Missing link in chronic hip and buttock pain

Chronic hip and buttock pain is common.  And there are a variety of causes including hip osteoarthritis, peripheral nerve entrapment, lumbar nerve root radiculopathy and sciatica.  I’ll be discussing a common cause of hip and buttock pain that is often overlooked and mismanaged in this month blog.  It is the so-called piriformis syndrome.

The piriformis is part of a deep buttock muscle group.  The piriformis gets more attention than other deep buttock muscles because the sciatic nerve pierces through it.  When the muscle becomes hypertrophied, it can squeeze and compress the sciatic nerve causing cramping or aching pain in the buttock and or hamstrings.  People often describe piriformis syndrome as deep, aching buttock pain.  Since the piriformis is part of a deep buttock muscle group, the piriformis syndrome should be called deep gluteal syndrome.

Piriformis hypertrophy occurs when the muscle gets tight, knotty and firm.  Chronic sacroiliac instability, core and gluteal muscle imbalance and weakness, excessive hip internal rotation and over pronation can cause the piriformis to become tight, knotty and firm.

Your hip and buttock pain may be coming from deep gluteal syndrome if:

  • Your buttock muscles have painful knots when press upon
  • Your sacroiliac pain relief by wearing sacroiliac belt
  • Hip flexion and external rotation, prolonged sitting and walking or getting in and out of the car exacerbate your hip and buttock pain
  • Your knees deviate outward during lunging or jumping exercises
  • You cannot fully internal rotate your hips
  • You have difficulty bringing your foot up to put on a sock while sitting

If your hip and buttock pain is cause by deep gluteal syndrome, stretching the piriformis muscle only provides temporary relief.  To properly treat hip and buttock pain associated with deep gluteal syndrome, you’ll need to activate and wake up the inhibited muscles to balance out the tight, overactive compensated muscles.  Thanks for reading.  🙂

How the flank muscles affect low back and hip pain

If you have low back and hip pain, did you know that posture can reveal a great deal about the potential causes of your low back or hip pain?  Posture is a mental and physical landscape of neuromuscular compensations and adaptations to your life.  Have you ever noticed that perhaps one of your hips is higher than the other or that one shoulder is lower than the other shoulder or that you feel twisted?  If this is the case, then your body is compensating and adapting to some dysfunctional area and muscle imbalance.

The quadratus lumborum is a common muscle to be affected in people with low back and hip pain.  It is a deep back muscle on either side of your flank.  The quadratus lumborum can hike your hip up and bend your low back sideway.  It can also assist other back muscles to extend your low back.  Low back and pelvis dysfunctions from bad posture can cause one quadratus lumborum to be weak and the other compensated quadratus lumborum to be too strong and tight.

A common cause of low back and hip pain is quadratus lumborum trigger points, fibrosis and myofascial restriction.   Here are a few ways that you can evaluate your left and right quadratus lumborum:

  1. Perform a right sided plank for 20 seconds and then 20 seconds on the left side. Make that you don’t turn or twist your shoulder or hip while doing the side plank. Keep the torso straight.  If you have difficulty maintaining a left sided plank for 20 seconds, then the left quadratus lumborum is weak.  The weakened quadratus lumborum may also cause pain during the side plank.
  2. Stand in front of a mirror with your feet together. Now raise both arms overhead.  Observe the spacing between your pelvis and rib cage on each side.  The side that has a weak quadratus lumborum will have more space between your pelvis and rib cage.
  3. Stand in front of a mirror with your feet together again. Now bend your body sideway to the left and to the right with your arms overhead.  Observe how far you can bend your body sideway.  The side that bends the least during sideway bending is likely the side of weak quadratus lumborum.

If you suspect that the quadratus lumborum is weak, does this mean that you should start to strengthen it with some exercise?  Not necessary.  There has to be a reason why one quadratus lumborum is weak while the other becomes too strong and tight in the first place.  If you start strengthening or stretching the quadratus lumborum without knowing why it was weakened, overactive or tight, then you’re not addressing the source of the low back and hip pain.

