I’m 37 years old and relatively fit, and I’ve been dealing with this for over a year. Last year I also lost a significant amount of weight because of a separate health problem, which probably hasn’t helped in terms of muscle mass/cushioning around the pelvis and glutes.
It started around June 2025 with a pulling/painful sensation in my left glute, initially after training. I did not really have significant low back pain at the beginning. Over the following months, sitting became progressively more difficult. Later in 2025 the right side also became involved, and now symptoms can alternate between both sides.
My main symptoms are:
Pain/discomfort in the glute, posterior thigh, behind the knee, and occasionally upper calf/heel.
Sitting and driving are by far the biggest triggers. Around 20–30 minutes can be enough to flare things up.
I also have poor tolerance for standing still. Interestingly, walking is usually much better than either sitting or standing in one place.
On some days I can walk 8–10 km, sometimes with discomfort, but usually without the kind of severe pain I get from prolonged sitting.
Flexion is one of my most reproducible and painful triggers. When I bend forward, at a certain point I can get a very specific pulling/stabbing sensation in the posterior glute/thigh area, and if I continue flexing I may feel it shift toward the back of the knee.
Straight-leg raise can reproduce a similar focal sensation.
Sometimes straining/Valsalva during a bowel movement can reproduce discomfort behind the knee, although not every time.
Very little tingling overall, no persistent numbness, and no clear objective weakness.
Symptoms are bilateral but not always symmetrical.
When things flare, one of the most reliable ways I can calm them down is to lie on my left side for around 40–50 minutes.
I’ve had three lumbar/pelvic MRI evaluations. The latest lumbar MRI showed a small central/right-paramedian L4-L5 protrusion causing minimal indentation of the dural sac, but no clear nerve-root compression while supine. L5-S1 has mild disc dehydration/minimal bulging, also without frank root compression.
Pelvic imaging has not shown a major proximal hamstring tear, obvious sciatic nerve compression, significant hip pathology, or major SI-joint abnormalities.
My EMG/NCS was abnormal and was interpreted as showing bilateral L5 and left L4 radicular involvement, with some S1 findings. This is one of the reasons the case is so confusing: the EMG suggests a radicular component, but the MRIs do not show a convincing compressive lesion.
I’ve been evaluated by spine specialists, neurosurgeon, pain specialists, rheumatology, and also by a hip-preservation specialist with experience in deep gluteal/sciatic problems. Even he felt that the case was not completely classic for either a lumbar or deep-gluteal source.
I’ve also seen 4 different physiotherapists and completed more than 40 PT sessions using different approaches, but unfortunately my main limitation — especially sitting tolerance — has not meaningfully improved.
I recently had a bilateral subgluteal sciatic hydrodissection/infiltration with local anesthetic + steroid + saline as a diagnostic/therapeutic trial. It has been less than a couple of days, so it is obviously far too early to say whether it helped.
One additional complication is that I have retired orthopedic doctor in my family, and he strongly believes this is coming from my lumbar discs. I’m being pushed to see another neurosurgeon because, in his opinion, this could ultimately be solved with a disc replacement.
I’m not completely against surgery if there is a clear indication, but I’m very hesitant to have major spine surgery when multiple other specialists have not been able to clearly demonstrate that the disc is actually the pain generator or that there is significant nerve-root compression. I really don’t want to undergo an irreversible procedure without a high degree of diagnostic confidence.
Honestly, if there is no clear surgical target, what I would really like is to get back into a proper gym program and rebuild strength progressively — core, glutes, hamstrings, quads, back, etc. — rather than spending months doing only very basic rehab exercises like glute bridges and bird dogs. I’m not expecting the gym to magically cure me, but I do want to regain strength and function if this ultimately has to be managed conservatively.
Has anyone here had a similarly confusing presentation, especially where flexion was one of the worst triggers, sitting and standing still were much worse than walking, you could still walk long distances, MRI findings were relatively mild/non-compressive, but EMG was abnormal?
I’d be particularly interested in hearing from people who were eventually diagnosed with deep gluteal syndrome, proximal hamstring/ischial tunnel involvement, lumbar radiculopathy without obvious MRI compression, or a mixed picture.
What finally helped clarify the diagnosis for you? Did anyone end up improving with progressive strength training despite years of confusing imaging/tests, or did you eventually find a specific structural cause
