No, I’m not talking about your significant other, that’s a different kind of nagging, and a whole other article. I’m talking about that painful sensation in your buttock and leg that may be originating in your back, that won’t let up!
When people think of pain (or even numbness/tingling) in the butt or leg, they often think sciatica. The dreaded sciatica. The one we hear everyday in clinic “my sciatica is flared up, fix it!” But the reality is, only about 5% of the population at any given time has sciatica. Sciatica occurs when we have chemical or mechanical pressure irritating the sciatic nerve. This can be from an intervertebral disc herniation, spinal canal stenosis, and muscular nerve entrapment (I’m sure most of us are familiar with ‘piriformis syndrome’ – very rare and over-diagnosed). Since these conditions are relatively uncommon, what is the actual cause of that pain in your rear? Let’s take a look at a few of the common causes of rear-end pain we see in clinic:
- Thoracolumbar joint dysfunction: Where the mid-back (thoracic spine) meets the low back (lumbar spine) is called the thoracolumbar junction. This is an area where the curves in our back start to take on a different shape. The mid-back has a kyphotic curve (concave in the front) and the low-back has a lordotic curve (convex in the front). This makes the area vulnerable to repetitive stress injury (think sitting all day), causing irritation of the of the joints and nerves in the area. These nerves can refer pain all the way into the buttock and even upper leg. Once we get get the joints moving better with manual adjustments and different exercises, we see resolution of this.
- Intervertebral disc pain- When an intervertebral disc is responsible for true sciatica, it is generally due to a bulge or herniation causing pressure on the nerve root. However, when your body is exposed to repetitive stress, the the intervertebral disc can become irritated and we can get what is referred to as axial discogenic pain. In this case, you’ll experience a back pain along with pain in the butt, maybe even a bit of numbness. You’ll also notice you have a hard time bending forward without pain. Decompression of the disc through specific exercises helps take care of this condition.
- Internal rotation of the hip– When the hip is excessively internally rotated, the small muscles of the pelvis become overstretched and as a result, become tighter. These smaller muscles, for one reason or another seem to be working overtime, causing them to be chronically tight. This can cause compression on the nerves and other muscles in the area, leading to butt and leg pain. A great way to help fix this is to get the larger muscles to do their job, making sure they are activated so when you go to use them, they fire at 100%. This is a very important issue that often goes overlooked. When we have a group of smaller muscles working overtime due to the larger muscles taking a vacation or a nap (gluteal amnesia), these overworked smaller muscles will eventually begin to ache and wine. It is crucial we teach your body to use the muscles in the correct way to help get you out of pain.
- Low back joint dysfunction– The joints of the low back can become dysfunctional for a number of reasons: repetitive stress, traumatic injury, or even, you guessed it, sitting too much. When this happens joints can refer pain into the hip and buttock area, something we see common here in practice. Through manual adjustments and specific exercises, your joints become less painful and function better.
- Fascial restrictions– generally, we see these in the deep hip internal rotator muscles. But let’s back up just a step or two. What the heck is fascia? Fascia covers every muscle and organ in the body. Think of the white fuzzy part of an orange covering the actual fruit itself, that’s what fascia looks like. Your muscles should move and glide smoothly under this connective tissue as long as it is healthy and functioning well. When they are not, it is due to fascial adhesions, making movement of the hip and low back muscles less efficient and painful. By helping the muscles of the hip and low back move more efficiently through re-training movement, muscular release, and muscle activation, we can help to the hip move and function with less pain.
So, if you have a nagging rear-end that seems to follow you everywhere you go, give us a call at Inertia Health Center. We can put a nagging rear end out of its misery (and yours!).