Once the reasons for quadratus lumborum weakness, overactive and tightness are identified and treated and you’re cleared to engage in rehab exercises,  here are a few simple and effective strengthening exercises for the quadratus lumborum:

  • The ipsilateral crawling which you can YouTube for demonstration
  • The single-leg-stance on your back is performed as follow: Let’s say that your left quadratus lumborum is weak.  Lie on your back with arms overhead and legs straight.  Brings the left leg into hip-flexion, single-leg-stance position and holds the position for 5 seconds; then lowers back to the ground and repeats 4 times.  Make sure the right knee passes the waist midline, and it’s ok to bend your right knee a little if your hamstrings are tight.
  • The standing hip hike. Hike your left hip up toward your left shoulder and lower the hip back to normal, neutral position.  Make sure that you don’t bend the torso while doing the hip hike.  Do 3 sets of 10 repetitions.

Thanks for reading.  🙂

Low back and hip pain revealed by squatting

Low back pain?  Blame the core muscles.  People who have low back pain often think that either their core muscles are weak or that they don’t exercise enough.  If that’s the case, why do professional athletes and people who exercise regularly are not immune to low back pain?  While it is important to have strong core muscles as they provide stability to the low back, it should not be the only one that you focus on.  There are other more profound causes of low back pain.  Lumbopelvic-hip dysfunction and muscle imbalance are among the most common causes of low back pain.  Unfortunately, they are also most often neglected during assessment and treatment of low back pain.

The lumbopelvic-hip region consists of the entire pelvis, the attaching hip joints on either side of the pelvis and the lumbar spine resting above on the pelvis.  Have you ever been told or noticed that one of your legs is longer or shorter than the other?  Unless you were born with one anatomical shorterleg or that the shortened leg was due to a fractured ankle or tibia, chances are that your unequal leg length is due to a functional leg length inequality rather than a true, anatomic leg length inequality.  Lumbopelvic-hip dysfunction causes functional leg length inequality.

The pelvis consists of two hip bones, a sacrum and a tailbone.  When there is no restriction and dysfunction between the two hip bones and the sacrum, everything is rosy.  You have good range of motion in your hips and low back.  You can bend over without the fear of putting your back out.  Your legs and pelvis feel even.  There is no stress and strain to the muscles, pelvis and low back.  However, hip and low back pain may become more frequent when there is lumbopelvic-hip dysfunction.

This is what happens when you have a lumbopelvic-hip dysfunction.  One hip bone will rotate backward and down while the other hip bone will rotate forward and up.  When this happens, one leg will feel longer and the other leg will feel shorter with standing and walking.  Lumbopelvic-hip dysfunction also affects the sacrum and the lumbar spine.  The sacrum will tilt forward and down on one side and backward and up on the other side.  With its sacral foundation tilted forward and down to one side, the lumbar spine resting on top of the sacrum will also rotate and tilt toward the low side of the sacrum.  People with lumbopelvic-hip dysfunctions will often be told that their pelvis is tilted or that they feel the pelvis is twisted.

Think of the sacrum as the foundation of your house.  If the foundation of the house sinks to one side, the house will be tilted.  What will happen to the walls, plumbing, electrical wires and frame of the house if this continues for many months and years?

There are many important muscles that attach to the lumbopelvic-hip region.  These muscles include low back muscles like the psoas and quadratus lumborum, gluteal muscles like the gluteal maximus and medius and hip and thigh muscles like the tensor fascia latae, iliopsoas, quadriceps and hamstrings.

Similar to the effects of a sunken house foundation on its supportive frame, wall, plumbing, etc., lumbopelvic-hip dysfunction can cause muscle imbalance to the low back, gluteal, hip and thigh muscles.  Some muscles will become tight and overactive while other muscles will compensate and become weak.

One simple assessment that you can do to reveal lumbopelvic-hip dysfunction and muscle imbalance is  with the “Y” pattern squat.  Stand with feet shoulder-width apart with hands overhead in a “Y” pattern.  Now slowly squat down as deep and low as you can.  While doing the “Y” pattern squat, you have lumbopelvic-hip dysfunction and muscle imbalance that may cause low back and hip pain if you:

  • tuck your tights into the hips and bring your belly toward the thighs
  • have tightness and stiffness in the low back, hips and pelvis
  • have difficulty squatting down

Proper treatments for low back and hip pain from lumbopelvic-hip dysfunction and muscle imbalance require soft tissue treatments, stretching tight and overactive muscles, strengthening the  weak muscles and manual chiropractic adjustments to correct any restriction and dysfunction involving the low back and pelvis.

Thanks for reading.  🙂