Mrs H is a 37 year medical specialist who presented with 6 month history of left sided buttock pain and tightness during and after running. She had been increasing her running volume over this time as she was training for a half marathon and also wanted to soon tackle the marathon.
The pain was localised to the left buttock with some spread into the back of the left thigh. It would also be aggravated by driving immediately after a run. Mrs H’s general health was otherwise good, and there were no other red/yellow flags(cautious signs).
A thorough whole body examination revealed the following main problem areas:
- Adverse neural tension in the right lower limb and the upper cervical quadrant.
- Muscle tension/guarding in the right shoulder and neck region( especially infaspinatous).
- Stiffness(hypomobility) in the neck and thoracic spine left>right.
- Restricted lumbar movement and early guarding of upper traps with shoulder abduction.
- Restricted hamstrings range on the left, but no other local signs of tension around the buttock.
- Good strength and activation of the gluteal muscles, but left hip flexor muscle weaker than right.
- Running assessment revealed some over-striding, and the shoulders held elevated and abducted(elbows away from body).
Through a systematic process of elimination and clinical reasoning, we found the main area that produced the most change to all of Mrs H’s signs(above) was release of the right infraspinatous(shoulder). This muscle had a large trigger point in it. This cleared the hamstring tension(on the left) and resolved Mrs H’s symptoms so she could run painfree again.
Why was Mrs. H’s right shoulder so tight? Further discussion revealed that Mrs H often performed Ultrasound testing with her patients, which often required holding her right shoulder away from her body and in awkward extended positions. This had lead to strain building up over time in the shoulder. She also ran with her shoulders in a tense state, which contributed to more accumulation of strain.
So why had this lead to buttock pain? There are a few possible explanations:
a. The tension in the right shoulder affected upper body rotation while running, which was compensated for by increased load on the left hip/gluteal area.
b. Tightness in the right shoulder lead to compensatory tightness developing in the left buttock following a diagonal pattern, a common movement pattern in normal bodily functions(right arm moves with left leg in walking/running).
c. The left buttock pain was an output signal from Mrs H’s brain warning of some imbalance in the body. The area of pain was not necessarily the area of greatest tension in the body, but this was the most effective area of symptoms to cause a behavioural change in Mrs H as it was affecting her running, something that was very important to her general health and well-being.
Whatever the mechanism there was measurable and objective improvement in Mrs H’s condition. Further correction involved teaching postural strategies Mrs H could employ at work to minimise strain from accumulating in her upper body, and some simple corrections to her running mechanics.
What is interesting about this case is that although Mrs H had buttock symptoms, no treatment was performed locally to that area, as there was no measurable signs of tension in the muscles or joints in the area.
Mrs H went on to run a PB (personal best) in the half marathon and is now well on the way to completing her 1st marathon.
