
• Inflammatory conditions: Conditions such as piriformis syndrome, sacroiliitis, or rheumatoid arthritis can cause inflammation in the deep gluteal region, leading to DGS.

It’s worth noting that in some cases, the exact cause of DGS may be unknown.

Symptoms of Deep Gluteal Syndrome

The symptoms of Deep Gluteal Syndrome (DGS) can vary from person to person, and may range from mild to severe. Some common symptoms of DGS include:

• Pain in the buttocks: Deep pain in the buttocks region is one of the most common symptoms of DGS. The pain may be sharp or dull, and may be felt on one or both sides of the body.
• Numbness or tingling: Some people with DGS may experience numbness or tingling in the buttocks, legs, or feet.
• Difficulty sitting or standing: Pain or discomfort in the buttocks region may make it difficult to sit or stand for prolonged periods.
• Difficulty walking: Some people with DGS may experience difficulty walking, or a sensation of weakness in the legs.
• Sciatica-like symptoms: In some cases, DGS can cause symptoms that are similar to those of sciatica, such as pain or numbness that radiates down the back of the leg.
• Pain during exercise: Physical activity or exercise may exacerbate the symptoms of DGS, leading to pain or discomfort in the buttocks region.
• Reduced range of motion: In some cases, DGS can lead to reduced range of motion in the hip joint.

It’s important to note that not everyone with DGS will experience all of these symptoms, and some people may experience additional symptoms not listed here. If you’re experiencing any of these symptoms, it’s important to speak with a healthcare professional for an accurate diagnosis and appropriate treatment.

Risk factor

There are several risk factors that may increase the likelihood of developing Deep Gluteal Syndrome (DGS), including:

• Anatomical variations: People who have certain anatomical variations in the pelvis, such as a narrow sciatic notch or a longer piriformis muscle, may be at a higher risk for developing DGS.
• Age and sex: DGS is more common in women than in men, and it tends to occur more frequently in middle-aged and older adults.
• Physical activity: People who participate in activities that involve repetitive hip movements, such as running or cycling, may be at a higher risk for developing DGS.
• Occupation: People who have jobs that require prolonged sitting, such as office workers or truck drivers, may be at a higher risk for developing DGS.
• Previous injuries or surgery: People who have a history of hip or pelvic injuries, or who have undergone surgery in the hip or pelvic region, may be at a higher risk for developing DGS.
• Inflammatory conditions: People who have inflammatory conditions, such as rheumatoid arthritis or ankylosing spondylitis, may be at a higher risk for developing DGS.

It’s important to note that having one or more of these risk factors does not necessarily mean that a person will develop DGS. However, being aware of these risk factors can help people to take steps to reduce their risk, such as by practicing good posture, taking frequent breaks from sitting, and performing exercises to strengthen the hip and pelvic muscles.

Differential Diagnosis

Deep Gluteal Syndrome (DGS) can be difficult to diagnose because its symptoms can be similar to those of other conditions. Some of the conditions that may be considered as part of the differential diagnosis for DGS include:

• Sciatica: This condition occurs when the sciatic nerve, which runs from the lower back down through the buttocks and legs, becomes compressed or irritated. Sciatica can cause pain, numbness, tingling, or weakness in the buttocks, legs, or feet, which may be similar to the symptoms of DGS.
• Piriformis syndrome: This condition occurs when the piriformis muscle, which runs from the lower back through the buttocks and attaches to the top of the thigh bone, becomes tight or spasms. Piriformis syndrome can cause pain, numbness, or tingling in the buttocks or down the back of the leg, which may be similar to the symptoms of DGS.
• Sacroiliac joint dysfunction: This condition occurs when the joint that connects the sacrum (the bone at the base of the spine) to the pelvis becomes inflamed or misaligned. Sacroiliac joint dysfunction can cause pain in the lower back or buttocks, which may be similar to the symptoms of DGS.
• Lumbar spinal stenosis: This condition occurs when the spinal canal in the lower back becomes narrowed, putting pressure on the spinal cord or nerves. Lumbar spinal stenosis can cause pain or weakness in the buttocks or legs, which may be similar to the symptoms of DGS.
• Hip osteoarthritis: This condition occurs when the cartilage in the hip joint wears down, causing pain and stiffness in the hip. Hip osteoarthritis can cause pain in the buttocks or groin, which may be similar to the symptoms of DGS.
• Endometriosis: This condition occurs when tissue similar to the lining of the uterus grows outside of the uterus, causing pain and other symptoms. Endometriosis can cause pain in the lower abdomen or pelvis, which may be similar to the symptoms of DGS.

