Lumbar Spine and Radiculopathy as a Source of Buttock Pain

The lumbar spine is the most common source of buttock pain, and the disc, facet joints, nerve roots and dura can all refer there. Back pain, neurological deficits and positive imaging are not required. Symptoms below the knee strongly suggest a lumbar source, and extension can be as provocative as flexion for a disc. Morning stiffness that eases within 30 to 60 minutes fits the spine better than an inflammatory condition. Strong indicators are pain reproduced by lumbar movement, a positive neural tension test, neurological deficits and symptoms that centralize. Tenderness on palpation is a weak indicator. The speaker demonstrates flexion, extension, the Stork test, rotation and side gliding, then repeated movements in the McKenzie approach, using five or more repetitions to see whether symptoms centralize or peripheralize. The neurological screen covers patellar and Achilles reflexes, myotomes and dermatomes. In the slump test, neck extension that eases symptoms points to the nerve rather than the hamstring. Management centers on load modification, movement restoration, neurodynamics, hip and trunk strengthening and manual therapy.