MYOFASCIAL PAIN SYNDROME
OF THE LOW BACK AND HIPS
Last updated: 1/19/2000
Myofascial pain syndrome of the low back and hips is caused by pain producing "trigger points"(TrP) in the gluteus medius muscle. Some patients will refer this as "a pain in the butt". It is important to stress that myofascial pain syndrome can affect any muscle in the body, and in any area of the body. A common area affected can be in the upper back over the shoulder blade (scapula) area that is caused by trigger points in the trapezius muscle. The myofascial pain syndrome can even affect the side of the face, causing pain in the jaw, commonly affecting the tempero-mandibular joint TMJ).
For now we will focus on the low back and hip myofascial pain syndrome. To understand what causes the myofascial pain syndrome, we need to understand what causes it. The pain is caused by nodules (knots) causing areas of irritation in the muscle or fascia associated with the muscle. These trigger points (TrP) are areas of irritation within extremely tight bands of muscle and or fascia.
These irritations are caused by various traumas, such as engaging in sports, aerobic exercises, working out with weights and sudden falls. Another cause can be standing on one leg for extended periods of time without changing positions. This causes the muscles of the leg you are standing on to be become tired making them work harder so that they go into spasm. This spasm sets up areas of irritation that become trigger points. Another precipitant can be when the muscle becomes chilled. The chilling of a muscle can cause it to go into spasm, resulting in the same phenonemen that will result in trigger points.
One of the muscles that are very often affected in this manor is the gluteus medius. This muscle starts at the top of the ilium (hip bone) and is attached to the outside head of the thigh bone (femur). The function of this muscle is mainly to stabilize and keep the pelvis level while the individual is walking. This prevents the pelvis from dropping when raising the foot on the opposite side.
Pains are not always localized at the trigger point area. These trigger points can also cause radiating pain in surrounding tissues, or radiate into areas further from the trigger point site. Pains in the buttock, back of the thigh, the sacral area (the large triangular bone between the hips), and up into the side of the lumbar spine, are commonly affected sites.
Structural instability of the lower spine and pelvis is the foremost cause for the myofascial syndrome. When there is a tilt or rotation of the pelvis and/ or a shortness of one of the legs, will set up the weakness that that makes the individual more prone to injuries. Once being prone to this type of situation produces injuries while engaging in sports, aerobic exercise, weight lifting, running, golf, tennis, or even sitting in a slumped position. Even lying on the affected side for a length of time can be a causative factor. This causes the gluteus medius muscle to become shortened and loose it's flexibility. It is the muscles loss of flexibility that makes it more prone to injury, and set up one or more trigger points within that muscle.
The pains, once they occur can last for extended periods of time, or there can be remissions that can last from hours to days, or even longer. The patient sustaining a myofascial pain syndrome may be prone to future episodes even after the initial occurrence is resolved, especially if there is a spinal imbalance unless it is properly diagnosed and treated. A spinal imbalance can best be diagnosed and treated by a Chiropractor. The Chiropractor will not only correct the spinal instability, but will treat the primary pain symptoms so as to give the patient the needed relief from pain.
The patient must also take an active part in their treatment if they wish to lessen the pain and length of disability. Home health care by the patient will determine how soon they will be pain free and able to get back to their normal daily activities. At first they should curtail any and all strenuous sports, exercise, and the more difficult household chores, such cleaning windows, mopping floors, vacuuming, ironing, etc. Applying heat (preferably moist), 3 or 4 times daily for 20 minutes will soothe and relax the muscles. After the heat, rub in a good analgesic gel such as BIOFREEZE. Massage with a vibrator, such as the MEDISANA 2-Head or 4-Head Vibrator is very effective. Use only for 5 minutes at a time, 3 or 4 times daily.
As the symptoms subside, the degree of activities can be increased. If, when they are increased, pain reoccurs or increases, then that particular activity should be stopped. When the individual is pain free, they then can resume their normal daily activities. At this point an exercise should be started. Exercise is the single most important component in the strengthening of the abdominal and low back muscles. Strengthening these muscles will help stabilize the back and prevent future episodes of this debilitating syndrome.
The type of exercise program must be carefully selected. A wrong type of program can reactivate the pain. A no impact exercise program would be best. A program such as THE DOCTOR'S SENIOR EXERCISE PROGRAM is excellent for strengthening the abdominal and back muscles. While it is a no impact program, it still gives you a total body workout. The exercise permits the individual to set their own pace and set their goals higher as their muscles become stronger and their strength increases. With the increase of strength will come a more flexible physique that will enable the individual to live a vigorous and a more vital lifestyle!