DEAD BUTT SYNDROME / GLUTE INHIBITION & HIP INSTABILITY: A SPORTS PHYSIOTHERAPEUTIC OVERVIEW
DEAD BUTT SYNDROME / GLUTE INHIBITION& HIP INSTABILITY: A SPORTS PHYSIOTHERAPEUTIC OVERVIEW In the following article wewill analyse and discuss the importance of the role of the gluteal muscles/hipinstability in human movement and how sports physiotherapy can help prevent, treat,and rehabilitate this type of dysfunction. Inhibited muscle groups are due towrong motor neural firing patterns or a sedentary life lacking mobility. Sittingall day at the office / or at working from home is also a health risk. It isnot the first time that we have been warned, so why do we keep doing it? WHAT CAN CAUSE HIP INSTABILITY? Hipinstability is a loose or unstable hip joint that is commonly exacerbated byproblems regarding the ligaments around the hip.Inhip dislocation, the head of the femur tends to come out of its socket. This unpleasantcondition requires medical treatment and a physiotherapeutic approach. You canbook a direct appointment with our sports physiotherapist / or chiropractor inManchester by visiting www.mysportsinjury.co.uk/booking Anaccident or sports-related injuries can bring about instability or dislocationof the hip. (Kwesi Dawson-Amoah et la 2018).However,there is a possibility where people are born with structural issues in the hipjoint, this is called hip dysplasia, which can induce the hip joint to bedislocated. If your situation is this one, doctors or sports physiotherapistsmay identify dysplasia at birth, or you may not observe it until you are older.Whateverthe source of your hip problems, we can help at our MY Sports Injury &physiotherapy Clinic in Manchester. Our orthopedic joint, physio’s inManchester and sports medicine specialists will thoroughly investigate your hipand put forward appropriate non-invasive solutions such as physical therapy orsports rehabilitation for hip instability & strengthening to improveposture and body mechanics for better alignment.WHAT ARE THE FIRST SIGNS OF HIP PROBLEMS? Itis important that we know when we suffer from hip dysfunction. My Sports InjuryClinic based in the heart of Manchester City will effectively provide athorough physical examination and assessment of the hip to solve the pathologyor symptoms and avoid the discomfort to efficiently function in pain free movement.The first symptom that we aregoing to feel with hip degeneration is the most obvious and precedes anyarthritic problem, and that is pain. But we will not feel pain in the hipitself, but rather it is focused on the inguinal area. In fact, it can extendto the front of the thigh, reaching the knee and the buttock.In this way, we cannot clarifyexactly that we have a hip wear problem, but if your pain radiates to all theseareas, it is very possible that it is, indeed, coxofemoral osteoarthritis. Ifit is only your hip that hurts, it is probably due to a muscle problem ratherthan wear and tear. Remember that the focus of pain appears in the groin. Another characteristic symptomis feeling crackling in the hip area. We can feel them with movement whenwalking and even when sitting down and crossing our legs. They are annoying and painfulcrunches that only stop when we stop moving. Apart from the crunches, a burningsensation in the groin will be indicating that something is happening in ourhip, most likely osteoarthritis.Weakness is another symptomderived from hip wear, and as it progresses, it makes it impossible for us tomove as before, so everything costs us more effort. The walks end with pain and itis very difficult for us to walk or climb stairs, carry weight or play sports.We will notice the loaded area as if it were very weak, even at night, just byturning or moving in bed, we will feel these creaks accompanied by pain. Onlywhen movement ceases, discomfort disappears. This symptom grows as wear isgreater, which is over time if we do not remedy it.Various investigations havelinked inactivity with heart disease, obesity, diabetes and even cancer (Arocha Rodulfo JI,2019). In fact, statistics from an article published by American Journal of PreventiveMedicine (AJPM) which show some implausible outcomes where around92,000 ladies with an age rate from 50 up to 79 years old were followed over a12 year-period, in this sense, by the inaction of being sitting for long timeperiods is utterly tied in with early decease (Rebecca Seguin et la, 2014). But now science has discoveredanother problem. It is known as 'gluteal amnesia', dead butt syndrome or gluteinhibition and it is an atrophy of the gluteal muscles brought on either byleading a too sedentary life or by performing improper movements whilst doingphysical activities , (says Cameron Whit, 2019) in an article published in Healthline. Hence, the term “Dead ButtSyndrome” essentially refers to the fact that our gluteal muscles tend to omittheir foremost aim that is to keep suitable alignment and provide support toour skeleton so it generates imbalance, muscle tightness, and weakness all overthe buttocks and the hip as well, according to an article issued by Parade. Gluteal amnesia introduces itself as a mechanicalalteration that yields deficiencies in lumbopelvic stabilisation. Thisfully affects the entire movement system that takes place in our body (MarcoAurélio N. Added et la,2018).Next, wepresent a brief analysis where we explain this condition, ways to detect it andcombat it. This seeks to guide the physio Manchester, coach and/or trainee, sothat they can "awaken" this powerful and necessary muscle group;which is responsible for stabilising the lower kinematic chains and is ofutmost importance in the correct quality of movement, but first let’s dive intosome anatomical insight of the gluteal muscles. WHAT ARE THE GLUTEAL MUSCLES? The glutes are 3 muscles thatare located at the back of the pelvis, in the gluteal region. These accordingto the shape and location are known as gluteus medius, maximus and minor, andare important for various movements of the lower extremities and the hip (AdelElzanie et la,2021). WHAT IS THE FUNCTION OF THE BUTTOCK/ GLUTEAL MUSCLES? Although all of them areimportant for various movements to be executed, each