Why Your Butt Hurts When Running and How to Stop It

Buttock pain during or after running usually traces back to one of a handful of causes: weak or fatigued gluteal muscles, irritated tendons near the sitting bone, nerve compression deep in the hip, or pain referred from the lower back or sacroiliac joint. The gluteal muscles are the largest and most powerful muscle group in the body, yet they are surprisingly prone to inhibition and underperformance, especially in people who sit for long stretches between runs. Pinpointing which structure is complaining changes the fix entirely, so understanding the most common culprits is worth the time before you start stretching everything in sight.

Why the Gluteal Muscles Are So Vulnerable in Runners

Your buttocks contain three muscles that do different jobs. The gluteus maximus, the big superficial one, is the primary hip extensor. During running it controls trunk flexion on the stance side and decelerates the swing leg, which means it works hard on every single stride.¹ The gluteus medius, sitting higher and deeper on the side of the pelvis, stabilizes your pelvis and controls hip adduction and internal rotation during dynamic movement.² The gluteus minimus assists the medius. Together, these muscles keep you from collapsing sideways every time one foot leaves the ground.

The problem is that gluteal muscles are prone to inhibition and weakness, which contributes to chronic pain, injury, and athletic underperformance.³ Prolonged sitting is one of the most commonly blamed culprits: hours in a chair can leave the glutes neurologically sluggish, so that when you lace up and head out the door, the hamstrings and lower back compensate for work the glutes should be doing. When those compensating structures fatigue first, the ache settles right where you feel it: deep in the buttock, along the sit bone, or wrapping around the outside of the hip.

Gluteal and Proximal Hamstring Tendinopathy

If the pain is a stubborn, localized ache near the outer hip or directly under the sit bone and worsens with hills, speed work, or sitting on hard surfaces, tendinopathy is a likely suspect. Gluteal tendinopathy affects the tendons of the glute medius and minimus where they attach to the greater trochanter, the bony bump on the side of your hip. Proximal hamstring tendinopathy affects the hamstring tendons where they anchor to the ischial tuberosity, the bone you sit on. In clinical experience, the two sometimes occur together.⁴

For proximal hamstring tendinopathy specifically, the main driver is compression and shear force at the ischial tuberosity during hip flexion combined with adduction.⁵ That means the tendon gets squeezed against bone every time you bend deeply at the hip, which happens during uphill running, high-speed strides, and certain stretches. Roughly one in eight distance runners deals with proximal hamstring tendinopathy at some point.⁴ If your pain is worst right on the sit bone and flares when you accelerate or climb, this is a strong candidate.

Tendinopathies do not resolve with rest alone. They need progressive loading, which we will get into later in the article. The key early takeaway is that avoiding compression is more important than avoiding movement. Sitting on hard chairs, deep stretching into hip flexion, and lunges with excessive forward lean all compress the affected tendon and can slow recovery.

Piriformis Syndrome and Deep Gluteal Syndrome

Piriformis syndrome is the diagnosis runners hear most often when they complain of deep buttock pain that radiates down the leg. The piriformis is a small muscle that sits underneath the gluteus maximus, running from the sacrum to the top of the femur, and the sciatic nerve passes very close to it (or in some people, right through it). When the piriformis tightens or swells, it can compress the sciatic nerve and produce a deep aching or shooting pain in the buttock that sometimes travels down the back of the thigh.

Clinicians increasingly use the broader term “deep gluteal syndrome” because the sciatic nerve can be pinched by structures other than the piriformis. A systematic review of surgically treated cases found the most common causes were iatrogenic (from prior surgery), piriformis-related pathology, trauma, and non-piriformis muscle problems like hamstring or obturator internus involvement.⁶ For runners who have never had hip surgery or trauma, piriformis tightness is the usual culprit, but it is worth knowing the picture can be more complicated than the classic “piriformis syndrome” label suggests.

The hallmark clue is that the pain worsens with sitting (especially on hard surfaces or with legs crossed), and you might feel it deep in the buttock when you externally rotate your hip against resistance. Runners with weak glute medius muscles often overload the piriformis because it tries to help stabilize the pelvis, a job it was not designed to handle at high volume.

When the Pain Is Not Actually Starting in Your Butt

Some buttock pain during running originates in the lower back or the sacroiliac (SI) joint. This is easy to miss because the pain is felt squarely in the gluteal region, not near the spine.

Lumbar disc herniations can produce buttock pain through several pathways. Compression or irritation of the L5 or S1 nerve roots can trigger pain via the cluneal nerves that supply the buttock skin, through referred pain from irritated facet joints and SI joints, or through direct compression of fibers in the superior or inferior gluteal nerves.⁷ You may not have back pain at all, just buttock pain that seems to come from the muscles. The giveaway is often that no amount of glute work, foam rolling, or piriformis stretching changes the pain, and it sometimes shifts location or intensity in response to spinal positions rather than hip positions.