To determine whether a person is experiencing DGS or another condition, a healthcare professional will typically perform a physical examination, review the person’s medical history, and may order imaging tests or other diagnostic procedures as needed.

Diagnosis

Diagnosing Deep Gluteal Syndrome (DGS) typically involves a combination of a physical examination, a review of medical history, and imaging studies. A healthcare professional may use the following methods to diagnose DGS:

• Physical examination: During a physical examination, a healthcare professional will assess the person’s range of motion in the hip joint, as well as the strength and function of the surrounding muscles. They may also perform various tests, such as the Pace maneuver or the piriformis test, to assess for pain or discomfort in the buttocks region.
• Medical history: A healthcare professional may ask about the person’s symptoms, including when they started, what makes them worse or better, and whether they have a history of hip or pelvic injuries or surgery.
• Imaging studies: Imaging studies, such as X-rays, CT scans, or MRI scans, may be ordered to help identify any structural abnormalities or damage in the hip or pelvic region.
• Injection tests: A healthcare professional may perform an injection test, such as a piriformis injection or a sacroiliac joint injection, to help determine the source of the person’s pain.

Once a diagnosis of DGS has been made, treatment may involve a combination of physical therapy, pain management techniques, and in some cases, surgery. It’s important to note that because DGS can be difficult to diagnose, it’s important to seek care from a healthcare professional with experience in diagnosing and treating the condition.

Examination test

There are several examination tests that healthcare professionals may use to help diagnose Deep Gluteal Syndrome (DGS). These include:

• Pace maneuver: This test involves the person lying on their back with their affected leg extended and their non-affected leg bent at the knee. The healthcare professional then moves the person’s extended leg inward and outward while applying pressure to the knee. Pain or discomfort in the buttocks region during this maneuver may indicate DGS.
• Piriformis test: This test involves the person lying on their back with their affected leg bent at the knee and foot flat on the table. The healthcare professional then applies pressure to the outside of the knee, causing the leg to rotate outward. Pain or discomfort in the buttocks region during this maneuver may indicate DGS.
• FABER test: This test involves the person lying on their back with their affected leg flexed and placed across their opposite leg. The healthcare professional then presses down on the flexed leg while stabilizing the opposite hip. Pain or discomfort in the buttocks region during this maneuver may indicate DGS.
• Single leg squat test: This test involves the person standing on one leg and squatting down as far as possible while keeping their knee in line with their toes. Pain or weakness in the hip or buttocks region during this test may indicate DGS.
• Trendelenburg test: This test involves the person standing on one leg and lifting the opposite leg off the ground. The healthcare professional observes for any dropping of the pelvis on the weight-bearing side, which may indicate weakness in the hip or buttocks muscles, possibly due to DGS.

It’s important to note that examination tests alone may not be sufficient for diagnosing DGS, and healthcare professionals may use a combination of tests and imaging studies to arrive at a diagnosis.

Treatment of Deep Gluteal Syndrome

The treatment of Deep Gluteal Syndrome (DGS) is often individualized based on the severity and underlying cause of the condition. Here are some common treatment options that healthcare professionals may recommend:

• Physical therapy: Physical therapy can help improve range of motion, strength, and flexibility in the hip and buttocks region. A physical therapist may use a variety of techniques, including stretching, massage, and specific exercises to help alleviate pain and improve function.
• Medications: Over-the-counter pain medications, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), may help reduce pain and inflammation associated with DGS. In some cases, stronger pain medications or muscle relaxants may be prescribed.
• Injections: Injections of corticosteroids or local anesthetics into the affected area can help reduce pain and inflammation.
• Surgery: In some cases, surgery may be necessary to relieve compression of the sciatic nerve or other underlying structural abnormalities in the hip or pelvic region.
• Lifestyle modifications: Lifestyle modifications, such as maintaining a healthy weight, avoiding prolonged sitting, and using proper body mechanics during physical activity, may help alleviate symptoms and prevent further injury.

It’s important to note that treatment for DGS is often multi-faceted, and may involve a combination of the above approaches. A healthcare professional with experience in treating DGS can help develop an individualized treatment plan based on the person’s specific needs and goals.

