When Driving Becomes a Pain in the Butt

4 Tips For Comfortable Car Rides

Buttock Pain from Driving

So, you’re taking a summer vacation this year – driving to the cabin with the family? The river? The lake? Six hours in the car isn’t so bad. You’ll leave early to miss the traffic and make sure to use the restroom beforehand so you won’t have to stop. You’ve made the drive dozens of times before, no problem. Then you feel it – halfway there you start squirming in your seat, shifting from one cheek to the other. An hour goes by and you’ve adjusted the backrest four times with no relief. Finally, you admit it: this drive is becoming a pain in the butt!

We’ve all been there. You got a new car, you tried pillows, adjusted the seat, yet nothing seems to make a difference. So, what causes this buttock pain during long car rides and what can you do about it?

Possible Sources of Buttock Pain After a Long Drive

Although it’s impossible to diagnose someone accurately without a thorough in-person evaluation (sorry Google), it may be worth educating yourself on some potential sources of your pain. This, in turn, can lead you to make some simple changes, which could potentially alleviate your symptoms without the need for further intervention.

That said, if you continue to have persistent pain, especially in the presence of weakness or incontinence, you should see your doctor.

In terms of localized buttock pain on one or both sides, particularly with long car rides, here are some potential causes:

My Opinion – the Most Likely Source of Your Pain:

Piriformis Syndrome: Secondary Piriformis syndrome is most often caused by trauma to the buttocks, leading to inflammation of soft tissue, muscle spasm, or both, which results in compression of the Sciatic nerve.

The cardinal sign of Piriformis Syndrome is sitting intolerance1,2,3,4,5 with complaints of buttock pain with or without radiating pain down the back of the thigh.

The Piriformis is a triangle-shaped muscle deep in the buttock running from your Sacrum to your hip. The sciatic nerve runs underneath the muscle, and in 22% of cases, actually pierces through the muscle/tendon itself6.

It’s been found that the main criteria for developing this syndrome is gluteal atrophy7,8,9 a.k.a. small buttock muscles.

Due to these facts, the location of the muscle, and how we tend to sit in cars, it’s my opinion the Piriformis is the most likely source of your pain.

However, other potential sources do deserve to be mentioned.

Other Potential Sources of Pain:

Coccydynia: Pain in the coccyx or ‘tailbone’. If your pain is centralized in the buttocks, it’s possible that the source could be the tailbone. The tissues surrounding the coccyx can become inflamed and the muscles attaching to it can strain10.

The most common cause of coccyx pain is direct blunt trauma such as a fall onto the buttocks. However, cumulative trauma from sitting awkwardly can cause coccyx pain, as well11.  Obesity is a main risk factor12.

Sometimes, depending on how we sit down, the coccyx can jut out backward as a result of the pelvis not properly rotating. This can cause increased pressure and even result in subluxation (altered position) of the coccyx13.

Sacroiliac Joint: This is the joint between your Sacrum at the base of your spine and your pelvic bone. Pain here can be caused by too much or too little movement of the joint.

It’s unlikely, in my opinion, that prolonged sitting from one long car ride would cause joint dysfunction here. For there to be too much movement at this joint would take a forceful misstep, rotation, or direct trauma.

Also, the SI joint is located just south of the lumbar spine and is often complained of as back pain14. If the pain you’re experiencing is in the part of the buttocks that you sit on, it’s unlikely the Sacroiliac joint you’re feeling.  However, if you’re pain is higher up the buttock, more likely on one side rather than both, this could be a potential source.

Ischio-gluteal Bursitis: a bursa is a fatty sack that acts as a buffer between a tendon and bone. Imbalances or tightness of muscles can cause rubbing and inflame a bursa which can lead to pain.

The main bursa in the buttock area is between the ischial tuberosity – your ‘sit bone’ – and your Gluteus Maximus. When standing, the large Glute muscle covers the bursa. With sitting, though, the Glute slides upward, leaving the bursa more exposed against the bone15.

Although ischiogluteal bursitis is rare16, prolonged sitting can irritate and inflame the bursa.

Radiating or Referred Pain: The nerves that run down your legs originate at different levels of the lumbar spine. If a nerve is being pinched or pressed on from a structure in the spine, pain can radiate into the buttock area.

It’s also possible that pain in the buttock can be referred from the L4-L5 facet joints of the spine17.

Hamstring Syndrome: the hamstring tendon attaches at the ischial tuberosity (your ‘sit bone’) and can become inflamed and painful. Pain with this syndrome is typically brought on by assuming a sitting position, stretching the hamstring, and running fast.

It’s unlikely, in my opinion, that this would be the source of pain from one long car ride, especially without other injuries preceding it. Studies show that most people with hamstring syndrome have a history of recurrent hamstring tears18.

