Back Pain and the Gluteal Region
When we think of lower back pain, we may think of problems in the spinal column itself. It is true that slipped lumbar discs, inflammation in the facet joints, and strains in the muscles attaching directly to the vertebrae are all common causes of back pain. But in many cases, pain radiates to the back from the pelvic region. Problems in this area can also cause pain, tingling, or numbness further down the leg, so it is important for patients to understand the importance of maintaining the health of the muscles in their gluteal region.
The Muscles of the Gluteal Region
The gluteus maximus is the largest and outermost muscle of the gluteal region. It stretches from the sacrum and coccyx, which are parts of the spinal column, down to the femur. Beneath it are the gluteus medius and the gluteus minimus, which stretch from the ilium, or crest of the hip, to the femur. The gluteus medius and minimus allow us to move our thighs outward and rotate them medially. The gluteus maximus allows us to straighten our legs as we move and provides our strides with strength.
There is another layer of diagonal muscles beneath the gluteus minimus that attach to the femur. The uppermost of them is the piriformis, which also attaches to the sacrum. The sciatic nerve and major arteries run beneath it. The piriformis and other inner layer muscles work with the gluteus minimus to rotate our legs laterally.
Causes of Irritation
Tightening of muscles in the gluteal region can cause them to become sore. This can happen to runners if they don’t do sufficient warm-ups or overexert themselves. People are also vulnerable to muscle strain if they move with an unusual gait. As their muscles become stiff, a patient’s posture will get worse, putting additional strain on their back and hip muscles. Hip muscles are also attached to the pelvis, and tightness in them can pull on the gluteal muscles. Irritation of the sacroiliac joint can also put pressure on the piriformis, causing it to spasm, as can internal bleeding. Contractions in the piriformis muscle can put pressure on the sciatic nerve, causing the patient to experience impeded leg function and shooting pains. This symptom is called sciatica.
Diagnosis and Treatment
An examination will be necessary to diagnose whether a patient’s lower back pain is due to muscle inflammation. Pain from sciatica can reach as far as the foot. Problems at the hip-level involving the gluteus minimus and medius may be felt in the leg. As part of the examination, patients will be put through a range of motions involving different muscles.
The location of the gluteal region makes it difficult for patients to massage on their own, although they may benefit from assistive devices. Common treatments include range of motion and strengthening exercises such as bridging and use of resistance bands. Patients may also benefit from deep tissue massages, use of heat or cold packs, manual manipulation, and electric muscle stimulation. Because other serious problems may feel like muscle strains, it is always advisable to seek professional help for persistent pain.