A literal pain in the butt…do you have this? 

I have treated many women with this deep ache in their toosh that just does not want to go away. Usually, I see or hear from them after they have exhausted other routes such as chiropractic, doctors, or even orthopedic physical therapy.

So what is this pain in the butt (both literally and figuratively)?

This is where it gets a little exciting…let’s do some detective work.

Is it coming from your back? 

Even though the pain is in your butt, it could be referred pain from your low back. Seeing a physical therapist to rule in/out the low back is ideal but here are a few things you can try to see if it reproduces YOUR PAIN.

Bend forward like you’re going to try and touch your toes (maybe you can touch your toes but this is not me). Do you feel the pain in your butt?

Bend backward with your arms overhead, hold a few seconds. Does this bring on your butt pain or maybe it makes the pain better in your butt.

If any of these movements bring on or improve your butt pain, it just may be coming from your back.

Disclaimer: If you didn’t have pain with these movements, we cannot be sure that the low back isn’t the primary source of pain. Again, many other special tests need to be performed to rule in/out low back but these general tests will give you some insight.

Is it coming from the big, beefy glute muscles?

It seems like an obvious place to start doesn’t it? The three large glute muscles, the gluteus medius, minimus, and maximus can become cranky and develop knots or trigger points that cause glute and leg pain.

To determine if this is the cause of your pain, palpate or feel for any tender, painful knots in your glute muscles. If you do have tender areas, and you push on them, does this reproduce your pain?

Another test you can perform to see if the large glute muscles are involved is activating those muscles.

• Lie on your stomach.
• Bring your leg straight up behind you without bending the knee, does this bring on your pain?
• You can also provide some overpressure by having someone push down on your leg while you have it extended behind you. Does this reproduce your pain?

If it isn’t coming from your back or your big beefy glutes, where is the pain coming from?

Hidden deep inside our pelvis, live some pretty thrilling muscles. The pelvic floor is one of these muscle groups as well as the deep hip rotator muscles. This is where the magic usually happens for those who suffer from deep butt pain that has not improved with other treatments.

The pelvic floor muscles and deep hip rotator muscles are like any other muscle, they can get a bit fussy. Have you ever had a trigger point or knot in your upper trap muscle? This very thing can also happen to your pelvic floor or deep hip muscles. When this happens, they can cause pain.

Storytime…

Once upon a time, I treated a kind young lady in her early 30’s. She was referred to me by her OB-GYN for an upper hamstring strain. The pain was deep in her toosh and hurt with prolonged sitting or walking for too long. After doing some different tests to rule in/out the low back and leg muscles, we performed an internal exam and sure enough, she had a nasty trigger point in her obturator internus muscle (a deep hip rotator muscle). After a few treatments, her pain diminished and she could go back to training for her marathons that she loved very much. And she lived happily ever after…

If you think you may have this very same issue, here are a couple of things to try to help diminish your pain.

Hip Pull-Backs

A subtle exercise but a goodie.

• Get into the 90:90 position with feet up on a wall with something in between your knees.
• You are going to squeeze the towel roll in between your knees and then think about bringing your femur or long leg bone back into your hip socket. (Think about it like you are pulling your hip back towards the floor)
• When doing the exercise, make sure you are not clenching your glutes, firing your hamstrings or quads but rather gently sliding the femur back into the socket.

 

External Release of the Deep Hip Rotators and Pelvic Floor Muscles

A lacrosse ball works great for this! You can find it here!

 

Strengthening for the glutes and core

The pelvic floor muscles and deep hip rotators can be fussy because they are working overtime for other muscles that are not doing their job. Developing generalized strength especially in the glutes and core is SO IMPORTANT! There are so many great exercises for the glutes and core so stay tuned for next week’s blog on some exercises to strengthen these areas!  

If you are struggling with this and would like some support…please reach out to me!

-taryn