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A Pain
in the Butt
By
George
S. Pellegrino, LMT, CMTPT and Victoria L. Magown, CMTPT, LMT
For some
people, “a pain in the butt” is not just a figure of speech. For those
who suffer with this affliction, there is hope.
At
MyoRehab, we see quite a few patients with chronic or persistent
buttocks pain. Many of these patients will give accounts of remedies
that were temporary at best. We often hear stories of money spent on
softer seat cushions, expensive chairs with contoured seatbacks and
over-the-counter medications, all to no avail.
For
Monica, the persistence of buttocks pain was interfering with her
livelihood. In her profession, sitting for most of her working hours,
buttocks pain was a problem … to say the least! She said that after
trying “all the conventional and unconventional” treatments, the pain
was still making her life miserable.
She had
been experiencing this pain for over a year. A review of her medical
history and an in-depth interview did not reveal a significant traumatic
incident that could have initiated this condition.
When she
sat down, she leaned to the left with her weight resting on her left
arm. She said that leaning to the left while sitting afforded her some
relief of the buttocks pain. When asked to side bend right, Monica
experienced pain in the buttocks on both sides with restriction on the
left between the lower ribs and left hip. The pieces of the puzzle
began to fit together.
When
asked if she ever had coughing spells, Monica said that about two years
ago, she had contracted a flu virus and it settled in her chest. She
developed a cough that “seemed to last forever.” Vigorous or long term
coughing can "whiplash" the muscles that stabilize the torso. The
primary muscle of torso stabilization is the quadratus lumborum (See
illustration).
Trigger
Point activity in the quadratus lumborum was found to be the source of
Monica's pain. A Myofascial Trigger Point is a hypersensitive point in
a muscle that when stimulated, produces pain that is referred in a
predictable pattern usually away from the Trigger Point. Myofascial
Trigger Points in other muscles that can cause or contribute to buttocks
pain are the gluteus maximus, the piriformis (found deep in the buttocks
under the gluteus maximus) and the semitendinosus (one of the hamstring
muscles).
Although
Range of Motion tests showed some Trigger Point activity in all these
muscles, the quadratus lumborum stood out from the others. It's no
wonder this muscle is referred to as "the joker of low back pain".
Trigger point activity was found in the other muscles tested, but it did
not cause the familiar buttocks pain.
Trigger
Pont activity in the quadratus lumborum refers pain into the buttocks,
hip and groin. This muscle attaches to the twelfth rib, the lumbar
spine and the crest of the ilium (hipbone). It has several functions
including stabilization of the lumbar spine and as a “hip hiker”. It
also acts as a lateral flexor, that is, it will pull the torso over to
one side. This muscle stabilizes the rib cage during activities such as
vigorous coughing, sneezing or laughing.
Sitting
while leaning to the left on her elbow was a postural distortion that
temporarily avoided the buttocks pain but, in fact, perpetuated Trigger
Point activity and pain in the long run. Perpetuating factors are, for
the most part, done unconsciously. Postural distortion to avoid pain is
one of the most common perpetuating factors of Myofascial Trigger Point
pain and muscle dysfunction.
After
several treatments of the quadratus lumborum and the other muscles
involved, Monica began to experience relief. The addition of an
Individualized Home Exercise program and the elimination of perpetuating
factors enabled Monica to sit pain free.
Do you have “A Pain in the Butt” or know someone who does? Give us a call at MyoRehab
OR click here to set up your thirty minute consultation |