Sacroiliac joint dysfunction is another common source. Runners with SI joint pain tend to show altered gait mechanics: less knee flexion, greater overstriding, and more pelvic drop on the painful side during midstance.⁸ Whether those gait changes are a cause or a consequence of the pain is debated, but they create a reinforcing loop: the altered mechanics increase load on the affected side, which keeps the SI joint irritated. If your pain is near the dimples at the base of your spine and sometimes shifts from one side to the other, an SI joint evaluation is worth pursuing before you assume the glutes themselves are the problem.

Sacral Stress Fractures Are Rare but Worth Knowing About

This is the one on the list you do not want to miss, because the treatment is fundamentally different. A sacral stress fracture produces deep, poorly localized pain in the buttock or lower back that worsens with impact and does not ease with typical stretches or strengthening. It can look a lot like piriformis syndrome or SI joint pain in the early stages.

Sacral stress fractures are uncommon in the general running population, but they appear more often in female runners with the combination of menstrual irregularity, disordered eating, and low bone density.⁹ That said, they can also occur in runners without those risk factors; a case report documented a sacral stress fracture in a 22-year-old female runner training about 140 kilometers per week whose hormonal levels were normal and who did not have disordered eating.¹⁰ High training volume alone can be enough. If your buttock pain is getting worse week over week despite rest, or you feel it with every footstrike even during walking, get imaging before continuing to run.

How Overstriding Makes Everything Worse

Whatever the underlying issue, poor running mechanics act as an amplifier. One pattern stands out in the research: overstriding. Runners who land with the foot well ahead of the body at footstrike place the hamstrings under greater eccentric stretch exactly when ground reaction forces are highest. Runners with hamstring injuries showed roughly five degrees more overstride angle than healthy controls, a large effect.¹¹ That extra stretch at the wrong moment increases tension on the hamstring muscles and tendons and on the structures they share load with, including the piriformis and the gluteal tendons.

Overstriding also affects the SI joint. Runners with SI joint pain were found to have significantly greater overstride angles and greater pelvic drop at midstance compared with healthy controls.⁸ The combination of a long stride in front and a wobbly pelvis on top is a recipe for irritating nearly any structure in the buttock region. Fixing the overstride is one of the most broadly useful changes a runner with gluteal pain can make.

Increasing Your Cadence to Reduce Load

The most straightforward way to reduce overstriding is to increase your step rate by a small amount. A moderate cadence increase of about five to ten percent consistently reduces vertical ground reaction forces, lowers loading rates, shortens stride length, and improves lower limb alignment.¹² These changes reduce stress on the tibia, knee, and hip joints, which means less force transmitted to the structures causing your buttock pain.

Interestingly, a higher step rate also changes which muscles do the work. Running at a faster cadence increases gluteus maximus and medius activation, which may benefit runners whose glutes are underperforming.¹³ At the same time, it reduces peak force and work in the gluteal muscles and piriformis during the early stance phase, the moment when those tissues are most loaded by impact.¹⁴ So the muscles engage more consistently throughout the gait cycle but experience less of the damaging peak loading. That is exactly what you want when a tendon or muscle is already irritated.

In practice, this means counting your steps per minute (most running watches will display cadence) and nudging it up by five to ten percent over several weeks. If you currently run at 160 steps per minute, aim for 168 to 176. Use a metronome app or music with the right tempo to help internalize the new rhythm. Do not force an extreme change overnight; treat it like any other training variable and build into it gradually.

Strengthening the Glutes and Hamstrings

Gait changes address the mechanical trigger. Strengthening addresses the capacity deficit that let the pain start in the first place. For tendinopathy specifically, heavy slow resistance training has shown real promise. In a case report of proximal hamstring tendinopathy treated with progressive heavy loading, pain dropped meaningfully within four weeks of starting the program, continued to improve over 12 weeks, and the improvement held at a 12-month follow-up.¹⁵

The principle behind heavy slow resistance for tendinopathy is that tendons adapt to load, not to rest. Gradual, progressively heavier loading stimulates the tendon to remodel and grow stronger. For glute and hamstring tendinopathy, exercises like bridges, hip thrusts, deadlift variations, and single-leg Romanian deadlifts allow you to control the load and increase it over time. The key is to start at a level that is moderately uncomfortable but manageable and increase load weekly, not to jump straight to heavy weights or avoid loading entirely.

For runners whose primary issue is gluteus medius weakness rather than tendinopathy, side-lying hip abduction, lateral band walks, and single-leg stance work are more targeted. A case report of a female runner with deep gluteal pain and pelvic involvement found that trunk stabilization and gluteus maximus strengthening improved the primary symptoms within the first four treatment sessions.¹⁶ Glute-focused strengthening does not need to be elaborate. Consistency and progressive overload matter far more than exercise variety.

