How to deal with a pain in the butt (a glute injury)
Gluteal Muscle Injuries: How to deal with a pain in the butt
By Doug James (Physiotherapist and Podiatrist)
What are “the glutes”?
The Gluteal muscles (also known as “the glutes”) are your backside muscles, found on your posterior pelvis. They play an important role in standing, walking, running and jumping. There are three different Gluteal muscles:
The Gluteus Maximus – which is the largest of the group – works with the hamstring muscles to move the thigh in a backwards movement during running. It is a large, thick muscle and can generate a lot of power particularly during sprinting, squatting and jumping.
The Gluteus Medius and Gluteus Minimus muscles – These are relatively smaller and help to keep the hip steady while standing, walking or running and can rotate the thigh and knee inwards and outwards, and move the thigh out to the side (abduction). These two muscles are found on the upper part of the hip bones towards the outside. When you place your hands on your hips, your thumbs would rest on these muscles).
Who is at risk of a glute injury?
In distance runners, a vast majority of Gluteal muscle injuries will occur to the smaller Gluteus muscles (the Medius and Minimus) or their tendons. The Gluteus Maximus may occasionally become strained or torn, but this is more likely seen in sprinters, weight lifters, or jumping athletes performing powerful explosive movements.
The Gluteus Medius and Minimus are important muscles for runners because they largely provide stabilisation on every step you take. They tend to be more likely injured in female runners and runners over the age of 40. The injuries that can develop in these muscles ranges from relatively mild injuries such as strains or slight tears; through to a full rupture of the muscle or tendon (which is more severe but thankfully much less common).
Types of Gluteal injuries
Tendonitis usually occurs when the amount of load (training stress) is greater than the capacity (strength) and healing capability of the tendon. These types of injuries, tendonitis of the Gluteus Medius/Minimus tendons, can be slow healing and nagging as they are often ignored or poorly managed. Healing capability is also affected by a number of factors including age, overall health, nutrition, stress and sleep.
Bursas are fluid filled sacs that usually exist peacefully in the human body. They have a role in protecting tendons from rubbing on bone. Bursitis develops when the bursa becomes acutely or chronically irritated. Gluteus Medius tendinosis (the chronic form of tendinitis) can become complicated by developing bursitis (swelling) on the bony part on the outside of the hip joint called the greater trochanter. Greater Trochanteric Bursitis is usually painful to touch or lay on, and can get irritated by running.
Most injuries to the Gluteus Medius / Minimus are due to overuse or weakness.
Overtraining by dramatically increasing the distance of a run, or the number of times each week that you run will cause your muscles to fatigue and become sore. Due to their relatively small size, the Gluteus Medius and Minimus are likely to fatigue earlier than the Gluteus Maximus, Hamstrings and Quadriceps (thigh) muscles. As these muscle fatigue, they can become damaged, and the risk of knee and ITB injuries increases.
Muscle imbalances can also increase the risk of Gluteal muscle injuries. Tight hip flexors and weak Gluteal muscles may cause the pelvis to tilt forward putting strain on muscles and joints in the hips and lower back. In some cases excessive foot pronation (rolling in) or incorrect footwear may contribute to Gluteal muscle injuries.
WHAT ELSE COULD IT BE?
While the gluteal muscles and tendons are a common source of discomfort in distance runners, there are a number of other conditions that can be occur. Deep Gluteal Syndrome or Piriformis Syndrome are complex conditions that affect a different group of muscle and nerves in the gluteal region. These syndromes tend to be felt deeper and lower in the glutes (further towards the hamstrings) and may have referred pain and numbness into the back of the thigh or legs.
Bone stress injuries to the pelvic bones, sacrum (lowest part of the spine) or the neck of femur (where the thigh bone become the hip joint) are rare but shouldn’t be overlooked, particularly if pain becomes worse with running and lingers for days afterwards.
How to deal with a pain in the butt?
There are three key strategies to manage gluteal injuries.
1. Calm the injury.
2. Rebuild strength
3. Sports specific conditioning
The mainstay of most sporting injuries is to initially calm an injury down, rebuild the strength in the affected and surrounding tissue, then focus on sport specific conditioning. If you are suffering a muscle or tendon injury, this may mean a relatively short period of reduced running volume before resuming regular training. With these ‘soft tissue’ type injuries, as long as some rehabilitation exercises are being undertaken, these shouldn’t significantly impact your running. If however you are suffering from a bone stress injury, this can take a number of weeks, to possibly months to heal particularly if adequate rest doesn’t occur in a timely manner.
The key here is to getting the correct diagnosis early, which can be achieved with clinical testing, and if necessary, an MRI scan (a Physiotherapist can refer you for this if deemed necessary).
For most hip and glute injuries, preventing these injuries involves making sure that the hip stabilising muscles (namely the Gluteus Medius and Minimus) are strong and have good endurance. Strengthening these muscles, along with your core (e.g. through Pilates type exercises) can not only help to reduce Gluteal muscle injuries but also reduce your risk of hamstring, ITB, and knee injuries. Making sure your hip flexor muscles are sufficiently flexible may also help. Having a proper biomechanical assessment of your running technique, footwear and hip strength and flexibility can identify risk factors and give insight into how to avoid or fix Gluteal injuries.
COME IN AND SEE OUR TEAM
Like any niggle, the sooner you get this checked and treated, the better outcome you will have. The intraining running injury clinic can help diagnose and treat your Gluteal (and other) injuries. Running shoe and biomechanical assessments can be performed by the experienced podiatrists and physiotherapist to help get you back running sooner.
Call today for an appointment with out team: 3367 3088.Re
Doug James, Physiotherapist and Podiatrist
Doug James is a qualified physiotherapist and podiatrist with a special interest in running and sports injuries. He combines the two treatment approaches to achieve successful outcomes for clients of all abilities from non-athletes to elite athletes. Bachelor of Podiatry (honours), Master of Physiotherapy Studies. Doug has undertaken further training in dry needling, Pilates, and Rocktape and may incorporate these as necessary during treatment. Doug is also a keen runner having completed the New York Marathon.