GLUTE MEDIUS / MINIMUS SYNDROME

Body parts don’t give up when they’re overworked or tired, so much as they just keep working until they give out. The gluteus medius and minimus muscles in the buttocks are no exception. When overworked, these muscles react by becoming tight, going into a constant state of contraction in order to perform their job, similar to a student staying awake all night to cram for an exam.

Eventually, however, the work catches up. They become exhausted and the body can’t perform as well, or become limited in what they can do. When this happens, people can develop gluteus medius muscle syndrome or gluteus minimus muscle syndrome. Because the two muscles are so anatomically and functionally related, healthcare practitioners often refer to either syndrome as gluteus medius/minimus muscle syndrome.

People with this syndrome often describe their pain as a deep, dull ache in the buttock that often radiates to other areas of the body. Rest or activity doesn’t determine the level of this pain, however. Instead, people with this syndrome often feel the pain when they’re startled or make sudden movements.

A number of things can cause or contribute to tight gluteus medius or minimus muscles. Muscle imbalances, poor posture or poor spinal or foot mechanics can be a factor, as can anything that overworks the muscles. When overworked, the muscles develop minor strains, which cause an inflammatory response. This inflammation is what causes the pain.

Because excess work can cause the syndrome, it’s very common among runners, who use these muscles extensively. But runners aren’t the only people susceptible, as generally anyone who is active and overuses their gluteus muscles can be affected. For this reason, it’s important for people with gluteus medius/minimus syndrome to avoid activities that put pressure on the gluteus muscles until their healthcare practitioners say its okay. But, inactivity isn’t the answer either.

This condition responds extremely well to neuromuscular reeducation (NMR), stretches and strengthening exercises.

PIRIFORMIS SYNDROME

Piriformis syndrome is a common condition that develops when there is a chain reaction of nerve irritation in your low back, buttocks and legs. It begins with an aggravated or strained piriformis muscle, which is a muscle in each of your buttocks. That muscle, in turn, irritates small surrounding nerves, which then irritate the larger sciatic nerve that runs from your low back through your buttock and into your leg.

Commonly, patients with piriformis syndrome complain about a deep pain in a buttock, but aren’t able to describe exactly where the pain is coming from. Sitting, climbing stairs or performing squats can make the bothersome, achy pain even worse.

Because the sciatic nerve supplies nerve function to the leg, patients may also experience pain that moves to the outside of the thigh or even as far as the foot. For that reason, piriformis syndrome is classified as a type of sciatica, which is category of conditions that cause tingling sensations, burning sensations, shooting pain, prickling and even numbness along the lower limb.

When there’s no pain, people usually take the piriformis muscle for granted and don’t realize that they’re responsible for an extremely important movement: external hip rotation. To understand how the muscles work, picture a soccer player trying to kick or pass a ball with the inside of his/her foot. To perform this motion, he must rotate his leg about 80 degrees, so the foot is pointing outwards.

Without the piriformis muscle, this movement would be impossible. But a number of factors can interfere with the muscle, hindering performance and causing great pain. These include trauma to the sacroiliac joint (a joint in the pelvis that’s compromised of two bones: the sacrum and the ilium), sitting with one leg crossed over the other, having one leg that’s longer than the other, sitting or driving while one leg faces outward, improper walking, poor posture and faulty spine mechanics.

Hormones can also be a factor, and for that reason women are more prone to piriformis syndrome because they experience constant hormonal changes, such as those caused by menstruation, oral contraceptives, pregnancy and menopause. During pregnancy, for example, the body produces a hormone called relaxin to loosen ligaments around the pelvis, including the piriformis muscle, react by tightening up, forcing the piriformis to work harder to stabilize the area.

Piriformis syndrome responds extremely well to a multi-disciplinary approach consisting of chiropractic care, rehabilitative exercise and NMR.

ISCHIAL BURSITIS

Ischial bursitis is a painful irritation in the buttocks, specifically around the ischia, which are the bony parts you can feel when you sit down. Usually, fluid-filled sacs called bursae protect the ischia, cushioning movements between the muscles and the bones in the area. With excessive use, however, friction on the bursa can make it inflamed and irritated.

The condition is quite literally a pain in the butt. Symptoms include soreness, tenderness and swelling in the lower buttocks, and these patients often notice that this pain worsens with movement. The area may also feel warm to the touch, as heat often accompanies inflammation.

Ischial bursitis can affect anyone, at any age. Patients with the condition aren’t necessarily athletic or involved in any physically demanding activities. Usually, they report sitting on hard surfaces for long periods of time, and also report frequently riding horses. Injuries that involve trauma to the ischial bursae, like landing on the buttocks during a fall, can also cause the condition.

In physically active patients with ischial bursitis, the condition often develops after they perform activities that involve excessive contraction of the hamstring muscles (muscles at the back of the thighs), like running. These muscles can rub on the bursae, making them sore and irritated.

Regardless of the cause, however, proper care is effective for ischial bursitis.

SACROILIITIS

Low back pain is one of the most costly and disabling of all neuromuscular skeletal conditions, affecting over 80% of the population at some point. In fact, at any given moment 7% of adults are experiencing a spell of back pain that will last two weeks or longer.

Sacroiliitis is a specific form of back pain that affects the area in and around the dimples in the upper buttocks. People with this condition usually experience localized pain in the low back, as well as pain in the groin, hip or back of thigh, but rarely below the knees. The latter is called referred pain, meaning it travels from the source of the problem to other regions of the body. Those suffering from sacroiliitis also commonly experience sharp pain after straightening up from a stooped position, often while lifting an object. Twisting, leaning forward, bending backward or sitting for long periods of time can make the pain worse.

While sacroiliitis can begin without warning, it’s often a continuation of a similar, milder condition called SI irritation. If people don’t seek treatment when they have SI irritation, which mostly manifest as localized pain in the mid-buttocks, the condition can develop into sacroiliitis.

Abnormal movement in the sacroiliac joint, a joint compromising two bones, the sacrum and the ilium, generates this pain. You have two ilia, and can feel them if you put your hands on your hips, just below your waist. The bony protrusions on either side of the ilia, which connect to the lower part of the spine, the sacrum. The connections between the bones are the sacroiliac joints.

Research estimates that these joints are responsible for about 10% - 30% of low back problems. Theories postulate that jamming of the joints, hormonal influences and arthritis are responsible and research also shows that lifting and bending make patients more susceptible to the condition, particularly children, pregnant women and those with degenerative disease.

All these factors can lead to local inflammation and joint irritation that then lead to pain. With sacroiliitis, the irritation and inflammation also affect nerves that provide sensation to other areas, like the thighs, which causes the brain to perceive pain as coming from the lower limb as well as from around the sacroiliac joints.

These symptoms are chronic and aggravating. Proper care can provide effective management for the condition, as it can improve joint function, decrease pain and get your low back to its original state.