Causes for lower back pain above the buttocks include gluteal tendinopathy, erector spinae muscle strain, posterior superior iliac spine pain, and other forms of non-specific low back pain.
Often times the exact structure that is irritated is not able to be determined regardless of what evaluative technique is used. Even using an x-ray or MRI often cannot give us a clear picture of exactly what structure is causing pain.
In this article, we will go over a few different reasons that might be contributing to your symptoms.
What causes lower back pain just above the buttocks?
Muscle spasm
If you experience a lumbar spinal erector or quadratus lumborum muscle spasm it’s very possible to experience pain just above the buttocks.
Spasms feel like tight, grabbing, and sharp pain. This usually improves over the course of a few days to a few weeks.
Fall or injury
If you’ve recently experienced a fall or injury and landing on your hip, back, or even fell forward, it’s possible you’ve bruised your pelvic crest on your back-side.
It’s also possible to sustain a lumbar spinal fracture. If you heard a crunch during the fall and felt it in your back, you should go to your doctor as soon as possible.
If it turns out that it’s a bone bruise and not a fracture, then there is not much to do for this other than use heat, ice, stay moving and give it time to heal and for pain levels to come down.
Lumbar Spinal Stenosis
Spinal stenosis can manifest above the glutes, however often times people will feel symptoms starting in the lumbar spine and then traveling into the glutes, down the back or front of the thighs, and sometimes down to the calf and feet.
I’ve written before about how lumbar spinal stenosis can be managed non-surgically and that a 5 year study that followed people who received spinal stenosis surgery vs. those who did not had the same exact functional outcome.
Fancy that…
Lumbar Disc Herniation
Usually, the pain related to a disc herniation in the lumbar spine is felt more intensely through the legs than the back.
As the symptoms in the legs start to go away, this indicates that symptoms are generally improving, although the pain may increase in the lumbar spine.
This is called “centralization,” and it’s a very common experience with those who are recovering from radiculopathy related to a lumbar disc herniation.
Heavy backpack or purse use
This isn’t a condition, however it’s worth mentioning that if you are always wearing a purse or back pack on one side, and you never switch sides, plus are wearing it for many hours a day, it’s possible you can develop some low back pain above the buttocks.
Of course this is not a guaranteed thing, so just be aware that if you are doing this, test out and see if changing it up makes it feel better.
Intensity spikes during workouts
Another common reason for pain just above the buttocks is if you recently spiked your intensity in your workout program (ran faster or lifted significantly more weight). It’s possible that this can contribute to some discomfort, however, again, this is not a guarantee.
You’ll need to test out and see if the symptoms you are having are related to the intensity of your workouts, or not. This requires reducing the intensity and then gauging how you feel 24 hours afterwards.
Belt is too tight
I’ve had a number of patients, and myself included who started wearing a belt and ended up having pain just above the buttocks due to the pressure that was being exerted by the belt.
Back when I was in grad school I started to wear belts a lot more as I was living in New York and it was a bit more formal than the west coast.
I noticed that by the end of the day, i’d have this pelvic crest type pain along my back that was relieved when I took off my belt when I got home.
Like I said above, i’ve seen this with several patients and it’s a low-hanging fruit intervention that’s worth trying.
Less Common Causes of Lower Back Pain
Spinal infection
Less than 1-2% of people will have this as a cause of lower back pain.
I’ve had one patient in my 5 year career as a therapist who’s had a spinal infection.
Spinal tumor or cancer
This is also rare. I’ve had one patient in my five-year career (thousands of patients), who’ve had this condition.
Usually the “tell,” with this is if it’s been going on for a couple months and there is absolutely nothing that makes it feel better.
I’ve never seen someone in so much pain trying to get up from the floor. It was hard to watch.
What probably doesn’t cause lower back pain just above the buttocks?
Sciatica
Sciatica is usually pain that travels into the legs from the lower back. Often times my patients don’t have back pain or pain above the buttocks but it’s all in the legs.
I’m not sure why some of these websites are listing this is as a cause.
Sacroiliitis
It’s possible that you could have symptoms from this if it was at the very top aspect of your SI joint, but again I would say this is a longshot of why you’d have pain above your buttocks.
Your glute max (buttocks) muscles attach to the pelvic crest, so to be above them that would mean it’s on the superior (top aspect), of the pelvic crest, or up into the level of the lumbar spine.
This just doesn’t make sense given the location of the SIJ.
Coccydynia
I saw this one on one of the other websites and I just wanted to include it here because it legitimately doesn’t make sense how this would cause pain ABOVE the buttocks.
The coccyx is below the buttocks. I think the authors of these articles are just keyword stuffing so that people click on the article and they rank for more keywords.
In any case, coccydynia is pain on the coccyx, particularly when you are sitting. Most people with this condition can’t sit for very long without using a soft pillow to sit on. Your coccyx is below your sacrum, it’s actually at the very end of it.
Obesity
While it’s true that people with Obesity do experience significantly worse health outcomes across the board, it’s not entirely clear that obesity “causes,” lower back pain above the buttocks.
While it’s true that when people start being more physically active they will have less pain, it’s not necessarily true that weight loss is required for that.
One of my favorite obesity medicine doctors to follow is Dr. Nadolsky.
Poor posture
Every dang article I read about pain chooses to include posture.
It’s not that posture can’t be important for certain athletic events, however, there is so much new data to show that posture is not even closely connected to any type of pain, especially low back, and neck pain.
I’ve had patients with “bad posture,” who have no pain, and I’ve had patients with “perfect posture,” who’d have the worst pain imaginable.
The most important thing to know with posture is to change it often and you’ll be fine (as far as posture is concerned)
On another note, have you wondered if the pain is related to your SI joint? You’ll want to check out this article!
Key Takeaways
There are many different reasons why you might be having lower back pain just above the buttocks.
There are also many things that likely don’t cause it.
I hope that this article was helpful for you to separate what could be causing it versus what is not.
I’ve got another article about how to choose the right stretches for lower back pain with a step-by-step guide. I encourage you to check it out!