4 Exercises to treat Deep Gluteal Syndrome

To treat Deep Gluteal syndrome, you should focus on exercises that target hip mobility, not just stretches that give temporary relief. Long lasting improvements are possible simply by strengthening the muscles that are weak and improving hip rotation. For deep gluteal syndrome syndrome, we are specifically talking about hip internal rotation. Here are the keys to banish this problem for good and improve your hip mobility.

We’ll jump right into the exercises since this isn’t a Pinterest recipe for garlic roasted asparagus. Delicious and annoying.

4 Deep Gluteal Syndrome Exercises to Decrease Pain and Improve Hip Mobility

You can click each individual exercise to go directly to the instructions.

1. Quadruped rock back

2. Reverse Clamshell

3. Seated Hip Flexion Isometric

4. Prone Hip Internal Rotation

Related: My back pain is REALLY bad, should I go to the ER? Click here for that answer

#1 How to perform Quadruped Rock Back for deep gluteal syndrome relief

  • start on your hands and knees
  • push butt to heels using hands
  • don’t let your back round excessively
  • hold 10 seconds while breathing in the nose, out through pursed lips to promote relaxation

#2 How to perform the reverse clamshell

  • comfortably lay on your side
  • place a towel roll or small pillow between the knees to keep your hips more neutral
  • rotate the top leg towards the bottom leg, the foot should automatically go towards the ceiling
  • hold 10 seconds while breathing in the nose, out through pursed lips to promote control

#3 How to perform seated Hip Flexion Isometric

  • start by sitting comfortable with the hips at 90 degrees
  • lift the hip towards the ceiling
  • don’t let the low back round excessively
  • hold 10 seconds while breathing in the nose, out through pursed lips to promote control

#4 How to Perform Prone Hip Internal Rotation for deep gluteal syndrome

  • start on your stomach with a small object between the knees to keep the hips neutral
  • slowly rotate the knees towards each other, the feet will fall out
  • hold 10 seconds while breathing in the nose, out through pursed lips to promote relaxation

Perform these deep gluteal syndrome exercises 2 sets of 15 reps of each exercise, and hold each rep for 10 seconds. These can be done 2-3 times a week.

For additional work on hip rotation, see here.

What causes deep gluteal syndrome, a.k.a, piriformis syndrome? 

The traditional idea is the Sciatic nerve is compressed because of overuse of the piriformis muscle.

Over time the piriformis muscle gets shortened and/or stiff, so any time you use the muscle, the compression causes pain in the butt or pain that goes down the leg.

piriformis as source of pain with deep gluteal syndrome
Sciatic nerve passes through the piriformis muscle

There’s only about a 10% chance (SOURCE) the piriformis muscle is the cause of your problem. 

The reason for the small percent chance is because there are so many structures back there that could be the source of the nerve compression besides just the piriformis muscle.

The medical community is actually trying to distance itself from the term sciatica since it is not specific. It does not tell WHY or WHAT is the cause. Don’t expect this to happen anytime soon.

Deep Gluteal Syndrome (DGS) DGS is the (new) preferred name insurance is more likely to reimburse since there is some structure deep in the gluteals that could be compressing the nerve. Assuming the source is not the disc.

It could be both – disc + nerve compression. Not uncommon for back pain to be causes by multiple things.

Don’t worry about what the condition is actually called, that’s a debate for academics and the insurance companies. The treatment DOES NOT CHANGE.

Diagnosing Piriformis Syndrome, or Deep Gluteal Syndrome

You can (kind of) confirm you actually have Deep Gluteal Syndrome, versus pain from a herniated disc, with the following 3 tests.

  1. Flexion Adduction Internal Rotation (FAIR) Test
  2. Flexion Adduction Internal Rotation (FADIR) Test
  3. Seated piriformis stretch test (starts 2:00 in)

The test is positive for deep gluteal syndrome if it recreates YOUR symptoms and pain in the SAME location.

If these are all all negative then likely your issue is disc related, so the nerve compression is at the spine, not somewhere along the path of the sciatic nerve. You can go here for advice on managing that type of pain.

Important to note the tests in the video are done by a therapist on ANOTHER person, but you can get close enough. If all 3 are positive, that’s good enough. 

Prognosis and Summary

If you’ve battled piriform…

…ugh, I mean Scia….

…I mean Deep Gluteal Syndrome and nothing seems to work, this probably will. This is a targeted approach to the hip lateral rotators and a great way to improve hip internal rotation ROM and strength, something lacking in most people anyway. You may notice reduce pain after 1 session, and you’ll likely notice a difference in overall pain in 2-3 weeks if it’s actually DGS.