Deep glute pain when running or hiking uphill: where it comes from

Pain in the back of the hip goes by many names

You feel a deep ache in your backside. Someone calls it piriformis. Someone else says deep gluteal syndrome. Another person calls it sciatica.

They are all describing the same area. Pain in the back of the hip (posterior hip pain).

I want to look at it from a referral standpoint. Meaning, where is this pain actually coming from?

Why I rarely blame the piriformis

Piriformis syndrome gets a lot of attention. In my experience, it's pretty rare. That's especially true for the runners, hikers and outdoor people we see.

The symptoms in the back of the hip, though, are very, very common.

I'd say probably 90% of the time, they are associated with something spinal. There are exceptions. Bodies vary. But if you are chasing a tight glute muscle and getting nowhere, that number is worth thinking about.

How posterior hip pain usually shows up

The most common presentation is a deep ache or throb in the back part of the hip. When it shows up varies from person to person.

• Prolonged sitting
• First thing in the morning
• Running, walking or hiking
• Going up steps or hiking uphill
• Single leg tasks, like putting on your pants or your shoes
• Some of your gym work

If a few of these sound familiar, you are in good company. This is a pattern we see all the time.

Why the same activity helps one person and hurts another

Here's the caveat. Different conditions can create pain in the back of the hip. Each one makes certain activities painful for some people and not for others.

Take sitting or bending over. Some people feel their pain more when they sit or bend. Others actually feel relief doing the exact same thing.

That's not random. It happens because the pain is a secondary complaint. The underlying problem decides which positions and movements make it worse or better.

So don't compare your triggers to your running buddy's. Write down what makes yours better and what makes it worse. That is a clue to the real source.

Sciatica is a symptom, not a diagnosis

I know lots of people say sciatica is a diagnosis. It's not.

Sciatica is a symptom of some other pathology. It presents differently depending on what that pathology is. The same goes for deep glute pain in general.

That's why naming the pain isn't enough. Calling it sciatica or piriformis doesn't tell you what's driving it. The pattern of what changes your pain does.

In most of the runners and hikers I see, that trail leads back to the spine. Not always. But often enough that the spine should be on the list before you spend months working on a glute muscle.

Key takeaways

• Piriformis, deep gluteal pain and sciatica are often different names for pain in the same spot.
• In my experience, true piriformis syndrome is rare in runners and hikers.
• I'd estimate about 90% of posterior hip pain is associated with something spinal.
• Common triggers include sitting, mornings, running, hiking uphill, stairs and single leg tasks like putting on shoes.
• Sitting or bending can make one person worse and give another relief, depending on the underlying condition.
• Sciatica is a symptom of another problem, not a diagnosis in itself.