hip Archives - CJ Physical Therapy & Pilates

Nobody likes a “pain in the butt.” But what do you do when you’re dealing with literal pain in your butt versus the figurative kind?

It starts with figuring out where it’s coming from. Understanding the origin of your pain is necessary if you really want to solve it! One of our Pilates regulars (“Stacy”) has a story that illustrates this concept perfectly.

Stacy had been doing all the right things. She keeps active, does Pilates with us, and walks regularly. But still, she ended up with that dreaded pain in her butt that so many of us deal with on a regular basis. She tried to work through it herself by foam rolling and stretching – but none of that worked to completely eliminate her pain. Plus, her symptoms were starting to limit her Pilates and walking. This made her nervous because staying active and mobile is one of the most important things to Stacy, and the idea of being stuck at home and in pain this winter season made her want to take action now. She did the right thing by going to see our PT team.

Their first course of action was to accurately determine the root cause of Stacy’s butt pain. It could be a few different things.

Most often, symptoms like Stacy’s will get “labeled” generically as any one of the following:

1. Bursitis

They’ll call it this if you’re feeling the pain more in the side of your hip versus center of your butt.

2. Piriformis syndrome

This refers to a pain in the center of your butt. You might feel some tightness as well.

3. Back problem/Sciatica

They’ll call it this if your pain is more diffuse and achy, and perhaps even running into your thigh. This last diagnosis will be more common if you’ve got back pain along with the hip or butt pain.

As I mentioned, any one of these things could be the source of Stacy’s symptoms, and getting it right is critical. The correct diagnosis is the determining factor of whether Stacy’s problem gets resolved for good, or becomes something she deals with for the rest of her life. The problem with diagnosing your butt pain (or any problem for that matter) based on the location of your symptoms alone is that it’s not a reliable diagnosis.

The location of your pain alone does not tell you where your problem is really coming from.

For example, I’ve seen people with pain in their hip and butt that is actually coming from their back – even when they’ve never had a back problem. If your butt pain is coming from your back, and you think it’s “piriformis syndrome,” you’re going to be really disappointed in a few weeks when your pain is still there (or perhaps even worse) because you’ve been going about treating it the wrong way. In order to accurately determine what was really going on with Stacy’s butt pain, we needed to do some specialized movement screens and tests.

Research has shown that your pain’s response to movement, and how it behaves, is a much more reliable way to figure out the source of your problem versus relying on the symptom location alone.

In Stacy’s case, some quick movement tests revealed that her butt pain was indeed coming from her back – even though she did not have any back pain. How did we know? Pretty simple actually. When we asked Stacy to move and bend her back in specific directions, it triggered her butt pain! Her piriformis muscle was also tight – and may still need to be stretched – but it’s very possible that the tightness she is experiencing is also being caused by whatever is going on in her back. It’s possible for nerves to refer both pain and a feeling of “tightness.” We’ll know for sure in a few weeks, because we prescribed Stacy a corrective exercise designed to target the problem in her back and take pressure off the nerve that was triggering her butt pain. In fact, if she had not come to see us and kept stretching what she thought was a tight piriformis, she likely would have aggravated her nerve and made her condition worse. Nerves don’t like to be stretched. This is a great example of why it’s critical to know the true source of your problem before you start treating it.

Hopefully Stacy’s story helped you understand that the first step in getting rid of a pain in your butt, is to accurately determine where it’s coming from! If you’re experiencing unexplained pain in your butt that isn’t going away with stretching or general exercise, perhaps you’re going after the wrong problem. Try paying closer attention to how your symptoms behave. Do you notice they get worse after you’ve been sitting for a while, raking leaves, or driving? Do they move around on you – and go from your butt, to your hip, to the back of your thigh?

Signs like this could mean you’re dealing with a back problem, not a butt problem. Click here for access to our FREE back pain guide! This guide contains our best tips and advice on how to start easing back pain and stiffness right away — and get on the road to pain-free movement just like Stacy did.

Knee pain is one of the most common complaints that brings people into our office.

Since most of our clients are in their 40’s, 50’s and 60’s, they start to really worry that knee pain could bring an end to their active lifestyle. But that doesn’t have to be the case! The good news is that unless you’ve had some serious trauma (like a major accident or fall), 80% of all knee problems can be resolved without any kind of procedure or surgery – and most importantly – you can learn how to continue managing them on your own so that they never get in the way of your favorite activities again.

