The Science of Deep Gluteal Syndrome
Deep Gluteal Syndrome (DGS) is a comprehensive term that describes the entrapment or irritation of the sciatic nerve not just by the piriformis, but by a number of other structures in the deep buttock space, such as fibrous bands, the gemelli-obturator internus muscle group, or hamstring issues. The most common misconception is that all buttock and leg pain is "sciatica" coming from the lumbar spine. For decades, a condition called "Piriformis Syndrome" was used as a catch-all term for this type of pain. While the piriformis muscle can be involved, we now understand the situation is more complex. The deep gluteal space is a busy anatomical neighborhood. The sciatic nerve must navigate a narrow tunnel surrounded by several deep hip rotator muscles like the piriformis. Irritation of the nerve in this space can cause DGS. This is the central mystery of DGS: buttock and leg pain that mimics a classic "pinched nerve" from the back, but originates from a completely different location - your back may be completely innocent. The way you move can contribute to DGS. A gait pattern where the knee collapses inwards (valgus) can cause over-activity and eventual tightness of the deep external rotator muscles of the hip (like the piriformis) as they work overtime to try to control the femur. This tightness can contribute to nerve compression. Similarly, weakness in the gluteus medius or maximus can lead to compensatory strategies that overload these deeper muscles. Living with nerve pain is unsettling. The tingling, burning, and unpredictable nature of the symptoms can create a high level of anxiety and fear. Patients often worry they have a serious spinal condition. Understanding that the nerve is simply "irritated" or "compressed" in the buttock, and not "damaged" in the spine, can significantly reduce fear.