Butt Pain: The Anatomy Blog!

Hello! I have to confess that I have been reading over the areas that I wanted to look at in this series of Butt Pain and I have hit upon the fact that there is a lot of anatomy to go through with a myriad of paths that we could trail down. So, instead of writing lists of muscle attachments and bony landmarks, what I will do is write about the common Butt Pains that are presented in the treatment room on a regular basis. Then we can look at the pain patterning that is common, the linked muscles and the stretches and exercises that may help and talk around the subject that way. It then becomes a lot more relevant to you guys and it won't bore you stupid!

As always, if you are new to the blog I want you to read “Pain Patterns Explained” that was written last year. The blog describe how I look at muscular based pain patterning and how it can manifest in the body. This is not a diagnostic tool and if you are in anyway concerned about the pain you are in please consult your medical practitioner for further advice and diagnosis.

Disclaimer over … phew!

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Generalized Butt Pain is quite easy for most people to describe. A lot of my clients tell me: “It hurts at the top of my hip bone and right in the centre of the bum and then I sometimes feel it on the out side of the hip”. There is a lot of variation, but the pain is pin pointed and normally feels quite achy and it can feel like a deep bruise.

In my experience, apart from headaches, other pain is rarely described with such acute accuracy when present.

Gilbert showing off a roughly portrayed
pain pattern.  

Today we'll look at the pain that I have just described; around one side of the butt from the top of the hip, circling down the inside near the sacrum and coccyx, then presenting at the side of the hip.

The 4 muscles that are known to radiate this pain are:

• Gluteus Maximus : Your big butt muscle at the top of the pile near your skin.
• Gluteus Medius: a very funky muscle that allows you to move your leg in all directions. You will find this under the Gluteus Maximus.
• Quadratus Lumborum: One of my top 3 favourite muscles! It hooks into the lowest rib, the outer edge of your spine and the top of your hip.
• Erector Spinae: These muscles run the whole length of your spine and can produce pain all the way down the back, but the lower part of your peachy butt cheek and the top of your hip can also be effected by them.

Gluteus Maximus: It gives your behind great shape and as the name suggests it's the largest of you bum muscles. It allows you to take your leg behind you which you do every time you walk, so it is used a lot.

If you are a keen walker, you may find that it gets very tight and the contracted state can lead to trigger point pain patterns, so make sure you stretch it out as much as possible.

If you lean forward a lot at a desk, or if you teach in a classroom with young kids and lean over their desks at a low height, you may find you over stretch this muscle, so you may find it helpful to tone it up by exercising it.

Gluteus Medius: This is very similar to your deltoid muscle in your shoulder as it allows you to flex, medially rotate, internally rotate, extend and externally rotate your thigh. (Your deltoid does the same for your humerus.) Your Gluteus Medius also allows you to stabilize your pelvis, so when you are moving your leg around, your pelvis is supported by it at the same time. Pretty cool really!

When it's in pain, it causes a lot of problems over the sacrum, around the S.I joint, the gluteal cleft and just behind the hip socket. You'll probably feel it when you slump in front of the sofa or if you lay on it.

The main problems seem to arise when you sit down a lot as it brings your thigh bone into flexion. For most of the day you are asking Glut Medius to lengthen and although it can do it, when asked to do it a lot it just gets long and weak, so you are more likely to get trigger points there. Also, if you have had any form of S.I joint dysfunction you'll probably have some issues with this muscle.

Walking is the A* treatment for this muscle, it can't get enough of it!

Quadratus Lumborum: Totally one of the coolest little muscles going! It's so deep and vitally important. I never really understood how much it worked until I went on a dissection course last year and learned how to appreciate it. Professor Kerry was getting us to tell him what it did and we all cried out “It hitches the hip up!”. Well, yes it does, but not in the over exaggerated way that we were taught about in our anatomy class. If you stand up, put your fingers between the lowest rib and the crest of your hip and hitch your hip up, you'll feel this beast contract. But it does that with every step you take! Basically, to allow your foot to swing through as you step forward, Q.L has to get your hip up to allow for the swing.

It also contracts to bend your body to the same side in lateral flexion and if both sides work together they allow you to extend so your spine arches backwards.

Often people come to me if they have been raking in the garden when they have been repeatedly swung from side to side, or moving heavy pots and boxes as they have bent down, picked up the item and then swung round to the other side.

There is a lot you can do for the Q.L and side stretches are one of easiest things to get going on releasing it.

Erector Spinae: These are long and as they are postural muscles they have to fight against gravity and with our propensity to slouch they get long and weak over time. Simply extending the spine will make them contract and get stronger, but we'll look at how to do that in more depth later.

The next four blogs will be looking at how we can exercise and stretch these muscles so that we can get them going for summer!