Physiotherapy treatment

Physiotherapy can be an important component of the treatment of Deep Gluteal Syndrome (DGS) and can help improve range of motion, strength, and flexibility in the hip and buttocks region. Here are some common physiotherapy treatments that may be recommended for DGS:

• Stretching: Stretching exercises can help improve flexibility in the hip and buttocks region, which can help alleviate pain and improve function. A physiotherapist may recommend specific stretches for the hip flexors, gluteal muscles, and piriformis muscle.
• Strengthening exercises: Strengthening exercises can help improve strength in the hip and buttocks region, which can help support the joint and alleviate pain. A physiotherapist may recommend specific exercises to target the gluteal muscles, hip abductors, and hip external rotators.
• Manual therapy: Manual therapy techniques, such as massage, joint mobilization, and soft tissue release, can help alleviate pain and improve mobility in the hip and buttocks region.
• Posture education: Poor posture can contribute to DGS symptoms. A physiotherapist can provide education on proper posture and body mechanics during physical activity to help alleviate pain and prevent further injury.
• Modalities: Modalities such as heat or ice therapy, ultrasound therapy, and electrical stimulation may also be used to help reduce pain and inflammation in the hip and buttocks region.

It’s important to note that physiotherapy treatment for DGS should be individualized based on the person’s specific symptoms and needs. A physiotherapist with experience in treating DGS can help develop an individualized treatment plan based on the person’s specific goals and needs.

Exercise for Deep Gluteal Syndrome

Exercise can be an important component of the treatment of Deep Gluteal Syndrome (DGS) and can help improve strength, flexibility, and function in the hip and buttocks region. Here are some common exercises that may be recommended for DGS:

• Gluteal muscle strengthening exercises: Exercises that target the gluteal muscles can help improve strength and stability in the hip and buttocks region. Examples include clamshells, bridges, and squats.
• Hip abductor strengthening exercises: Exercises that target the hip abductor muscles can help improve strength and stability in the hip and buttocks region. Examples include side-lying leg lifts, standing hip abduction, and resistance band exercises.
• Piriformis muscle stretches: Stretching exercises for the piriformis muscle can help alleviate pain and improve mobility in the hip and buttocks region. Examples include the figure 4 stretch and the seated piriformis stretch.
• Hip flexor stretches: Stretching exercises for the hip flexors can help improve flexibility in the hip and buttocks region. Examples include the kneeling hip flexor stretch and the lunge stretch.
• Low-impact aerobic exercise: Low-impact aerobic exercise, such as walking, cycling, or swimming, can help improve cardiovascular health and overall fitness without putting excessive stress on the hip and buttocks region.

It’s important to note that exercise for DGS should be individualized based on the person’s specific symptoms and needs. A healthcare professional or physiotherapist with experience in treating DGS can help develop an individualized exercise program based on the person’s specific goals and needs. It’s also important to start slowly and gradually increase the intensity and duration of exercise to prevent further injury.

Home treatment for Deep Gluteal Syndrome

Here are some home treatments that may help alleviate symptoms of Deep Gluteal Syndrome (DGS):

• Rest: Avoiding activities that aggravate symptoms and taking regular breaks from sitting or standing for prolonged periods can help reduce pain and inflammation in the hip and buttocks region.
• Ice or heat therapy: Applying ice or heat to the affected area can help reduce pain and inflammation. Ice can be applied for 15-20 minutes at a time, several times a day, while heat can be applied for 15-20 minutes at a time, up to three times a day.
• Over-the-counter pain medications: Over-the-counter pain medications, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can help reduce pain and inflammation associated with DGS. Always follow the instructions on the label and talk to a healthcare professional if you have any concerns.
• Gentle stretching exercises: Gentle stretching exercises can help improve flexibility in the hip and buttocks region and alleviate pain. Examples include the seated piriformis stretch and the standing hamstring stretch.
• Good posture: Maintaining good posture while sitting or standing can help reduce pressure on the hip and buttocks region and alleviate pain. Try to sit with your feet flat on the floor and your back straight, and avoid crossing your legs for prolonged periods.

It’s important to note that while these home treatments may provide some relief, they should not be used as a substitute for professional medical advice and treatment. If you are experiencing persistent or worsening symptoms of DGS, it’s important to seek medical attention from a healthcare professional.