What Can You Do About It?

Regardless of the source of your pain, the cause remains the same: sitting for too long in the car!

Therefore, some adjustments need to be made:

  1. Remove your wallet from your back pocket: It seems like this should go without saying, but most men, especially, still do it. Make it a habit now to put your wallet in your front pocket or remove it while driving.
  2. Adjust your seat: most car seats are designed like buckets and put you in a slouched position. This position places your body weight directly on your Piriformis Muscles and Sciatic nerves.Thankfully, though, most car seats are adjustable. Typically, when we adjust our seats, we only adjust the backrest, while the seat itself is still tilted backward. Try making the seat flat or even tilt it forward slightly – this will redistribute your weight to more comfortable areas.
  3. Adjust your backrest: Now that your seat is positioned properly, you can adjust the backrest upright, or slightly leaned back – play with the position and set it to your comfort level.  This may feel awkward at first – as we are all used to reclining in our cars – but make no mistake, your butt will thank you in the long run.
  4. Use lumbar support: Some fancy cars have a built-in lumbar support option to adjust to your liking – if you’ve got it, use it. If not, try using a small hand towel rolled up in a cylinder or a pillow placed between the small of your back and the backrest. This will allow you to maintain a neutral spine posture and keep your pelvis from rotating back onto the painful area.

In addition to these car adjustments, and if the source of your pain is indeed Piriformis Syndrome (which is likely, in my opinion), here are a few self-treatment options:

  • Stretching: the mainstay of conservative treatment for Piriformis Syndrome is stretching19. Here is how you would stretch the Right Piriformis Muscle:
    • Lie on your back
    • Bend both knees
    • Cross your Right foot over your left knee
    • Place both hands behind the Left knee
    • Pull the left knee toward your chest
    • Hold the stretch at least 30 seconds
    • Repeat on other side if necessary
  • Self-myofascial release: although this can be performed with a foam roller or a lacrosse ball, I wouldn’t recommend this right away while you’re still in acute pain from the long car trip. Maybe once your symptoms calm down you can implement this treatment to help relax the tense muscle. You can also work on this as a preventative measure beforehand to inhibit any trigger points in the muscle:
    • Sit on the foam roller or ball
    • Cross your Right foot over your Left knee
    • Lean back onto your Right hand
    • Find that tender spots and roll back and forth on them
    • Repeat on other side if necessary
  • Glute strengthening: It has been proposed that perhaps the Piriformis muscle isn’t always stiff and in need of stretching, but that it can be overstretched with faulty movement patterns pulling the leg inward (adduction and internal rotation of the femur). This alternative conservative treatment focuses on strengthening the Glute muscles that abduct and rotate the hip away from midline, along with re-educating you how to perform certain movements that may lead to pain20. Of course, the re-education process would require you to see a Physical Therapist, but here are a few ideas to start strengthening the Glutes.

Don’t Cancel Your Road Trip Just Yet

With all of these ideas in place, I would recommend making the adjustments to your car seat now. This will give you time to get used to the new position as you drive around town before venturing out on longer trips.

It might not be a bad idea to start strengthening your Glutes now as a preventative measure – not only for Piriformis Syndrome, but stronger Glutes help support your back, your knees, and ankles, as well.

The bottom line when it comes to preventing buttock pain with long car rides is to prepare in advance and make the necessary adjustments beforehand, rather than reacting to the pain once it hits you.

Enjoy your road trip!

Question: What else have you found to be helpful in reducing buttock pain while driving? You can leave a comment by clicking here.

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  13. Maigne, J, et al. Causes and Mechanisms of Common Coccydynia: Role of Body Mass Index and Coccygeal Trauma. Spine. 2000; 25(23):3072-3079. ↩︎
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  15. Anderson CR. Weaver’s Bottom. JAMA 1974;228:565 ↩︎
  16. Chavetz N, Genant HK, Hoaglund FT. Ischiogluteal tuberculous bursitis with progressive bony destruction. J Can Assoc Radiol 1982;33:119-120. ↩︎
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  • jo lo

    thanks for the great tips
    would be great if you can add in a picture of the exercises 🙂

  • Pingback: When Driving Hurts | Brookside Physical Therapy()

  • Debbie Cichra

    In addition to the exercises and adjustments to the car seat, what about a pillow designed for relieving pressure? I’m thinking about other situations like attending conferences or a desk job where one is sitting for an extended period.

    • Michael Curtis

      A pillow can provide temporary relief, however, I’ve found that the position your pelvis is in to relieve pressure off of the piriformis is most beneificial, regardless of the softness/firmness.