Deep Gluteal Pain Syndrome (DGPS)

DGPS is a recently coined phrase and replaces the previously used ‘piriformis syndrome’. It has changed due to the belief that the latter term is too narrow and specific a diagnosis for those presenting with varied signs and symptoms. The hip provides an avenue for numerous structures to pass through it as it descends into the lower limb and also provides attachment points for numerous different muscles. Therefore the term DGPS is an umbrella term that encompasses any cause of pain deep within the buttock region or pain at the back of the hip joint. 

The development of DGPS is multifactorial and could be causes by anatomical variations, microtrauma, muscle spasm, altered biomechanics or rapid increase in load or activity

People report many symptoms which can include:

• Pain over lower back or buttock area which may involve pain down the back of the thigh due to the involvement of the sciatic nerve. Therefore there may also be altered symptoms such as pins and needles or numbness that radiates down to the lower limb

• Pain after sitting for a period of time or first standing up and weight bearing through the affected leg.

• Symptoms may increase after a period of activity as this may irritate already sensitised tissues.

Following a thorough history of your symptoms it is important that a detailed physical assessment takes place to rule out any referral symptoms from the lumbar spine to the buttock or any neural involvement that also originates from the lumbar spine.

Hip active and passive range of movement plus strength testing will be performed in an attempt to illicit symptoms. Palpation of the deep tissues will also take place to identify areas of sensitivity and possible reproduction of symptoms more distally into the lower limb

Once a diagnosis of DGPS has been established physiotherapy can help improve symptoms and function by:

• Massage, soft tissue release and trigger pointing

• Acupuncture

• METs

• Education and advice

• Biomechanical analysis and re-education

• Load management

• Exercise therapy to include stretching and graded strength based exercise programme.