Most people occasionally experience minor aches and pains of no major consequence. But burning pain tends to be a sensation that commands your attention, whether you are in the middle of your workout or sitting at your desk. Burning pain in the back of your thigh usually points to a nerve problem, which should be evaluated by your doctor.
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Sciatica describes a constellation of symptoms caused by compression of the sciatic nerve. The roots of this nerve arise from lower end of the spinal cord, exiting between the spinal bones, or vertebrae. Vertebral discs separate these bones, maintaining sufficient space to allow nerve roots from the spinal cord to exit unencumbered. Protrusion of a disc, or disc herniation, often leads to compression of nerve roots at the level of the affected disc.
Herniated discs in the lumbosacral spine in the low back at the L4, L5 or S1 level characteristically cause pain in the back of the thigh and buttocks. The painful sensations that result vary and may be described as burning, shock-like, achy or cramp-like. Low back pain is also frequently present, although the thigh pain tends to be more severe. Pain in the back of the thigh caused by a herniated disc is typically aggravated by sitting or bending forward, and relieved by lying down.
Deep Gluteal Syndrome
Among people who do not have a herniated disc, deep gluteal syndrome (DGS) -- formerly known as piriformis syndrome -- is a leading cause of burning pain and other painful sensations in the back of the thigh and buttocks. The sciatic nerve courses through the back of the pelvis, emerges in the buttock (gluteal) region and continues down the back of the thigh and leg. With DGS, the nerve is compressed somewhere in the gluteal region, leading to symptoms virtually identical to those of a lumbosacral disc herniation but without the low back pain. Several structures in this area can potentially entrap the sciatic nerve, including the piriformis and gluteal muscles, among others.
Posterior Femoral Cutaneous Nerve Pain
The posterior femoral cutaneous nerve (PFCN) arises from the lowest level of the spine, the sacrum, and carries sensory messages to and from the skin of the back of the thigh and knee. Compression of or an injury to the PFCN causes pain in this area, predominantly while sitting. The pain might also radiate into the groin. PFCN compression and pain occurs relatively commonly among avid cyclists. Injury to the nerve can occur in association with a severely pulled hamstring muscle, or hip or pelvic surgery.
Other Considerations and Next Steps
All of the nerves whose compromise can potentially lead to burning pain in the back of the thigh arise from and travel through the same general areas of the back, pelvis and gluteal regions. As such tumors, bone injuries and blood vessel abnormalities in these areas can potentially cause this type of pain.
See your doctor if you experience posterior burning thigh pain. Medical evaluation will include a detailed physical examination and may involve imaging studies, such as x-rays, an MRI or a CT scan. Treatment depends on the underlying cause of your pain and might include physical therapy, activity modification, anti-inflammatory medication and/or injections into the problem area. If other treatments fail, your doctor might recommend surgery.
Reviewed and revised by: Tina M. St. John, M.D.
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