How to Sit with Deep Gluteal Syndrome?

If you have Deep Gluteal Syndrome (DGS), sitting for prolonged periods can aggravate your symptoms and cause pain and discomfort. However, there are some tips that you can follow to help reduce pressure on the hip and buttocks region and make sitting more comfortable:

• Use a cushion: Sitting on a cushion or a foam pad can help reduce pressure on the hip and buttocks region and provide additional support and comfort.
• Adjust your chair: Adjusting the height of your chair and the angle of your seat can help reduce pressure on the hip and buttocks region. Try to keep your hips slightly higher than your knees and your feet flat on the floor.
• Take breaks: Taking regular breaks from sitting and standing up and moving around can help reduce pressure on the hip and buttocks region and improve circulation. Aim to stand up and move around for a few minutes every hour.
• Use proper posture: Maintaining good posture while sitting can help reduce pressure on the hip and buttocks region and improve alignment of the spine. Try to keep your back straight, your shoulders relaxed, and your feet flat on the floor.
• Avoid crossing your legs: Crossing your legs for prolonged periods can increase pressure on the hip and buttocks region and aggravate symptoms of DGS. Instead, try to keep your feet flat on the floor and your legs uncrossed.

It’s important to note that these tips may provide some relief, but they should not be used as a substitute for professional medical advice and treatment. If you are experiencing persistent or worsening symptoms of DGS, it’s important to seek medical attention from a healthcare professional.

How to Prevent Deep Gluteal Syndrome?

Unfortunately, there is no surefire way to prevent Deep Gluteal Syndrome (DGS) as it can be caused by a variety of factors such as anatomical abnormalities or previous injuries. However, there are some general measures you can take to reduce your risk of developing DGS or to prevent the condition from worsening if you already have it:

• Maintain a healthy weight: Being overweight or obese can put extra pressure on the hip and buttocks region, increasing the risk of developing DGS or exacerbating existing symptoms.
• Stretch regularly: Incorporating regular stretching exercises into your routine can help improve flexibility and mobility in the hip and buttocks region, reducing the risk of injury and alleviating symptoms of DGS.
• Practice good posture: Maintaining good posture while sitting or standing can help reduce pressure on the hip and buttocks region and improve alignment of the spine. Try to keep your back straight, your shoulders relaxed, and your feet flat on the floor.
• Take regular breaks: Taking regular breaks from sitting or standing for prolonged periods can help reduce pressure on the hip and buttocks region and improve circulation.
• Wear appropriate footwear: Wearing appropriate footwear that provides good support and cushioning can help reduce the impact on the hip and buttocks region when walking or running.
• Warm up and cool down properly: Before engaging in any physical activity, be sure to warm up and stretch properly to prepare your muscles and joints. Afterward, take the time to cool down and stretch to prevent stiffness and soreness.

It’s important to note that while these measures may reduce the risk of developing DGS or prevent the condition from worsening, they may not be effective in all cases. If you are experiencing persistent or worsening symptoms of DGS, it’s important to seek medical attention from a healthcare professional.

What does Deep Gluteal Syndrome feel like?

Deep Gluteal Syndrome (DGS) can cause a variety of symptoms, including pain, numbness, tingling, or weakness in the hip and buttocks region. The pain is usually described as a deep, aching sensation that is often worsened by sitting or activities that involve prolonged periods of sitting, such as driving or working at a desk.

In some cases, the pain may radiate down the back of the thigh or into the lower leg, mimicking sciatica or other conditions that affect the nerves in the leg.

Other common symptoms of DGS may include:

• Pain or discomfort when walking or standing for prolonged periods
• Pain or discomfort when sleeping on the affected side
• Pain or discomfort during sexual activity
• Stiffness or limited range of motion in the hip joint
• It’s important to note that the symptoms of DGS can vary from person to person and may depend on the underlying cause of the condition. If you are experiencing persistent or worsening symptoms in the hip and buttocks region, it’s important to seek medical attention from a healthcare professional to determine the underlying cause and receive appropriate treatment.

How long can Deep Gluteal Syndrome last?

The duration of Deep Gluteal Syndrome (DGS) can vary depending on the severity of the condition and the effectiveness of the treatment. In some cases, mild cases of DGS may resolve with conservative treatment such as physiotherapy or pain management within a few weeks to months. However, more severe cases of DGS or those caused by underlying anatomical abnormalities may require surgical intervention, which can take longer to recover from.

