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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.
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