“Lumbago” Anyone?

Chronic Low Back Pain – Gluteus medius and gluteus maximus  cause low back pain in multiple ways. These “glute” muscles include the fleshy and outermost gluteus maximus, gluteus medius and the gluteus minimus, deepest of the group. Some also include piriformis and some of the other rotators of the hip. In times past, this problem was often referred to as “lumbago”.

The first step in managing any case of lower back pain is to confirm or eliminate more serious spinal injury or degeneration as a cause. Once these more serious factors are examined we can focus on the soft tissue aspects of chronic lower back pain – glutes are just one them.

Janda's Lower Crossed Syndrome

Myofascial dysfunction in the glutes often occurs as part of a larger pattern of imbalance with other hip muscles acting on the hip. This is called Janda's Lower Crossed Syndrome.

The "cross" is an imbalance between four different groups of muscles; the iliopsoas/spinal erectors, which are too tight, and the glutes/abdominals, which are too weak.

Correcting this requires treatment and stretching of the hip flexors and spinal erectors. However, this is only addresses half of the problem. It is also necessary to strengthen the glutes and certain abdominal muscles to restore balance to this key area.

Activation of Glute Trigger Points

Trigger points in the gluteus maximus tend to cause pain in the butt and rear of the upper thigh, not the low back. However, a strong gluteus maximus is key to a healthy back. And, myofascial dysfunction in the gluteus maximus is one of causes of weakness in this area. A successful strengthening program may require inactivation of glute max trigger points.

Trigger points in the gluteus medius do refer into the low back. You can activate gluteus medius trigger points by falls, sports injuries, running, hikes in the woods, long walks on sandy beaches or other uneven surfaces and bearing weight on one leg for an extended time.

However, in 21st century life, inactivity and prolonged hip flexion from sitting with poor seating are the number one cause of problems with gluteus medius.

What Makes This Type of Glute Pain Worse?

Seating is a big deal. Prolonged flexion at the hip aggravates trigger points in the glutes. For example, typical desk seating or sleeping in the fetal position flex the hips. Sitting on a wallet or cell phone can cause sustained pressure on the gluteus medius, leading to trigger points.

In fact, sitting in any position for a long time can irritate your glutes. You may also find that crossing your legs aggravates your glutes. If you tend to cross your legs, you this may suggest an asymmetry of your pelvis that can be easily corrected.

When sitting for prolonged periods, try to modify your seating so that your the angle of your hips is more open. The sloping chair pictured is just one of a variety of ways you can achieve this. This type of seating is a better alternative than standing for many office workers.

Consider using a rocking lounger or even old-fashioned rocking chair at home. It reduces immobility while sitting and promotes muscular relaxation. When driving, cruise control will provide you the opportunity to move a bit over extended distances. For those who sleep on their side it is important to avoid sleeping in the fetal position, with the hips sharply flexed.

How Therapy can Help With Low Back Pain

The various glutes influence the low back in a variety of ways.

Trigger points in the glutes often occur as part of a larger pattern of imbalance and myofascial dysfunction.

Most of us are busy, so designing a program that will provide the most benefit with the least time and effort expended is important.

Extra – Details on Gluteus Maximus and Medius!