What a pain in the butt

I'm starting to see it everywhere.  Stick with me, this may get a little more technical than usual.

Weak gluteal muscles are creating a cascade of problems in people from the trained athlete to the novice.  What are gluteal muscles supposed to do and how do we know if they are not keeping up?

The problem of pain comes in when our bodies masterfully make up for weaknesses.  We call this "compensation strategies".  You use your body differently, trying to avoid pain or make up for fatigued muscles.  When it becomes habit for one muscle group to cover for the other and the underlying problem is never addressed, pain is a likely result.

The gluteus is made of 3 major parts.  The major 2 will be our focus.  The gluteus maximus (the large, most superficial of the bunch) is responsible for hip extension (backward kicking) and external rotation (toe out position) as well as abduction (bringing the leg out to the side).  Strengthening the gluteus maximus provides support to the low back through the thoracolumbar fascia, and stabilizes the pelvis.  The next deeper, gluteus medius, acts as the primary hip abductor when the foot is off the ground.  When the foot is on the ground, as in running, it stabilizes the pelvis.

Weak gluteus medius is temporarily covered up by over use of the ITB, piriformis, popliteus, lumbar spine, sacroiliac joint and the patellofemoral joint.  Therefore, over time, pain in any of these areas can be related back.  Additional areas of concern include achilles tendon pain and pain on the inside of the lower leg.

Why are we seeing so many manifestations of this one little pain in the butt?  Thank our sedentary nature. Spending time sitting, not using our gluteal muscles, is really something to consider.  How much of your day, and for how many years, has the seated position been your primary one?  Additionally, being in a seated position for a prolonged time will contribute to tightness in the hip flexor group.  When the opposite muscle is tight, the gluteus medius will become weak.

So what is the remedy?  Well, depending on your activity level, you may be best served by having a physical therapist evaluate your situation.  As musculoskeletal experts, the intimate workings of the muscle imbalances that cause pain can be assessed and specific stretches and exercises given to prevent the reoccurrence of the symptoms.  If you are not as active as you could be, take on a walking program before the weather gets too cold.  Yes, that's it.  In all seriousness, you have to get off your butt to work it.