Pain and numbness always results from either blood vessel or nerve compression /restriction.
You’re describing a classic presentation - movement followed by tight musculature along with pain & numbness.
Based on the region the majority of these cases are related to a tight Piriformis.
Why not the Glutes?
Typically, your hip abductors (Glute Min / Med) are weak or lengthened Jaunda’s Upper and Lower Crossed Syndrome
As the pain is located in the upper gluteal area - the glutes are rarely implicated as you’d likely see pain laterally. This would also commonly present as lateral knee soreness or hip snapping (during movement).
See the image below it shows the vessels that pass exactly where you’re describing. As the sciatic nerve actually pierces the Piriformis muscle in 15% of the population.
Free 3D Anatomy Model
Symptoms are very similar to Piriformis Syndrome or SI Joint Dysfunction. There are a ton of secondary causes that could exacerbate this (spinal pathology, an innominate torsion, stenosis, weak abdominals etc.).
Below I posted some great exercises aimed at alleviating this found at spine-health.com
Supine Piriformis Stretches
(Three Different Stretches)
- Lie on the back with the legs flat. Pull the affected leg up toward
the chest, holding the knee with the hand on the same side of thebody and grasping the ankle with the other hand. Trying to lead with
the ankle, pull the knee towards the opposite ankle until stretch is
felt. Do not force ankle or knee beyond stretch. Hold stretch for 30
seconds, then slowly return to starting position. Aim to complete a
set of three stretches.
- Lie on the floor with the legs flat. Raise the affected leg and place
that foot on the floor outside the opposite knee. Pull the knee of
the bent leg directly across the midline of the body using the
opposite hand or a towel, if needed until stretch is felt. Do not
force knee beyond stretch or to the floor. Hold stretch for 30
seconds, then slowly return to starting position. Aim to complete a
set of three stretches.
- Lie on the floor with the affected leg crossed over the other leg at
the knees and both legs bent. Gently pull the lower knee up towards
the shoulder on the same side of the body until stretch is felt. Hold
stretch for 30 seconds, then slowly return to starting position. Aim
to complete a set of three stretches.
Buttocks Stretch for the Piriformis
- Begin on all fours. Place the affected foot across and underneath the
trunk of the body so that the affected knee is outside the trunk.
Extend the non-affected leg straight back behind the trunk and keep
the pelvis straight. Keeping the affected leg in place, scoot the
hips backwards towards the floor and lean forward on the forearms
until deep stretch is felt. Do not force your body to floor. Hold stretch
for 30 seconds, then slowly return to starting position. Aim to
complete a set of three stretches.
Single Knee to Chest Stretch.
- Pull one knee up to the chest at a time, gently pumping the knee
three to four times at the top of the range of motion. Do 10
repetitions for each leg. Press-up. From the prone position, press up
on the hands while the pelvis remains in contact with the floor. Keep
the lower back and buttocks relaxed for a gentle stretch. Hold the
press-up position initially for five seconds, and gradually work up
to 30 seconds per repetition. Aim to complete 10 repetitions.
UPDATE
Thanks for the additional info – love trying to make sense of what’s going on.
I work PRN as a PT so I can run it by coworkers if needed but obviously would need a full eval to get a proper Dx.
A couple questions:
- Is this pain unilateral or bilateral?
- When exactly does the pain first occur (are you just tight after a
run or is there pain as well)?
- When is the pain most intense? How long before it goes away?
- When did you first notice this (sudden onset or gradual)?
- Once sore, any specific movement(s) make the pain worse or better?
- Have you recently changed your program in anyway (distance,
intensity, mode etc.)?
- Have you even had any kind of movement screen done? Such as the
FMS, SFMS etc.. https://www.functionalmovement.com/system/home
See this:
http://www.irunfar.com/2016/04/if-you-cant-do-this-exercise-you-will-get-hurt-hip-stability-and-alignment-for-trail-runners.html
Possibly hip and altered neuromuscular firing patterns.
I’ll wait to go any further till I have more info.