one of them has a specifictask depending on the place of origin and insertion. So, the functions of eachgluteal muscle are given as follows. Gluteus minimus; it ismainly involved in abduction, but it also has certain functions related torotations (Anthony J.Greco et la, 2021).Gluteus medius; it is thesame abductor, but it also works on internal and external rotation andextension (Sean Sadler et la, 2019).Gluteus maximus; its mainfunctions are related to extension and external rotation, although it alsocollaborates in adduction and abduction (Judith Borger et la, 2021).In conclusion, they aretissues that are involved in most joint movements in the pelvic and buttock area. With that being explained wecarry on learning more about this Gluteal Amnesia condition. WHAT ARE THE SYMPTOMS OF GLUTEAL AMNESIA? A dead butt, as we will see,increases the chances of presenting lumbar pain, pubalgia, knee valgus, referredpain, stiffness, and false support, amongst other issues. Ultimately, this willcause a greater risk of injury as a result of muscular deficiencies and over-compensation(Ortiz, Jonathan Nahuel, 2018). This phenomenon has also been associated withthe development of low back pain, either as a cause or as a consequence,however, Dr. Baily says, lower back aches might be experienced as a result of lossstrength in your core, hips, and buttocks, sometimes a pretty similar sciatic-likepain can be inflicted all the way down your leg by gluteal inhibition. So, working this muchrequested muscle group then becomes something extremely essential and farbeyond fad aesthetics. Where everyone wants to tone it, but few investigate thecorrect way to activate it in response to this need.SEDENTARY LIFESTYLE AND ITS ROLE IN GLUTEAL AMNESIA It is important to firstclarify the importance of the gluteus maximus muscle which is altered in ourdaily activities; either by sedentary lifestyle or lack of movements thatactivate it.This is mainly due to spendinghours and hours sitting at work or in the car in the wrong positions; whichends up causing muscle groups such as the iliopsoas and hamstrings to shortenand our hips to be retroverted due to gluteal inhibition.But thisdoes not happen only in sedentary people. It also occurs in athletes who do notperform corrective and preventive work to strengthen their buttocks, as can bethe case of soccer players, rugby players, amongst others. Where the excessive use ofclosing chain muscles and flexor action cause their antagonists to beinhibited, let us remember that the glutes participate or should participate inall motor actions, from being upright to running.If we prolong these bad habitsover time, we obtain what is currently called "gluteal amnesia"syndrome. Or what would basically be an inhibition of the gluteus in its actionof stabilisation and extension of the hip (Gowitzke, B. A et la, 1999). MUSCULAR COMPENSATIONS CAUSED BY GLUTEAL AMNESIA Forgettingthe gluteus maximus muscle ends up triggering the shortening of other musclegroups. Such is the case with the hamstrings which begins to take on the fulland main function of extending the hip. By its counterpart, the iliopsoas ishypertonic in its excessive hip flexion action.To beprecise, the gluteus maximus is one of the strongest and most important musclesin the body, relevance that increases as it is also responsible for lumbopelvic/sacroiliacjoint stability.Formingpart of the well-known and so important CORE, central stabilisation zone andfrom where the centrifugal force that will be translated to our extremitiesarises (Akuthota, V et la,2008).HOW IS GLUTEAL AMNESIA DIAGNOSED? Todetect it, physical therapy specialist in Manchester resort to a simplephysical clinical examination, the Trendelenburg test. It consists of liftingone leg while standing in front of the specialist.Ifthe pelvis sinks on the side of the body where the leg was raised, thatindicates weakness in the gluteus medius on the opposite side. STRATEGIES FOR ADDRESSING GLUTEAL AMNESIA & HOW PHYSICAL THERAPY CANBENEFIT YOU? Rehabilitationexercises for gluteal injuries are essential to achieve the empowerment andstrengthening of these muscles, which are vital for walking, balance and thelower back.Whenan injury of any kind has occurred in the gluteus area, physiotherapy work isvery important to be able to achieve a good recovery in the area that allows usto continue with our level of autonomy and independence.Inprinciple, rest is usually beneficial in most cases, since forcing and loadingthe area more will only contribute to aggravating the problem. As for theexercises that can be performed, it must be taken into account that they willdepend on the area of the affected gluteus.SPECIFIC EXERCISES TO ACTIVATE AND TREAT GLUTEAL AMNESIATheonly way to prevent the "death" of your butt, according to the WorldHealth Organization (WHO), is to exercise. This muscle group is involved inexercises such as squats or the Romanian deadlift.Theglute bridge is an exercise that can be practiced in isometry or withrepetitions. Lying on the ground, with the knees bent and the heels close tothe buttocks, the execution consists of raising the hips without taking theshoulders off the ground.Abductionbridge is a variant of the previous exercise that helps to activate theabductor. With an elastic band placed on the legs and in the same initialposition, it is about opening the legs when the hip has already been raised andthe gluteus is contracted. Simplehip abduction, lying on your side, with your legs bent at 90 degrees and a resistanceband a little above your knees, it is about opening the leg that is on top andleaving the other on the ground. ReferencesArochaRodulfo JI. Sedentary lifestyle a disease from xxi century. Clin InvestigArterioscler. 2019 Sep-Oct;31(5):233-240. English, Spanish. doi:10.1016/j.arteri.2019.04.004. Epub 2019 Jun 17. 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Treasure Island (FL): StatPearlsPublishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538193/Akuthota V,Ferreiro A, Moore T, Fredericson M. Core stability exercise principles. CurrSports Med Rep. 2008 Feb;7(1):39-44. doi: 10.1097/01.CSMR.0000308663.13278.69.PMID: 18296944.