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Referred Pain from the lumbar spine?
A Pain deep in the cheeks of your bottom can be referred from the lower back. There does not necessarily have to be pain in the lower back as well for pain to be referred into the buttocks.
What are the symptoms of pain referred from the back?
An aching in the buttocks that is difficult to pinpoint.
The slump test may reproduce buttock pain which is eased when the neck is relaxed back (extended).
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Areas of the lumbar spine may be tender and have poor mobility.
Tight gluteal muscles and other muscles of the buttocks.
What can I do?
See a Physical Therapist who can identify the problems in the lower spine.
Begin an exercise programme that will stretch and strengthen the muscles supporting the lumbar spine.
Stretch the gluteal muscles and hip rotator muscles.
What can a Physical Therapist professional do?
Manipulate and mobilize the segments of the lumbar spine. This is a good way of assessing whether the lumbar spine is a cause of buttock pain. If it is then symptoms will be relieved.
Deep tissue sports massage techniques can be applied to the lower back and buttocks to release muscle tension, particularly in chronic conditions.
Acupuncture or dry needling can also help reduce chronic tension in muscles.
What other injuries are related or similar?
Piriformis syndrome
Sciatica
Sacroiliac joint pain.
The Sacroiliac joint Is?
The Sacroiliac Joints are located at the bottom of the back. You have one either side of the spine. The Sacroiliac joints help make up the rear part of the pelvic girdle and sit between the sacrum and the ilia.
There are torsional or twisting forces applied to the pelvic girdle when the lower limbs are moved. These limbs act like long levers and without the sacroiliac joints and the pubic symphysis (at the front of the pelvis) which allow movement, the pelvis would very likely be subject to a fracture.
These joints can often get stuck or in some cases one half of the pelvis can glide forwards or backwards, which is often referred to as a twisted pelvis. When this occurs it often irritates the Iliolumbar ligament which results in Inflammation. This is usually indicated by tenderness around the bony lumps which you can feel if you place your thumbs either side of your lower back.
Inflammation of the sacroiliac joints and associated ligaments are very common, especially following pregnancy where the hormone relaxing is released and this results in the relaxation of ligaments in preparation for childbirth. In most cases the causes of sacroiliitis are mechanical, however there may be other medical inflammatory conditions present such as Ankylosing Spondylitis as well as others which will need attention.
Symptoms include:
Pain located either to the left or right of your lower back. The pain can range from an ache to a sharp pain which can restrict movement.
The pain may radiate out into your buttocks and low back and will often radiate to the front into the groin. Occasionally it is responsible for pain in the testicles among males.
Occasionally there may be referred pain into the lower limb which can be mistaken for sciatica.
Classic symptoms are difficulty turning over in bed, struggling to put on shoes and socks and pain getting your legs in and out of the car.
Stiffness in the lower back when getting up after sitting for long periods and when getting up from bed in the morning.
Aching to one side of your lower back when driving long distances.
Specific assessment tests:
The Stork test - to assess weather the sacroiliac joint is moving correctly.
Leg length difference measurements - both straight leg and bent leg assessments.
Ilia rotation - this assesses weather the ilia is rotated on one side creating imbalance.
What can a Physical Therapist or GP do?
Use diagnostic tests to discover the cause of the problem.
Eliminate medical diseases such as Ankylosing Spondylitis..
Treat the cause as well as the symptoms.
Prescribe anti-inflammatory medication (e.g. ibuprofen) and rest.
Use electrotherapy equipment to treat affected tissues.
If indicated and safe to do, level the pelvis via manipulation.
Articulate sacroiliac joint and restore normal function.
Sports massage will help relieve any soft tissue tension in the area.
Use injection therapy.
Advise Ice and cold therapy to reduce inflammation.
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What are the similar or related injuries and conditions?
Ankylosing Spondylitis
Myofascial pain
Low back pain
Coping with Sciatica
Sciatica is a pain that starts in the back and radiates down one of the legs. It is quite a common complaint and is sciatica is caused by pressure on the sciatic nerve which runs down into the leg. The medical term is acute nerve root compression. The cause of pressure can be varied from a Slipped (Prolapsed) disk to muscle tension (Piriformis syndrome) or something less common such as a tumors, bony growths and infections.
A prolapsed disc or slipped disc as it is sometimes known is not simply a disc that has 'slipped' out of place. Intervertibral discs separate the bones of the spine (or vertebrae) and their function is to act as shock absorbers or cushioning for the spine and allow movement.
They quite happily allow flexion and extension (bending forwards and backwards), lateral flexion (sideways movement) and twisting. However a combination of the two can put excess stress on the spine and damage the discs. This is particularly common in people who may lift heavy objects and twist with them for example unloading heavy boxes off the back of a lorry.
The intervertebral discs are filled with a soft liquid in the middle called nucleus pullouts and when a disc prolapses this liquid squeezes out and puts pressure on the spinal cord compressing the nerve routes and causing pain.
Depending on where the sciatic nerve is pinched will determine where you feel the pain which can radiate to the front of the knee or right down the back of the leg to the foot. The L5-S1 disc is the disc most commonly damaged and the L4-L5 disc the next most commonly damaged.
Sciatica Symptoms
Acute low back pain.
Pain radiating down the leg. This pain may be sharp and accompanied by pins and needles and / or numbness.
Pain is often triggered by a minor movement such bending over to pick something up.
Pain may be worse by sitting, lifting, coughing or sneezing.
Pain is usually relieved by lying down, often on one side.
Pain is often better in the morning after a nights rest.
Scoliosis or an S shaped or bent spine as seen from behind is often present with the patient bending away from the side of pain.
There may be muscle spasm in the lower back.
Tenderness in the lower back when pressing in.
Pain on the straight leg raise test which is not apparent when just stretching the hamstring only.
Sciatica treatment
A Short Rest in bed if necessary in a position that is comfortable.
A doctor may prescribe NSAID's (non steroidal anti inflammatory drugs) such as ibuprofen. Should always be taken under the direction of a doctor and do not if the patient has asthma.
Apply heat or a hot bath may help to relieve muscle spasm.
Use a heat retainer or back brace can provide support in the early stages.
See a sports injury specialist or doctor.
Begin extension exercises as soon as pain allows.
What can a Physical Therapist or GP do?
Determine the cause of the sciatic pain.
Prescribe anti-inflammatory medication e.g. ibuprofen or muscle relaxants.
Use sports massage techniques to relax tight muscles.
Gently apply mobilization techniques to the spine.
Use traction or advise on the use of and Inversion Table.
Apply electrical stimulation in the form of a Tens machine or Interferential.
Apply ultrasound treatment.
Operate on a slipped disk if neurological signs (nerve related symptoms) continue or worsen.
After the acute painful phase
Restore pain free movement to the back through mobilization and stretching techniques.
Ensure posture and correct lifting techniques are learned and maintained.
Strengthen the core stabilizing muscles of the spine.
Terry O'Brien
http://www.BackTrouble.co.UK
Brandy J
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