In general, the goal of treatment for DGS is to alleviate symptoms, improve mobility and function, and prevent the condition from worsening or recurring. With proper treatment and management, many people with DGS are able to resume normal activities and maintain a good quality of life.

It’s important to note that the duration of DGS can be influenced by various factors, including the underlying cause of the condition, the severity of symptoms, the individual’s overall health, and their response to treatment. If you are experiencing persistent or worsening symptoms of DGS, it’s important to seek medical attention from a healthcare professional to determine the underlying cause and receive appropriate treatment.

Is walking good for Deep Gluteal Syndrome?

Walking can be beneficial for people with Deep Gluteal Syndrome (DGS) as it is a low-impact form of exercise that can help improve circulation, flexibility, and strength in the hip and buttocks region. However, it’s important to approach walking with caution and to listen to your body to avoid exacerbating symptoms.

Here are some tips for walking with DGS:

Start slow: If you are new to walking or have been inactive for a while, it’s important to start slow and gradually increase your intensity and duration over time. This will help prevent injury and allow your body to adjust to the increased activity.

Wear supportive shoes: Wearing supportive, well-fitting shoes can help reduce the impact on the hip and buttocks region and improve stability and balance while walking.

Use walking aids if necessary: If you have difficulty walking or experience pain or weakness in the hip and buttocks region, using a cane or walker may help provide support and stability.

Take breaks as needed: If you experience pain or discomfort while walking, taking breaks to rest and stretch can help alleviate symptoms and prevent further injury.

Incorporate stretching and strengthening exercises: Incorporating stretching and strengthening exercises into your walking routine can help improve flexibility and mobility in the hip and buttocks region and reduce the risk of injury.

It’s important to note that if you experience persistent or worsening symptoms while walking, it’s important to seek medical attention from a healthcare professional to determine the underlying cause and receive appropriate treatment.

What exercise should I avoid with Gluteal pain?

If you are experiencing gluteal pain, there are certain exercises that you should avoid or modify to avoid exacerbating your symptoms. Here are some exercises to be cautious with or avoid:

Squats: Squats can put a lot of pressure on the hips and buttocks, which can exacerbate gluteal pain. If you are experiencing pain or discomfort during squats, consider modifying the exercise by reducing the depth of the squat or using a resistance band to provide support.

Lunges: Like squats, lunges can put a lot of pressure on the hips and buttocks and may exacerbate gluteal pain. Consider modifying the exercise by reducing the depth of the lunge or using a resistance band to provide support.

Leg press: The leg press machine can put a lot of pressure on the hips and buttocks, which can exacerbate gluteal pain. Consider avoiding the leg press or using a lighter weight or fewer repetitions.

Running or high-impact activities: Running or other high-impact activities can put a lot of pressure on the hips and buttocks, which can exacerbate gluteal pain. Consider switching to low-impact activities such as swimming or cycling.

Sit-ups or crunches: Sit-ups or crunches can put pressure on the hip flexors, which can exacerbate gluteal pain. Consider modifying the exercise by using a foam roller to support the hips or using a different exercise to target the abs.

It’s important to note that the exercises that exacerbate gluteal pain can vary from person to person, and it’s important to listen to your body and adjust your exercise routine accordingly. If you experience persistent or worsening symptoms, it’s important to seek medical attention from a healthcare professional to determine the underlying cause and receive appropriate treatment.

Conclusion

Deep Gluteal Syndrome is a condition that can cause pain in the buttocks and hip region, and can be caused by a variety of factors such as trauma, inflammation, or nerve compression. The symptoms can include pain, weakness, and numbness in the buttocks and hip region, and can be exacerbated by certain activities such as sitting or exercising.

The diagnosis of Deep Gluteal Syndrome is typically made through a combination of physical examination, imaging tests, and diagnostic injections. Treatment options can include medications, physical therapy, and in some cases, surgery.

If you are experiencing symptoms of Deep Gluteal Syndrome, it’s important to seek medical attention from a healthcare professional to determine the underlying cause and receive appropriate treatment. Additionally, it’s important to approach activities such as sitting and exercising with caution and to listen to your body to avoid exacerbating symptoms.