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Running has substantially shaped human evolution, it is one of the most transforming events in human history. We have literally evolved to run and our big incredible butts are evidence of this.

Professor Dan Lieberman, evolutionary biologist, Harvard University

The assessment and diagnosis of an athlete with buttock pain can be a challenge for the clinician due to the complex anatomy as well as the many different structures that can refer pain into this area. Buttock pain can be experienced by a wide variety of athletes, but higher incidence is often seen in those who are involved in running, sprinting and kicking sports. Buttock pain can be either sudden or gradual in onset, it can occur in isolation or with low back, posterior thigh and even groin pain, and it can also be due to direct trauma from falls or collisions. A list of causes of buttock pain can be found in Table 30.1. Anatomy of the buttock region can be found in Figure 30.1.

Table 30.1

A list of causes of buttock pain

Figure 30.1

Anatomy of the buttocks (a) Surface anatomy (b) Superficial muscles (c) Deep muscles


Assessment of any reported buttock pain should always first try to ascertain if there is any involvement from the lumbar spine. This can be challenging due to the complex nature of low back pain especially in chronic states. For more on low back pain and lumbar spine assessment and treatment see Chapter 29.

Detailed, comprehensive and careful questioning around the onset, duration and nature of the buttock pain, together with identifying the aggravating and easing factors will help guide the clinician to probable causes and help plan the physical examination.

However when taking a history it is important for the clinician to focus not only on the painful area, but to recognise the many other factors that can contribute to injury and pain in athletes. Time should be taken to explore and obtain a detailed history of an athlete’s lifestyle and other psychosocial factors. For example, lack of sleep, chronic levels of stress and fatigue have been found to contribute to injuries and recovery in athletes.1, 2, 3, 4 It is also important for a ...

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