Suffering From Hip Pain?
Are you suffering from hip pain? Lower back pain? Or a pain in the butt? Do you have pain travelling down the back of your thigh (sometimes called Sciatica)?
There are many possible reasons you may feel this pain or discomfort. However, this article deals with one particular, yet common reason. I’ve chosen this particular combination of muscle issues because clinically, it’s what I see most often.
Which Muscles Are Involved?
The three affected muscles are:
- The Gluteus Minimus muscle
- The Gluteus Medius muscle
- The Piriformis muscle
The most common story is that Gluteus Minimus & the Gluteus Medius become weakened (functionally, these two muscles work together). The Piriformis tries to compensate for the weakness. Eventually, the Piriformis goes into spasm. This, in turn, causes pain.
When the Gluteus Minimus & Gluteus Medius muscles are weak, the industrious Piriformis muscle tries to compensate by overexerting itself. The Piriformis attempts to do both it’s own job, as well as that of the Gluteus Minimus & Gluteus Medius.
If left in this state, other muscles can (& will) become involved. As well, due to irregular muscle tension tugging on the hip joint, damage may start to accumulate within the hip joint itself.
Prevent irreparable damage by dealing with this issue as soon as you feel hip pain or discomfort!
Pain Referral Patterns
This article is called “Hip Pain” because all three muscles attach at the hip. However, pain may also be felt in areas far reaching from the hip.
Each of the three muscles send out their own pain referral patterns:
- The Piriformis
- The Gluteus Minimus
- The Gluteus Medius
If indeed you are experiencing this particular combination of muscle issues, you may feel:
- Only a small part of one pain pattern,
- One complete pain pattern,
- A combination of two of the pain patterns,
- A combination of all three pain patterns or
- Nothing at all.
At different times you may feel different pain pattern combinations.
Although it’s more uncommon, the Sciatic nerve can become involved. This will cause pain to travel down the back of the leg & possibly into the foot. (There will be more details about this later in the article.)
What Causes Weakness in The Gluteus Medius & Gluteus Minimus Muscles?
Among other causes, the Glute Med & Glute Min can weaken from:
- Standing on one leg with the opposite hip dropped for an extend length of time
- Long walks on a soft sandy beach
- Walking perpendicular to an incline (such as on a beach that inclines down to the water)
- A leg length discrepancy
- Morton’s foot structure (2nd toe being the longest) causing differentiation in walking (gait)
So what can you do?
Following are the three simple exercises that can alleviate this common muscle issue combination. You’ll need to continue & progress these exercises to maintain strength & flexibility.
Gluteus Medius & Gluteus Minimus Strengthening
You want your hip pain to stop! The only way to accomplish that is by making the Glute Med & Glute Min do their job. The strengthening exercise that isolates these two muscles is called The Clam.
- Lying on your side (unaffected side up)
- Make sure your spine is in a straight line
- With your bottom arm, cradle your head
- Knees bent
- Keep your feet “glued” together.
- Lift up the top knee as high as it will go without rolling your top hip backwards
- Work your way up to 25 repetitions
- Flip over & lie on your other side (affected side up)
- Repeat exercise & notice the difference in strength
Your Hips Must Remain “Stacked” (with the top hip directly over the bottom hip) throughout the exercise. If your Gluteus Medius is weak, your body will automatically roll your top hip back to allow another muscle to take over.
Don’t let this happen! If your top hip rolls back, even a little, a different muscle is worked, possibly exacerbating your problem.
There are two ways to prevent this mistake:
- You can place your hand over your sacrum so that you will feel if your top hip rolls back
- Better yet, place your bottom hip against a door (or a wall without a baseboard) so that it becomes impossible for your top hip to roll back
Whenever you strengthen a muscle, it’s important to stretch out that muscle immediately after the exercise:
- Lie on your back
- Keep one leg straight
- Bring up the other knee toward the chest
- Grasp knee with opposite hand
- Pull knee toward your opposite shoulder
- Ensure that you do not twist your torso & that both buttocks stay in contact with the ground
- Hold for one minute by the clock
- Repeat on the other side
- You should feel this stretch across your bottom
When the Piriformis muscle is in spasm, a slight stretch can provide some relief! But the Piriformis is a very sensitive muscle. Please stretch gently!
- Sitting on a low stool or ottoman
- Place one ankle over top of the opposite knee
- Bottom leg: ensure ankle stays directly under the knee
- Ensure lower back remains straight & even arched (if you can manage it)
- You should feel a stretch across your bottom or in your hip
- To increase this stretch, keeping your lower back arched, lean slightly forward
- Hold for well over a minute
- Repeat on the other side
- Warning: If you stretch the piriformis too fast or too hard, it will only spasm more. Remember, gentle stretch.
Please note: this muscle responds best to a gentle stretch held for a long period of time. It would be beneficial for you to set yourself up comfortably so that you can hold the stretch:
- pillow under top knee,
- buttocks pushed way back into seat &
- pillow behind lower back to maintain arch.
Perhaps you could be drinking a cup of coffee, reading a book or watching a movie. Anything that will allow you to remain in this very gentle stretch.
Complications With The Piriformis Muscle & The Sciatic Nerve
Even if the Gluteus Medius & Gluteus Minimus muscles are strong, the Piriformis muscle can still spasm in response to:
- Prolonged sitting
- Twisting sideways while bending & lifting a heavy weight
- Forceful rotation with the bodyweight on one leg
- Sitting on one foot
- Slight displacement of the Sacroiliac joint
- Arthritis in the Sacroiliac joint
- Arthritis in the Hip joint
Sometimes the Piriformis muscle can spasm so much that it begins to press on the Sciatic nerve. This may be felt as pain travelling down the back of the leg &/or pain into the foot.
There are four possible routes that the two portions of the Sciatic nerve can be threaded in different people!
Degenerative diseases in the spine of the lower back can also cause entrapment of the nerves. This can be another cause of pain down the back of the leg &/or pain into the foot.
Are you are experiencing lower back pain? Please try these four fixes:
- Tight hip-flexors > Lower Back Pain | The Hip-Flexor Fix
- Tight hamstrings > Lower Back Pain | The Hamstring Fix
- Tight upper back > Lower Back Pain | The Thoracic Fix
- Core weakness > Lower Back Pain | The Core Strength Fix
No one body is the same as another – bone structure dimensions differ vastly requiring the muscles, tendons & ligaments to be different lengths & attach at slightly varying angles. To gain the most success from the above exercises, make an appointment with your physiotherapist or massage therapist & ask them to lead you through an inaugural session & make the appropriate modifications unique to you.
– LEONG Orthopaedic Health
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