Driving You Crazy

By

Victoria L. Magown, CMTPT, LMT and George S. Pellegrino, LMT, CMTPT

Summer is a wonderful time to visit the many beautiful attractions in and around New Mexico.  Fortunately, most of them are within short driving distance.  Did you do a lot of driving this summer and discover that you had a "pain in the butt" that was "driving you crazy"?

Through the course of the summer, the therapists at MyoRehab treated several cases of buttocks pain.  Some cases were straightforward while others were not quite so simple.

When Mary Jo came to MyoRehab she had buttocks pain that prevented her from enjoying any pastime that involved sitting for even short periods of time. The pain was the result of an injury that occurred more than 15 years ago when she landed on her right buttock as a result of a spill during a bicycle trip.  Most of her pain had resolved over the years but came back every time she drove long distances or sat for long periods of time like at the movies.

This pain problem is all too familiar to people who have fallen and landed on their buttocks.  Sometimes, the precipitating incident occurred so long ago that the actual event has been long since forgotten.  Most people attribute this pain to the design of their car seat or office chair.  No matter how many different chairs they try, long drives or hours at a desk can bring back the pain.

One of the muscles that can cause this type of buttocks pain is the gluteus medius (Illustration A).  At first glance this muscle may appear to be an unlikely candidate for butt pain because it is located on the side of the hip.  As you can see from Illustrations A1 & A2, the pain patterns located in the buttocks are the result of myofascial trigger points represented by the black and white ‘X’ marks.

A myofascial trigger point is a hypersensitive spot in a muscle that when stimulated, usually produces pain referred in a predictable pattern away from the trigger point. These points also trigger contractions in muscles that are called taut bands which restrict full range of motion.

The gluteus medius is a powerful muscle whose primary function is to hold the hip steady while standing. In Mary Jo's case, when she fell off her bicycle, she landed on her buttocks and jarred her hipbone causing her gluteus medius to go into spasm and develop points that trigger her pain.

The piriformis muscle is located deep in the buttocks under the gluteus maximus.  Its pain pattern is shown in Illustration B.  It is also impacted when you land on your buttocks.

After treating these muscles and giving Mary Jo a home exercise program to keep the release gained during treatment, she was discharged without buttocks pain.  Two weeks later, we got a call from Mary Jo; she was coming back in for treatment.  She said her buttocks pain had returned, but it seemed different somehow.

After careful analysis of when and how the pain occurred, we decided to do more range of motion testing.  We expanded our search for the cause beyond the obvious.  Her pain pattern was at the gluteal fold. This is the curve at the lower buttocks at the point where the buttocks joins the thigh.

The semitendinosus and semimembranosus muscles are part of a group of muscles called the hamstrings. Their pain pattern shown in Illustration C is at the gluteal fold.  This turned out to be the source of pain that until now had been masked by pain from the other muscles.

Though the hamstring muscles could have been injured during the original fall, there had to be a perpetuating factor that kept trigger points actively producing the lower buttocks pain. Since Mary Jo's profession required hours seated at a desk, we questioned the design of her workstation.

From the description, we learned that her keyboard was on top of the desk instead of on a dropdown keyboard tray.  In order to avoid wrist pain while typing, she had her seat raised to its highest level to accommodate the keyboard.

Do to the fact that Mary Jo is not very tall, her legs and feet dangle from the chair.  This caused the edge of the seat to press into the back of her thighs establishing trigger points in her hamstring muscles.

After treating her hamstrings, Mary Jo was given another exercise to retrain these muscles to remain at their full resting length.  She also added a dropdown keyboard tray to her desk.

Since Mary Jo often encountered chairs that did not fit her, we gave her a small portable footrest that fit in her purse.  This ensured that Mary Jo's hamstrings would not be compressed by the edge of any chair she used. Do you have a pain in the butt that's "driving you crazy"?  If you do, give us a call at MyoRehab.