Is Your Rear in Gear?
Is Your Rear in Gear?
by Tona Wilson
Gluteal Amnesia”, “Dormant Glute Syndrome”, “Dead Butt Syndrome”, or “Numb Bum Syndrome”. Have you heard of any of these musculoskeletal ailments du jour? If you spend a prolonged part of your day sitting or if you are mostly sedentary to begin with, chances are you have symptoms of these issues and you’re blaming your pain on all kinds of other problems without realizing a simple root cause could be glute muscles that forgot how to fire.
The hips are the most important joint in our activities of daily life (ADLs). They are the hinge where the upper and lower body meet. They are the most important joint in gait, sport, and stability. The hip joint contains 21 muscles that abduct, adduct, extend, flex, and rotate the hip. They house the strongest muscle in the body: the gluteus maximus. Or at least it’s supposed to be the strongest muscle. As with any function our body is made to perform, “if we don’t use it, we lose it”.
Gluteal amnesia is really just a term coined by biomechanist Stuart McGill for a collection of symptoms and muscle testing results. It hasn’t been scientifically classified as a specific diagnosis, but it does help in identifying and treating some of the root issues associated with chronic back pain, sciatica, chronic knee pain, and gait discrepancies. The difficulty with this “syndrome” is we can’t really say which came first, the dormant glutes or the cascade of pain points associated with dormant glutes.
One theory, based on how sedentary the US population tends to be, posits that prolonged sitting causes the glutes to deactivate because the hip flexors remain shortened for extended periods of time. This theory is based in the physiological phenomenon of “reciprocal inhibition”, in which one side of a joint must relax and lengthen when the other side contracts and shortens. Take for example the biceps and triceps of the arm that act as antagonistic muscles. Whether the biceps flex to perform an arm curl or while sitting with the elbow bent and head resting in your hand at your desk, the triceps must relax and lengthen or else they will pull the elbow or shoulder apart. The same thing must happen with our gluteus maximus and hip flexors, whether we lift our knee or just sit comfortably in a chair. The longer the glute max spends relaxed and lengthened, the less it activates and therefore the less it “remembers how” to activate. Hence the term, “gluteal amnesia”. It becomes inhibited and eventually loses strength and function as a result. Once this happens, it no longer remembers how to be the prime mover in ADL’s, gait, sport, or stability, so other muscles must do the gluteus maximus’ job. In lieu of the glutes, the low back and quadriceps instead then initiate squatting and lunging motions, the piriformis initiate gait, and the hamstrings initiate extension. This compensatory “synergistic dominance” can eventually cause low back pain and injuries, sciatica, iliotibial band syndrome, knee pain, quadriceps strains, and hamstring injuries.
Another explanation for gluteal inhibition is the other way around. An injury or maladaptive movement pattern somewhere in the gait sequence, a limp, lumbar disc pain, hamstring inflexibility, or a tight iliotibial track (among so many other possibilities) can cause the muscles to fire out of sequence to create a different movement pattern that somehow omits the gluteus maximus in the movement firing order. Inadvertently, the glutes becomes weak and inhibited, thus compounding the pain and problem.
When I worked in physical therapy clinics and in my work as a corrective exercise specialist, so many of my patients were being seen for injuries and pain that could be directly related to gluteal inhibition for one reason or another. Strengthening and re-educating the glute complex was the first order of business after any back, knee, hip, or foot surgery. If you’ve ever been in PT for anything below the arms, you’ve probably had to do glute bridges and clamshells every single session. Hopefully after reading this article, you have a better understanding of why we put you through this torture.
How do you know?
How to you know if your glutes are working or not? A simple test we do in corrective exercise and physical therapy is the one-leg bridge test. Try this: Lie on your back with your knees bent and feet flat on the floor. Then push your hips all the way up until only your shoulders are touching the floor. Finally, extend one leg out and hold for 10 seconds. Where do you feel the work? Where do you feel the pain? If you feel burning, tension, or pain in the quadriceps, hamstrings, knees, or back, you are compensating for the glutes that didn’t do the work. Hence, your glutes are inhibited, dormant, and/or have forgotten how to be the prime movers in this glute-centric movement. If you have chronic pain in your back, knees, hips, or hamstrings and you felt the bulk of the work anywhere other than the glutes during this test, your pain could be caused by glutes that are not firing correctly.
The glutes are the strongest muscle group in your body. If they aren’t, the body must compensate by using muscles that cannot correctly reproduce the same movement. As we perpetuate the problems caused by this maladaptive movement and create more pain, we continue to create maladaptive movement patterns. It becomes a viscous downward spiral that can easily be corrected with the help of a trained and certified corrective exercise specialist or physical therapist. By simply strengthening the glute complex and correcting incorrect movement patterns, it’s possible that a lifetime of chronic pain can be remedied. Look into movement as medicine before you contemplate injections, surgery, or giving up your favorite activities.
You’re always worth your effort.
Tona DeAúne Wilson, MA Ed, PhD
Health Psychologist, Nutrition and Health Coach
www.coachdoctorfitness.com
coachdoctorfitness@gmail.com