Why Won’t My Glute Pain Go Away? It Might Not Be Your Glute at All
You’ve tried everything. Foam rolling. Glute activation exercises. Maybe even a cortisone injection. But that deep, nagging ache in your buttock — the one that gets worse when you sit for long periods or climb stairs — just won’t quit.
Here’s what most people (and unfortunately, many clinicians) miss: that pain may not be coming from your glute muscles at all. It could be coming from a small, deep hip rotator called the obturator internus.
The Muscle Nobody Talks About
The obturator internus sits deep inside the pelvis, running from the inner surface of the pelvic bone, through a notch in the sciatic notch, and attaching near the top of the femur. Its job is to externally rotate and stabilize the hip. Because it sits so deep — underneath the glute maximus and right next to the sciatic nerve — it’s one of the most commonly overlooked sources of deep buttock and hip pain.
When this muscle becomes tight, irritated, or develops trigger points, it can mimic — and often gets misdiagnosed as — several other conditions:
- Piriformis syndrome
- Sciatica
- Hip bursitis
- Sacroiliac (SI) joint dysfunction
- Deep gluteal syndrome
Why Your Past Treatments Haven’t Worked
If you’ve been down this road already, this list might sound familiar:
Glute strengthening programs — Loading up on clamshells, band walks, and hip thrusts can actually aggravate an irritated obturator internus, especially if the muscle is already overworked trying to compensate for poor hip mechanics elsewhere.
Piriformis stretches — Many people are told they have “piriformis syndrome” and given a standard stretching protocol. It offers temporary relief at best because the piriformis isn’t always the true culprit — and stretches aimed at it often don’t reach the obturator internus at all.
Cortisone injections — These can quiet inflammation short-term, but if the underlying muscular restriction and movement dysfunction aren’t addressed, the pain typically returns within weeks.
General massage or foam rolling — The obturator internus sits too deep for a foam roller to reach. Surface-level soft tissue work rarely touches it.
Rest alone — Deep hip rotator dysfunction usually doesn’t resolve with rest. Without targeted intervention, compensations elsewhere in the hip and low back tend to build up over time.
Signs It Might Be Your Obturator Internus
While only a hands-on evaluation can confirm the diagnosis, these are common red flags:
- Deep, aching pain in the buttock that’s hard to pinpoint with one finger
- Pain that worsens with prolonged sitting, especially on firm surfaces
- Discomfort during or after activities involving hip rotation (climbing stairs, getting out of a car, pivoting)
- A sensation of tightness or pressure deep in the hip that doesn’t respond to typical glute stretches
- Pain that sometimes radiates toward the tailbone, groin, or down the back of the leg — mimicking sciatica
- Symptoms that haven’t improved despite months of standard “glute” or “piriformis” rehab
The Missing Piece: Manual Assessment and Targeted Treatment
Because the obturator internus is so deep and its symptoms overlap with so many other diagnoses, most standard treatment plans never actually address it. Getting real, lasting relief requires:
- A thorough manual assessment to differentiate the obturator internus from the piriformis, glutes, and hip capsule
- Hands-on techniques capable of reaching deep hip rotators — not just surface muscle work
- A movement and loading plan that addresses why the muscle became overworked in the first place
- Progressive rehab that restores full, pain-free hip rotation and stability
Meet the Expert: Maryann Daniels
At Pursuit Physical Therapy, Maryann Daniels is the go-to specialist for exactly this kind of stubborn, deep hip and glute pain. Patients who’ve struggled for months — sometimes years — with unresolved “piriformis syndrome” or vague hip pain often find that Maryann is the first clinician to correctly identify the obturator internus as the true source.
Her approach combines a detailed hands-on evaluation with targeted manual therapy and a customized movement plan, so patients aren’t just told to stretch and strengthen the same muscles that never worked before. If your glute pain has outlasted every treatment you’ve tried, it may be time for an evaluation that actually gets to the root cause.
Ready to Get an Accurate Diagnosis?
Pursuit Physical Therapy is a cash-based, concierge model — meaning your evaluation and treatment are one-on-one with a board-certified specialist from start to finish, with no insurance limitations dictating your care.
Schedule an evaluation with Maryann Daniels at either of our locations:
📍 Orlando — 1004 Delridge Ave 📍 Winter Garden — 1620 Daniels Rd, Suite 130
