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One thing that’s struck me over the past few months, is how many people suffer from chronic pain caused by neglecting their gluteals and external hip rotator muscles. This can be as diverse as lower back pain, particularly around the sacro-iliac joint at the base of the spine, anterior (front of) knee pain and sciatic pain.
The gluteus medius is a very important muscle, which until recently has been relatively misunderstood. Thought of typically as an external hip rotator and adductor, used to lift your leg sideways and rotate it outwards, it’s now known to have a key role in stabilising the hip joint during walking, running and hopping etc. In other words, whenever you need to balance on one leg whether you’re standing still or on the move. Because we spend so much time sitting on it, it’s rather inclined to get lazy and may even switch off altogether, forcing postural changes and pushing the work onto muscles such as the tensor fascia latae and the ilio-tibial band.
Even if you’re a regular runner and gym goer it’s possible that you have good gluteal strength in a squat or leg press, yet the same muscles may still not stabilise your hip effectively in a different position, such as with your hip extended. Effectiveness has more to do with multi-directional stability and, because your muscles never function in isolation, when that stability is lacking it can result in mechanical changes and, ultimately, pain elsewhere.
The piriformis is another demon waiting to cause discomfort. Often becoming very tight, but not necessarily strong, it can pressurise the sciatic nerve causing the same symptoms as sciatica, which we associate more commonly with nerve compression at the lumbar vertebrae. The position of the sciatic nerve relative to the piriformis varies between individuals: in some people it runs above the muscle, in others below and in some the nerve may actually pass through the belly of the muscle, so it’s easy to understand how muscular tightness can restrict it. Along with the gluteus maximus, biceps femoris and multifidus, the piriformis also contributes to the stability of the sacro-iliac joint by tensioning the sacrotuberous ligament. Remedial massage techniques can be used to reach this deep muscle and release tension. Combined with regular stretching and strengthening exercises this can improve it’s functionality, which in turn may relieve pain in the lower back, along the top of the iliac crest and around the sacro-iliac joint.
At the end of the ski season this year when I intensified my running, I began to feel pain in the front of my knees when coming down stairs. A winter of pretty intensive Telemark skiing had built up my quads and hip flexors to the point where they were dominating my hamstrings and gluteals,so I needed to redress the balance by strengthening these weaker muscles and stretching my quads, which had definitely shortened. A few weeks later, no knee pain! I’ve also been working on my running technique to use my gluteals and hamstrings more, lifting my heel higher and flexing my knees more. This reduces the length of the lever as you bring your leg forward making it easier on your quads and hip flexors.
My point is, with chronic injuries the pain is rarely in the same place as the problem. Unfortunately, our instinct is often to address the pain at the point where it occurs, ignoring the fact that our bodies are complex and interconnected systems where nothing acts in isolation. You might not have a pain in the butt, but it could be the source of a problem elsewhere!
Some useful resources:
Unbeatable Buttocks for injury free performance. Read my review at Peak Performance
Gluteals and Core workout with Tamsin Lewis
Gluteal inhibition or weakness by Kinetic Revolution