Low Back Pain, Buttock Pain

Gluteus Maximus Pain in the Low Back or Buttocks when Bending or Sitting?

When you "throw your back out" everything in your life can suddenly be put on hold. Low back pain costs Americans over $50 billion each year and is the most common cause of job-related disability (National Institute of Neurological Disorders 2008). In this issue, we highlight a muscle which plays a major role in low back/buttock pain and injury, especially from bending over or sitting - the Gluteus Maximus. The Gluteus Maximus is an amazing muscle that is primarily responsible for giving us the strength to stand and walk upright. When you are bent over, it is the major muscle that you use to stand back up. However, our lifestyles have relegated us to sitting too much of the time, causing this muscle to become overstretched, weakened and filled with myofascial trigger points. The results are: 1.) Referred pain throughout the buttocks and even into the tailbone (as show in the diagram below) 2.) Low back weakness and instability that poses a significant risk of injury.

If you tend to "throw your back out", experience pain in the buttocks, have difficulty walking uphill or bending forward, or find prolonged sitting to be uncomfortable in your back or buttocks, do yourself a favor and perform the following tests and self-care tips to identify and correct possible trigger points in your Gluteus Maximus. Not only will you likely relieve unnecessary pain, but you might very well prevent a low back injury and all the difficulty that comes with it, as well. *The information in this article is not intended to diagnose or treat any medical condition and does not substitute for a thorough evaluation by a medical professional. Please consult your physician to determine whether these self-care tips are appropriate for you.

(2) Quick Self-Tests to Tell if You have Trigger Points in Your Gluteus Maximus: Follow the instructions below to test whether myofascial trigger points might be present in your Gluteus Maximus.TEST 1: Knee to Armpit Test

PASS FAIL While lying on your back, bring one leg up toward your chest. Grasp behind your thigh (not over your knee) and pull your thigh up and as far as you can toward your opposite armpit. Keep your knee and abdominal muscles relaxed. A Passing result is when you can bring your knee quite close to your chest. A Failing result occurs when the knee remains further away from the chest (as shown). The further the knee is from the opposite shoulder the greater the amount of myofascial dysfunction and trigger points present in the Gluteus Maximus. TEST 2: Seated Toe Touch in Chair

To further isolate and test the Gluteus Maximus, sit in a stable and comfortable chair, lean forward, and reach toward your toes (as shown). A Passing result is being able to place your hands flat on the floor. If you can't reach your hands flat on the floor, that is a Failing result, again indicating the likelihood of trigger points.

3-Step Simple Self-Care Remedies Here are simple self-care remedies for treating myofascial trigger points in your Gluteus Maximus. Repeat 2-3 times per day and observe how your flexibility and pain can improve! Step 1: Warming Up with Moist Heat

To relax and warm up the fibers of the Gluteus Maximus, take a warm bath or sit on a Fomentek bag (or Mother Earth pillow as shown here) for 10-15 minutes. Step 2: Compression To compress trigger points in the Gluteus Maximus, you can use the Jacknobber (as shown) or balls in a variety of sizes and firmness. with a Backnobber Click here to view larger image

The Backnobber is a precise tool best used lying on the floor. Position the tool as shown and press upward on the upper part of the S curve, allowing the tool to do most of the work. To add stretching, lift the leg and cross it over the opposite knee. For less intensity, leave both feet flat on the floor. with a Ball

To use a ball for compression, you can either stand leaning against the wall with the ball between your Gluteus Maximus and the wall, or you can lie on the floor on top of the ball (as shown). If you find a lot of tenderness in your Gluteus Maximus, you can use a softer, larger ball such as a slightly deflated volley ball. For firmer pressure, you can use a softball or firm basket ball. For more isolated pressure, you can use a tennis ball or racquetball. Roll slowly over the ball, searching for tender spots and tight bands in your Gluteus Maximus muscle tissue. With either tool, when you find a tender spot, press into the muscle to pain tolerance ("good pain" - not pain that is sharp or makes you want to withdraw). Hold for 10 seconds while completing at least two full breaths in and out. Then continue searching for more tender spots until the entire muscle is covered.

Step 3: Range of Motion and Strengthening for the Gluteus MaximusThe Gluteus Maximus is a great example of how trigger points and muscle weakness go together. In the case of the Gluteus Maximus, there are a couple very helpful exercises that combine range of motion, stretching and gentle strengthening. The first exercise is called the Leg Swing Series¹:

Using a countertop or sturdy chair back like a ballet bar, swing your leg forward (a) and then back (b). Next, swing your leg out to the side (c), then across in front of your body (d). Finally, swing it out to the side (e), then across behind your body (f). Try to complete this whole series before switching legs. Work up to 8 sets alternating legs. The second exercise is called the All 4's Series¹:

From an all-fours position, bring your knee to your chest (a). Next, extend that same leg back and up (b). Alternate legs and do at least 2 sets. Then, from an all-fours position, bring your knee toward your chest and across toward the opposite shoulder (c). Next, bring that same knee out and up to hip level, then bring your leg down to the starting position (d). When starting, alternate between right and left leg. As you gain strength and flexibility, do multiple reps using the same leg, and slowly build your endurance until you can do 8 reps in a row for each leg, twice a day. ¹Sharon Sauer, CMTPT, LMT and Mary Biancalana, CMTPT, LMT Trigger Point Therapy for Low Back Pain. New Harbinger Publications: Oakland, CA 2010.

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