Ouchie — I don’t know how else to say this but I have one painful buttock. I can barely sit down and can’t put any weight on that side. It just seemed to come on all of a sudden. I don’t recall twisting wrong or doing anything sudden. What could be causing this?

Pain along the back of the hip or buttock can be a very complex and puzzling condition to figure out. Sometimes a muscle gets overworked and goes into spasm. There could be an alignment problem of the spinal joints in the lumbar spine causing your symptoms. There could even be a disc pressing on a nerve creating your symptoms.

The best way to find out is to see a musculoskeletal specialist. This could be a sports medicine physician, orthopedic surgeon, or physical therapist. Give some thought to your symptoms because the physician or therapist will ask you many questions about where it hurts, how it feels, what makes it better or worse, how long it lasts, and so on. The answers to these questions are key to understanding what’s going on.

Pain along the back of the hip is rarely coming from inside the joint. We know this from anatomy studies and understanding the nerve pathways that supply the joint and surrounding soft tissues.

It is most likely coming from elsewhere — like the sacroiliac joint, low back, or knee. It could be from a muscle strain, hernia, bursitis, degenerative disc disease, fracture, or even from a hip dislocation. Rarely, buttock pain can be caused by more serious problems like infection or tumor.

There are many clinical tests that can be done to sort out what anatomical structure is getting pinched, overworked, or is out of balance or alignment. Change in joint motion, areas of muscle weakness, muscle tightness, and even the way you stand and walk will provide the necessary clues to identify the underlying problem.

Sometimes, X-rays or other imaging studies such as MRIs, CT scans, or ultrasound studies are needed. But most of the time, the problem clears up with conservative care and doesn’t require expensive or invasive tests.

If your symptoms don’t improve or go away with a few days rest, warm baths, and stretching, then make an appointment for an evaluation. Early diagnosis and treatment preventing worsening of the problem often saves both the pocketbook and the buttock from further suffering.