Dead butt! (syndrome)

Yes, it’s a real thing!

The phrase “dead butt” refers to a painful condition caused by inflammation in the tendons of the gluteus medius muscle, one of several major muscles composing the buttocks. This condition, known medically as gluteus medius tendinopathy1, is also called “dead butt syndrome.”

What is dead butt syndrome? Do the muscles in your backside die?

While the name may have a level of seriousness to it, our bodies are naturally very resilient; unless the muscle is cut off from its blood supply, it doesn’t die easily. However, gluteus medius syndrome can be painful, and pain experienced during this tendinopathy can bring the buttocks to the front and center of your attention.

Although a person’s posterior may look relatively simple, our backsides are actually quite complex. The gluteus medius is a smaller, lesser-known muscle with an essential function; it actively contracts during weight-bearing while we run or walk.1 The gluteal muscles (there are three) are just several muscles that compose the familiar anatomical structure we call the “butt” and originate from the bony pelvis (ilium) and insert on the long leg bone (femur).

To best understand gluteus medius tendinopathy, we need to understand what happens with tendinopathies in general, how exercise or well-intentioned but poorly managed daily routines can contribute to our butts becoming “dead,” what to do about it!

Explaining the “dead” part of dead butt syndrome

There are several options to weigh regarding muscle-based conditions that cause pain in our backsides. Although the gluteus medius helps compose our buttocks, the location of this tiny but powerful muscle is essential. Because of its connection to the lateral part of the hip, it is important to consider gluteus medius tendinopathy as a possible cause of outer hip pain1. In particular, the moderate to intense pain associated with this condition can be found on the bony part of the femur called the greater trochanter, a bony eminence located at the top of our leg bone near the outer part of our hips. This pain does not always stay localized. It can extens down into the lateral thigh, mimicking other conditions.

Causes for gluteus medius tendinopathy are opposite of one another. The first stems from chronic underuse of our glutes, such as that experienced during a sedentary lifestyle.  Sedentary lifestyles cause hip flexor muscles to tighten while lengthening gluteal muscles, leading to inefficient muscle activation.  Sedentary lifestyles also cause gluteal compression2; sitting for extended periods.  Think of having a career involving driving for long hours or commuting for a job only to sit in an office chair for more hours, with few breaks to get up and exercise.  That’s a lot of time spent with your butt compressed into a (hopefully comfortable) flat surface!

The other cause for gluteus medius tendinopathy is overuse. Repetitive exposure to overloading, such as during long-distance running, can also contribute to the development of this condition.3

On an ideal day, the tendon undergoes a cycle of balanced movements, including weight-bearing, bending, expanding, contracting, and adapting to our regular activities. When our tendons experience changes in loading type — think of increased intensity such as taking up a new exercise routine or lifting more weights for a personal record, or daily habits that fail to engage in consistent loading and movement — this disrupts the tendon’s ability to adapt over time.3 Sustained compression can be just as damaging as improper loading. Loading during rapid increases in intense or frequent exercises with insufficient recovery times can reduce the capacity of the tendon to adapt, predisposing it to injury. Dead butt syndrome refers specifically to the tendons of the gluteus medius muscle failing to adapt.

Pain and dysfunction with gluteus medius tendinopathy

Not all types of pain are created equal! Lateral hip pain with an insidious onset can be caused by several conditions of the low back or hips, such as hip osteoarthritis. Therefore, pain alone isn’t enough to make a definitive diagnosis, however, MN Spine and Sport, your trusted chiropractor in Woodbury, MN, takes their time to properly evaluate the causes and develops a customized treatment plan based on your unique condition! Dysfunction of the gluteus medius tendon should be considered in the following scenarios where the pain accompanies other situations4, such as:

• Pain into the lateral thigh and knee
• Pain with prolonged sitting or sitting in a crossed-legs position
• Pain with weight-bearing activities such as walking, climbing stairs, running, and standing
• Tenderness on the hip with palpation, especially along the greater trochanter
• Pain while laying on the affected hip, such as experienced in bed
• Weakness with other muscles of the affected leg

If you’re experiencing any of these signs or symptoms, give MN Spine and Sport, your local chiropractor in Woodbury, MN, a call and make an appointment for a thorough evaluation.

Treat Dead Butt Syndrome with a Chiropractor in Woodbury, MN

Imaging is rarely utilized for most gluteus medius tendinopathies. Ultrasound or MRI may be used to rule out another possible diagnosis if the diagnosis is unclear or if conservative treatment has failed.

Correct management of gluteus medius dysfunction is imperative. The wrong exercise or rehabilitation approach may delay or decrease optimal recovery!  Our chiropractors in Woodbury, MN, will work with you to develop a rehabilitation plan that mitigates pain and discomfort while getting you back to normal life as soon as possible.

Management of this condition1,5 includes specific loading exercises and management strategies for the affected tendon(s), rehabilitation including guided exercises and movements, ergonomic changes to your work or home, or co-management with another doctor.  Certain exercises may need to be modified or changed from your usual workout routine, or you may have new exercises introduced as a home exercise program.  Our chiropractors in Woodbury, MN, may ask you to avoid or change other postures4,5; for example, avoid sitting with your legs crossed or adding a pillow between your knees while you sleep at night.

Some treatment options are more invasive than the conservative musculoskeletal route and may be considered if recovery is slow or progress is less than optimal. These include corticosteroid injections, platelet-rich plasma (PrP) injections, and surgery.5

Is a chiropractor in Woodbury, MN, right for your dead butt syndrome?

 Absolutely.  In fact, the gluteus medius is our favorite muscle here at our Woodbury chiropractic office! If you’re not sure about what step is appropriate to take, call us for an evaluation! We will determine the extent of muscle injury and if further intervention is required, especially since proper assessment and early diagnosis lead to the best outcome possible.  

However, not all patients will respond to conservative musculoskeletal care.  If you have gluteus medius tendinopathy and you are not getting better in the prescribed treatment, ask your healthcare provider about other options for treatment.  Every case is unique, and your situation may call for further intervention.  Give our Woodbury chiropractors a call today and see how MN Spine and Sport can get you back to feeling happy and healthy. 

 

References

1. Allison, K., Vicenzino, B., Wrigley, T.V., Grimaldi, A., Hodges, P.W., and Bennell, K.L. (2016). Hip abductor muscle weakness in individuals with gluteal tendinopathy. Medicine and Science in Sports and Exercise;48(3):346-52.
2. Almekinders, L.C., Weinhold, P.S., and Maffulli, N. (2003). Compression etiology in tendinopathy. Clinics in sports medicine;22(4):703-10.
3. Cook, J.L., and Purdam, C.R. (3009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine;43:409-416.
4. Grimaldi, A., and Fearon, A. (3015). Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. Journal of Orthopaedic & Sports Physical Therapy;45(11):910-33. 

5. Bennell, K., Wajswelner, H., and Vicenzino, B. (2015) Gluteal tendinopathy: a review of mechanisms, assessment, and management. Sports Medicine;45(8):1107-19.