Excruciating Back Pain Due to Hamstring and Gluteus Medius Issues
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Ever get up in the morning with excruciating back pain? You think it will work out but it doesn’t, so that every time you walk, sit, or go to bend forward it just kills? Me, too. I’ve been afflicted with this sort of pain ever since becoming a sedentary student who sits for huge amounts of time, then heads out for usual activities of fast-paced broomball and hilly cycling.

The back pain got so bad I had to stop my activities, while I chased around the trigger points (TrPs), trying to figure out what was going on. I’d ruled out disc derangement, with specific tests, so no worries there. What I had was strictly musculoskeletal brought on by overstrain because I’d gone from a very active lifestyle to one of sitting, and that wasn’t working well in combination with my attempt to continue intensive sports.
When trying to figure out what’s causing your back pain, a trip to the doctor or physiotherapist/physical therapist can be enlightening as to what kind of muscle length, strength, imbalance, and joint issues you are having. The physio can then tailor a program specifically to you, one that will lengthen overly tight muscles and strengthen weak or over lengthened muscles, which will help sort out muscle imbalances that you have going on.

For myself, a tight and shortened left hamstring loaded with TrPs was leading to glute TrPs on the left side. So every time I tried to bend forward, lengthening my shortened glute muscles, excruciating pain resulted. My quadratus lumborum (QL) wasn’t the cause, but it too was part of the problem. As well as a few other muscles along for the trigger point ride, such as piriformis, and the rest of the glute gang.

Hamstring & Gluteus Medius Pain Patterns

Hamstring trigger points can be painless even while causing painful trigger points in the gluteus medius through various muscle imbalance interactions. These TrPs can occur on one side of the body only or both sides.

When the situation really gets aggravated you may find both glute medius and hamstring trigger points firing up and causing extreme pain. Pain that seems to originate in the lumbar and buttock area (glute med pattern), then radiating down one or both legs (hamstring pattern).

Gluteus medius & hamstring TrPs on flare. This combined pattern is typically associated with disk problems only in this case, the disk is not the issue, the TrPs are.
Hamstring TrPs indirectly causing gluteus medius TrPs through muscle imbalances.
Clair Davies says in The Trigger Point Therapy Workbook:

Pain from trigger points in the gluteus medius muscles is felt in the low back just above and below the belt line and often extends into the buttocks and hips. Back pain from this source can be excruciating and disabling, seriously undermining endurance. Pain in the hips can make it hard to find a comfortable sleeping position. Gluteus medius trigger points are [also] a frequent cause of hip and low back pain in the later months of pregnancy. Pain in both the hips and low back can make walking almost impossible.

Some causes of trigger points in the gluteus medius are:
  • Carrying extra pounds in body weight--because when you walk the glutes work to keep your hips stabilized and so work harder if you are overweight. Similarly, carrying heavy packages while walking can have a similar effect.
  • TrPs in the quadratus lumborum (QL), a stabilizing muscle that runs along the spine between the ribs and pelvis, can cause trigger points in the glutes.
  • Standing for long periods of time, especially on concrete floors.
  • Sitting for long periods of time, especially if you sit with the knees splayed out or legs crossed, which puts the glutes into a shortened position.
  • Intensive exercise, especially in combination with sedentary lifestyle.
  • Davies notes that other causes include weight lifting, running, falls, aerobic exercise, and constant weight bearing on one leg, such as when carrying a baby or favouring the other leg.
  • Muscle imbalances...
Here are some strategies to get your body back to normal:
  • Release the TrPs in your glutes, hamstrings, and QL (if part of the problem), which you can do with a foam roller, ball, trigger point release cane, trigger point massage, or with vacuum cups. Try the YouTube foam roller routines below.
  • Make sure you don’t have issues with other muscles, such as quadriceps and calves. Everything is connected and has an effect on other parts of the body.
  • To prevent re-injury always warm-up before getting into your physical activities or before stretching. If you’re not in the research loop, it’s been out for a few years now that stretching prior to activity with no warmup leads to an increase in injuries.
  • And...dynamic stretching is preferred over static. However, that type of stretching can be difficult for the unathletic. So don’t forsake the static stretch.
  • Increase your base condition so the intensive workouts don’t kick your butt. Literally.
  • Stretch your glutes, hamstrings, and QL, post warm-up. Try the following YouTube examples below.
  • If you’re a cyclist with excruciating back pain, you also need to go to a reputable bike shop and get properly fit to your bike. A bad fit can be giving you a bad back.
Common sense applies. If the stretches or TrP release exercises either make things worse or make no change at all, then they aren’t appropriate and you may have some other issue going on, such as other muscle or joint problem, disk issues, nerve compression, tumour, or nervous system problem. So check in with your MD before starting. With a go ahead, get that body moving and releasing.

Not moving at all is one of the worst things you can do!
YouTube Vids: Stretches and Releasing Trigger Points
Foam Roller
Routine 1
Restoring Lost
Physical Funciton
Foam Roller
Routine 2
Dynamic Glute
Med Stretch
QL
Stretch
Static Gluteus
Medius Stretch
QL
Stretch
Glute/Ham Release
w Tennis Balls
Hamstring
Stretch
The Pain Clinic notes: Warning: None of these stretches is to be performed in the presence of severe sciatica with pronounced leg weakness. If there is pronounced leg weakness then an MRI scan and a surgical opinion is indicated quickly.

Same goes for changes in bowel and bladder function. Suddenly going too much then/or not at all? That's an emergency situation. Numbness or pins and needles tingling in the pelvic floor/genital area is also a red flag, as is the weakness in the legs mentioned above.

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