Warming Up Before You Run

A dynamic warm-up before running helps activate muscles that may be neurologically sluggish from sitting. Dynamic warm-ups have largely replaced static stretching as the preferred pre-exercise routine because they enhance musculoskeletal, neurological, and cardiovascular readiness before performance.¹⁷ For runners with buttock pain, this is especially relevant because the glutes often need to be “woken up” before they will fire properly during running.

A useful pre-run activation sequence for the glutes takes about five minutes:

• Glute bridges: Two sets of 10 to 15 repetitions, squeezing hard at the top and holding for two seconds.
• Lateral band walks: Two sets of 10 steps each direction with a resistance band around the ankles or just above the knees.
• Single-leg balance: 30 seconds per side, focusing on keeping the pelvis level.
• Walking lunges: 10 per side, controlled and upright, not deep enough to compress the hamstring tendon if that is irritated.

These should feel like they turn on the muscles, not exhaust them. If you are doing 50 reps of everything before even starting your run, scale back. The goal is activation, not fatigue.

The Role of the Gluteus Maximus in Preventing Hamstring Injury

Many runners with recurrent buttock and hamstring pain get stuck in a cycle: the pain improves, they return to running, and within weeks it comes back. One reason may be insufficient gluteus maximus contribution during the stance phase of running. Research comparing runners who had experienced hamstring injuries with those who had not found that the gluteus maximus may prevent hamstring injury recurrence during stance by sharing the load that the hamstrings would otherwise absorb alone.¹⁸ When the glute max is weak or fatigues early, the hamstrings pick up the slack and the cycle repeats.

This explains why isolated hamstring rehab sometimes fails to break the pattern. If you strengthen the hamstrings but never address glute max capacity, the hamstrings remain the primary load-bearing structure during late swing and early stance, the exact phases where they are most vulnerable. A return-to-running program that includes hip extension strengthening (hip thrusts, step-ups, heavy bridges) alongside hamstring-specific work is more likely to prevent recurrence.

When Injections Enter the Picture

For runners who have tried progressive loading, gait retraining, and activity modification for months without enough improvement, injection therapy becomes a conversation. Corticosteroid injections have historically been the go-to for tendinopathies, and they often provide short-term pain relief. Platelet-rich plasma (PRP) injections have gained popularity as an alternative. A review comparing PRP to corticosteroids for gluteal tendinopathies found that the PRP group showed better pain and function outcomes between three months and one year after injection, though the two treatments were not significantly different before the three-month mark.¹⁹

That timeline is important. Corticosteroids give faster relief but may not hold up over the longer term, while PRP takes longer to kick in but appears to produce more durable results. Neither injection is a substitute for the underlying rehab work. Think of injections as a way to reduce pain enough to make the strengthening program tolerable, not as the primary treatment. If someone offers a corticosteroid injection with no plan for progressive loading afterward, the relief is likely to be temporary.

Sorting Through the Possibilities

With this many potential causes, how do you figure out which one you are dealing with? Location and behavior of the pain offer the strongest clues:

• Outer hip, worse lying on that side: Gluteal tendinopathy (glute med/min tendons at the greater trochanter).
• Directly on the sit bone, worse with sitting and hill running: Proximal hamstring tendinopathy.
• Deep in the buttock, possibly radiating down the leg, worse with sitting and crossing legs: Piriformis syndrome or deep gluteal syndrome.
• Near the dimples at the base of the spine, may shift sides: Sacroiliac joint dysfunction.
• Vague buttock pain unresponsive to hip-focused treatment, changes with spinal position: Lumbar referred pain.
• Deep ache worsening steadily over weeks, present with walking, not relieved by rest: Possible sacral stress fracture; seek imaging.

Overlap is common. Someone with weak glutes can develop piriformis tightness and hamstring tendinopathy simultaneously, because the dysfunction that caused one also predisposed the other. If your symptoms match multiple categories, a clinician experienced with runners can help tease apart which structures are contributing the most.

Why Humans Are Built for This to Happen

There is an irony to gluteal pain in runners. The human gluteus maximus appears to have evolved specifically for running. Research into evolutionary biomechanics found that the gluteus maximus plays a minimal role during walking but becomes critical during running, supporting the hypothesis that the muscle’s enlargement in human ancestors was driven by the demands of running, not just upright posture.¹ We evolved the biggest glute muscle in the primate world precisely to run long distances.

The mismatch is that modern life does not prepare those muscles for the job they were designed to do. Spending most of the day seated, then asking the glutes to suddenly stabilize the pelvis, decelerate the swing leg, and control trunk flexion across thousands of strides is asking for trouble. The muscles have the genetic blueprint for endurance running, but they need consistent stimulus to maintain the strength and neuromuscular control to perform it. That is why the most effective long-term prevention is not any single stretch or shoe change but a sustained habit of glute strengthening and a gradual, patient approach to building running volume.