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A pain in the backside

Nurturing

Health
Andrew O'Brien

As I sit here this morning, I’m thinking about a pain in the backside. My wife and son are complaining about other pains in the backside. Five minutes ago, someone rang me about a right royal pain in the backside. Everyone knows at least one!
As it turns out, we spent yesterday on our bikes on the Greenway, so our family gripe is easily explained. The phone call wasn’t someone whinging about his boss either, he genuinely had a sore bum and is due to spend several hours in the car tomorrow with a game of golf thrown in the mix. So, while the O’Brien family will make a quick recovery, what of my caller?
Buttock pain in sportspeople is generally related to either the sacroiliac joint or the buttock muscles (or most likely a combination of both). Each of these is worth discussing in a little detail before looking at what you can do to alleviate the pain, or reduce your risk of developing pain in the first place.
At the base of your lower back is a triangular bone, called the sacrum, which wedges between the two bones that make up your pelvis (the ilium). The sacroiliac joints (SIJ for short) at either side are covered by a cross hatching of ligaments and muscles which permit only a small amount of movement and act mostly as shock absorbers, transmitting forces between the trunk and legs.
This is particularly significant in running sports, where impact forces are the equivalent of at least double your body weight and create a rotational force through the pelvis and lower back. Stiffness in the lower back can cause problems at the SIJ for golfers, as they jam into the area on backswing and follow through.

Biggest muscles
No doubt you have heard that the buttocks, or the glutes, are the biggest muscles in your body. But what do you really know about them? There are actually eight different muscles in the buttock, attaching from the pelvis and sacrum at the midline, to the top of your thigh bone laterally. Each muscle is described as having its own separate action, but the reality is that our buttocks work as a whole unit. Their job? To propel you forwards and upwards, and to absorb impact and rotation forces when you walk and run. Considering the magnitude of those forces, it’s no wonder we have big butts!
If we have eight powerful muscles in our buttocks, and a joint that is covered by thick ligaments that doesn’t move much, why do we develop pain there? Well, what are you doing right now as you read this? Sitting, I assume. As I said, the job of the glutes is to propel you forwards and upwards - not to act as cushions! In fact, if you look at our closest relatives in the animal kingdom, the great apes, you will see that they don’t really have buttocks. The reason for this is that sometime around six million years or so ago, our ancestors started to spend less time in the trees, and more on the ground.
Over time, our anatomy evolved to make upright walking, then running, easier. To do that, we needed bigger buttocks. Sadly, in the last hundred years or so, we have stopped using them properly, so those muscles get weaker, tighter and lazier - according to statistics the average adult spends 50 to 70 percent of their day sitting. Now, when we go for a run, the muscles may struggle to do their job properly and over time become sore. As muscles get sore, they tend to get weak, creating a downward spiral.

Cures
What can you do? Well, get off your backside for one! As I said, it’s not a cushion. If you work at a desk, every hour, get up and move for a few minutes. Go for a walk, or get a glass of water. Better still, get a standing desk if you can.
If you already have pain, it’s best to have it assessed by a Chartered Physiotherapist to see just what the cause is. Depending on the severity and duration of your symptoms, a few treatment sessions, an exercise programme and some tips on how best to adjust your training should see you right, although in severe cases further assessment may be required.
Literally or figuratively though, a pain in the backside is a pain in the backside. If you have one, or there’s one nearby, get up and move to get away from it!

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.