Why are my glutes sore?
I have pain in the cheek of my butt, is this normal?
It can be very frustrating when you experience pain. What a pain in the butt!
But the Break Free team is here to help you find out why your buns hurt so much.
The muscles around your hip area are known as the gluteal region or glutes for short. It comprises of the muscles around your pelvis and femur. There are layers of muscle that help rotate and extend your hip. Here are some of names of these muscles:
Gluteus maximus, gluteus medius, gluteus minimus
Tensor fasciae lata
Gemelli (superior and inferior)
Quadratus femoris
Obturator internus
Piriformis
Fun fact – the gluteus maximus is the strongest and largest muscle of them all!
This diagram depicts the exterior layer of gluteal muscles.
These grouping of muscles help you walk, run, climb stairs, stand, and keep your body stable and balanced. A lot of these muscles originate from the pelvis and hip area. Many of them attach to a bony prominence on your upper thigh bone known as the greater trochanter. If you poke the side of your hip, can you feel a bony area or a tender spot? This is roughly where a lot of these muscles attach to.
Why do my glutes hurt?
Pain depends on how the person experiences it and where it’s located. We all experience and describe pain differently. Some could describe their discomfort as a deep ache. Others may characterize it as sensitivity to touch or sharpness with movement. The location may determine what structure is injured. This could include:
The hip joint
Gluteal muscles
Ligaments
Nerves that come from the lower back and travel through or near the hip
It can be very challenging to find the rights words to describe your pain. How can we differentiate and find out what it is?
Physiotherapy and what it can do for you
Your physiotherapist will often ask you questions such as:
What does it feel like?
Where is it located?
When did it start?
What happened when it started hurting?
Is it constant or intermittent?
How long does your pain last?
What is the intensity out of 10?
What makes it worse? What makes it better?
These questions can help the physiotherapist familiarize themselves with your pain language and look for patterns.
One question I love asking is “does it feel like muscular strain or pain?”. It’s fun to hear how others interpret what they are feeling because everyone has their own way of explaining what they feel. What I later find out is the pain they are feeling is muscle activation rather than a negative painful response. On the other hand, if the sensation you are feeling increases in intensity, this could be an issue that needs to be addressed. The big question is, how do you know what good or bad pain is?
First, we need to define what good and bad pain are. A negative pain is something that prevents us from completing daily activities or going back to something we love. Good pain often won’t linger long and will in fact allow us to return to something we love and even make us stronger. An example is when we lift something heavy that we are not used to and we are sore the next day. We know that after 1-3 days, the soreness should dissipate and the result is that we can lift the same amount of weight with greater ease! This soreness that develops is called delayed onset muscular soreness (DOMS). When we exercise, microscopic tears are created within our muscles in which we recover from by a process known as protein synthesis. Our body uses protein as building blocks to repair these microscopic tears which results in a stronger, and over time, larger muscle. There may be tenderness to touch, stiffness, and discomfort with delayed onset muscle soreness. But with gradual light activity, stretching, and rest, your muscle will recover and you can continue exercising.
However, if your pain lasts greater than 3 days and is constant, this could indicate that you have developed an injury. A common scenario I see at my clinic is a client participating in an activity they are not accustomed to leading to lingering pain that is constant. The pain shows no signs of decreasing even after 3 days. At times, the pain is so intense that it keeps my clients up at night until they take pain killers. As time progresses, certain activities will flare up this pain and it shows no sign of improving after weeks, months, or even years. If this is the case for you, it is time to seek help from a professional.
What could be causing the pain in my glutes?
There are a couple of reasons why this could occur. Here is a list of some potential reasons:
Muscular strain
Gluteal or hamstring tendinopathy
Bursitis
Osteoarthritis or Rheumatoid Arthritis
Fracture
Pain from the lower back
I want to draw your attention to the last item on that list. Pain originating from the lower back.
This diagram depicts an irritated nerve travelling down the spine, which is referring pain to the gluteal area.
In this article 71% of patients with hip pain were actually experiencing a lower back issue. In this study, they repeated lower back movements and were able to change their hip pain, indicating that it was related to something in their lower back. How neat is that! At Break Free, we also use this same methodology to see if your back is the cause of your hip pain. To help you understand the process, here is an example of a squash player:
Mr. C twisted while planting his left leg and felt something ‘let go’ in the back of his leg. He discontinued playing the sport. There was no bruising or swelling. However, there was a pinpoint pain in his right buttock where the sit bone is, and tightness around the top of his glute. When he went to physiotherapy, they found that his hamstring was weak so they began strengthening his hamstrings and glutes, but found no relief after 6 weeks. After several visits, he wanted a second opinion and saw a physiotherapist trained in Mechanical Diagnosis Therapy. From there, the lower back was screened and he found that his lower back was causing the weakness in his hamstring. By stretching out the lower back, the strength of his hamstring was restored and the tightness in his glutes diminished. Exercises afterwards started to become more effective and he returned to sport shortly thereafter.
