Deep Gluteal Strains, Nerve Syndrome and Ischiofemoral Impingement

Deep gluteal muscle strains are often overdiagnosed and may really be a hamstring tendon or lumbar problem. They usually follow sprinting, acceleration or sudden hip extension, and hurt on resisted hip extension or external rotation, though hip extension also loads the hamstring. Deep gluteal nerve syndrome, often labeled piriformis syndrome, is a rare non-discogenic entrapment of the sciatic nerve in the buttock, sometimes linked to anatomical variants. It causes sitting intolerance and symptoms down the leg, and is a diagnosis of exclusion after the lumbar spine, sacroiliac joint and hip are ruled out. A diagnostic injection is the gold standard. Management reduces sitting, adds hip strength and neurodynamics, and avoids aggressive stretching; surgical release is a late option. Ischiofemoral impingement narrows the space between the ischial tuberosity and lesser trochanter. It is often reported on MRI without being the cause. Pain comes with long strides and passive hip extension with adduction, while sitting is usually comfortable. A comparison table covers sitting, stride, resisted knee flexion and nerve tension findings for all three conditions.