Deep gluteal syndrome:
Deep gluteal syndrome (DGS) is a condition characterised by pain and dysfunction caused by the entrapment of the sciatic nerve or other structures in the deep gluteal space. Unlike piriformis syndrome, which specifically implicates the piriformis muscle, DGS encompasses various muscular, vascular, and fibrotic entrapments affecting nerve function. It presents with buttock pain, sciatic nerve symptoms, and discomfort during prolonged sitting or physical activity.
Anatomy:
The deep gluteal space is located beneath the gluteus maximus and includes several key structures:
- Piriformis muscle.
- Obturator internus and externus muscles.
- Quadratus femoris muscle.
- Sciatic nerve (which passes through this region and can be compressed).
- Blood vessels and fibrous bands This area plays a vital role in hip stability, movement, and neuromuscular control.
Physiology and Function:
The deep gluteal muscles contribute to:
- Hip stabilisation during weight-bearing activities.
- External and internal rotation of the hip.
- Postural control and movement efficiency. When functioning normally, these muscles allow for smooth lower limb movement and protect the sciatic nerve from excessive compression or irritation.
Mechanism of Injury:
DGS can develop due to:
- Prolonged sitting causing nerve compression.
- Repetitive strain from activities like running, cycling, or squatting.
- Muscle imbalances leading to sciatic nerve irritation.
- Trauma or injury (e.g., falls, hip surgery, or deep tissue scarring).
- Anatomical variations affecting nerve pathways.
Risk Factors:
Individuals at higher risk of developing DGS include:
- Athletes engaging in repetitive hip movements.
- People with sedentary lifestyles who sit for prolonged periods.
- Individuals with poor posture or biomechanical imbalances.
- Patients recovering from hip surgery or trauma.
- Those with tight or weak gluteal muscles.
Signs and Symptoms:
Common clinical features of DGS include:
- Deep buttock pain, sometimes radiating down the posterior thigh.
- Sciatica-like symptoms without lumbar involvement.
- Pain during prolonged sitting or driving.
- Tenderness on palpation of the deep gluteal region.
- Weakness or discomfort with hip movements.
Physiotherapy Management:
Effective physiotherapy strategies for DGS include:
- Pain and Symptom Management
- Ice or heat therapy for pain relief.
- Activity modification to reduce aggravating movements.
- NSAIDs or pain management techniques as prescribed.
- Manual Therapy
- Soft tissue mobilisation to relieve muscular tightness.
- Myofascial release of the piriformis and other deep gluteal muscles.
- Neural mobilisation to reduce sciatic nerve irritation.
- Exercise Rehabilitation
- Stretching exercises for the piriformis, hamstrings, and gluteal muscles.
- Strengthening exercises for the glutes, core, and hip stabilisers.
- Neuromuscular control training to improve movement patterns.
- Postural and Biomechanical Correction
- Gait analysis and correction of movement dysfunctions.
- Core stabilisation to enhance spinal and pelvic alignment.
- Ergonomic advice for sitting and daily activities.
- Gradual Return to Activity
- Progressive loading to restore function.
- Sport-specific rehabilitation for athletes.
- Long-term strategies to prevent recurrence.
References:
- Martin, H. D., Reddy, M., & Gómez-Hoyos, J. (2015). “Deep gluteal syndrome.” Journal of Hip Preservation Surgery, 2(2), 99–107.
- Stafford, M. A., Peng, P., & Hill, D. A. (2007). “Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management.” British Journal of Anaesthesia, 99(4), 461–473.
- Hernando, M. F., Cerezal, L., Pérez-Carro, L., Abascal, F., Canga, A., & García-Valtuille, R. (2015). “Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space.” Skeletal Radiology, 44, 919–934.
- Zhang, Y., Wang, S., Zhang, R., & Jiang, Q. (2023). “Arthroscopic treatment of deep gluteal syndrome and the application of intraoperative neuromonitoring.” BMC Musculoskeletal Disorders, 24, Article 33.
- Hopayian, K., Song, F., Riera, R., & Sambandan, S. (2010). “The clinical features of the piriformis syndrome: a systematic review.” European Spine Journal, 19(12), 2095–2109.