What was the root cause?
Mr. C was troubled by a seemingly mechanical problem that required intervention from a physiotherapist trained in the McKenzie Method also known as Mechanical Diagnosis Therapy (MDT). When the spine is not screened well, it can result in confusion as to what the leading cause is. This doesn’t exclude the hip being the culprit of your injury. But it always begs the question: why are the glutes weak?
Let’s take another example:
Lizzy is a trail runner with upper gluteal pain with running on decline, she finds it better when she is leaning forward on a steep hill pushing through her glutes. For the longest time, she felt like her glutes were weak. But frustration begins to set in as her symptoms are terrible one day and better the next. She is finding that her training is being limited and needs a solution before her fall trail run. She seeks treatment from a chiropractor and receives regular adjustments only finding one day of relief. She tries osteopathy and massage, but finds that she has to rely on the hands of other practitioners to give her relief. She wants a solution that she can do herself so she can prepare for her trail race. She finally sees a physiotherapist who is trained in Mechanical Diagnosis Therapy who quickly finds out that her gluteal pain is coming from her lower back. Bending forward feels better whereas bending backwards makes her gluteal pain worse. The physiotherapist zeros in on the problem and provides Lizzy with stretches to decrease the irritation of the nerve in her back that is causing her glute pain. She is then provided trunk strengthening exercises to increase the stability of her lower spine resulting in relief in a matter of weeks. She now has consistent pain free days on the trails where she can run up and down hills without any anxiety.
Does this sound like you?
Having pain is no fun and what’s worse – not being able to find solution despite seeking help. At Break Free, we utilize a method called Mechanical Diagnosis Therapy (MDT), also known as the McKenzie Method. This framework helps physiotherapists find the potential source of the problem when it comes to injuries. The spine is thoroughly screened first before moving on to the painful area. Physiotherapists that use this type of therapy are specially trained to look for patterns both in what you say and how you move. As your first session unfolds, patterns will start to emerge which will lead to an answer.
This does not mean all your injuries are stemming from your neck or lower back. Sometimes it is good to exclude potential sources to determine the right course of action for you. Your body is unique and responds differently than everyone else. If after a series of tests, there are no conclusive results, other methods of treatment or a referral to a specialist may be the next step.
Trail runners getting back into action after a glute injury.
The human body is connected. That means there are certain connections to all moving parts. It can sometimes be overwhelming to navigate this all by yourself. That is why Break Free Physiotherapy and Wellness exists – to help shed light on where your injury is coming from. If you are interested in learning more about this methodology or seeking a practitioner who understands the importance of screening the spine, book with us.
How do you know if it is the spine or not?
McKenzie or MDT therapists will use repeated movements to help discern where the potential source is coming from. They will often repeat a movement in your lower back or neck to see if there is any change with the area you are having pain in. If the pain begins to move or intensity changes, there may be a connection with the spine and your associated pain. Another sign is whether the muscles where you are having problems becomes stronger or weaker with movements. Your physiotherapist should be able to show you the connection if it evident.
What if it’s not the spine
Then we check the hip joint and the muscles and provide exercises to mobilize and strengthen! What is exciting about clearing the lower back of involvement is the fact that you can be certain that you are just dealing with the hip itself! No more confusion about what it is and isn’t. It makes treating your injury a lot clearer for both you and your physiotherapist.
Final thoughts
I spent a good five years banging my head against the wall because there were a lot of clients in my early career that I could not figure out. It wasn’t until I learned about MDT that I began to see results consistently. This doesn’t mean MDT is the be all end all; there are many ways and paths to get better. But with this approach, it is systematic, thorough, and helps you gather answers by asking more questions using testing. If you feel like this is the method you want to try to solve your nagging injury, click here to book with one of our skilled physiotherapists in London, Ontario.
Corey Kim
Physiotherapist
Hey, my name is Corey, and I’m a co-owner of Break Free Physiotherapy and Wellness. I was born in Seoul, South Korea but grew up in London, Ontario. I finished both my Bachelor of Arts in Kinesiology and Master of Physical Therapy degrees at Western University. I’m passionate about helping people find pain relief through movement and believe in self-empowerment by sharing knowledge of the human body and its ability to heal. [full bio]