Sound too good to be true?

It’s not – I promise – but the first step is figuring out where your knee pain is coming from. Once you know that, you can get on the right path to resolve it.

Here are three of the most common causes I see that make people suffer from knee pain and what you can do about them:

1. Iliotibial band syndrome

This is a very common problem that typically affects runners, avid walkers, and hikers. It is often misdiagnosed and confused with patellofemoral syndrome (see below). Your iliotibial band (IT band) is a very large thick band on the side of your knee that will often get overworked due to a muscular imbalance elsewhere in your body (usually your hips and core). When this happens, you’ll feel pain that is on the side of your knee that is usually very sore and tender to touch, and typically sharp and stabbing versus achy. It will impact you most when you’re going downhill or down the stairs.

It’s important to note that even though a tight, and painful IT band is the structure causing you to have pain – it is typically a symptom of an underlying problem. Like I said before, IT band problems are usually the result of your core and hips not stabilizing your pelvis properly – which ultimately results in your knee not receiving the support it needs when you’re running, walking, or hiking.

Getting rid of the actual pain is the easy part… in our office we use things like dry needling, soft tissue work, and sometimes even some taping. But if you want to keep the pain gone – you MUST address the underlying causes as well. This is what a lot of people miss. We love using Pilates-based exercises in our office because they not only target your core, but also get your muscles working in a coordinated, symmetrical fashion, helping to keep things balanced as you get back to your favorite activities.

2. Patellofemoral Knee syndrome

This problem is very similar to IT band syndrome, with just a few key differences. This first is that it can impact almost anyone – not just runners, hikers, and walkers. You’ll also experience the pain in the front of your knee – typically under your kneecap – and it will tend to be more achy than sharp. This problem will often come on very slowly and can be more chronic than its IT band cousin. You’ll feel this more when you’re going up stairs, up hills, and with squatting. You’ll also notice stiffness and pain in the front of your knee after sitting awhile – that usually will go away once you start moving.

Much like IT band syndrome – these are all symptoms of an underlying cause. A weak core and hips can cause this problem too, but I usually see more weaknesses in glutes and hamstrings with this one. When the backs of your hips and legs aren’t kicking in like they should, it can result in tight hip flexors or quads. This is a super common culprit for patellofemoral syndrome. So once again, you can get rid of the pain quite easily in most cases, but you must make sure to determine – and address – the root cause so that you can keep this pain gone for good.

3. Osteoarthritis

Many people hear that they have osteoarthritis in their knee and think there isn’t anything they can do about it. Not true!! Arthritis is often blamed for knee problems but it isn’t always the cause of what you’re feeling… Let me explain….

When arthritis is the true cause and culprit for your knee problem, it will be painful and stiff all the time. You’ll lack significant mobility and it will be almost impossible to walk and bear weight without support or a cane. When this is truly your problem – you are a great candidate for total knee replacement surgery. Now here’s the catch… sometimes your X-ray or MRI will show that you have terrible arthritis or that you have “bone-on-bone”… but that doesn’t mean you need to rush to surgery! Your symptoms should really decide that.

If your pain comes and goes (meaning you have good days and bad days), if you can walk around most days and go up and down the stairs and your knee just “catches”, or maybe you feel stiff a lot but this eases up with movement – you might have arthritis in your knee but it is not the root cause of your knee problem. Because here’s a hint – arthritis does NOT come and go – but other common musculoskeletal problems can. When your pain comes and goes, you know it can’t be entirely from arthritis.

So what should you do?

With arthritis, whether it’s partially to blame, or whether it’s just something that shows up on the X-ray and gets blamed… we still need to look at the surrounding structures and root cause of the problem.

If your quads are really tight, and the muscles around your knee are imbalanced, this can create compressive forces in your knee joint which will exacerbate what might normally just be “mild” arthritis (compression will aggravate arthritis). You could also have weakness or problems in your ankles, feet, or core that are causing your knee to work harder than it needs to. This can cause pain all on its own, OR aggravate your arthritis. The point is, get checked by a musculoskeletal expert – people trained like us – so that instead of just fishing for the problem or only treating symptoms, you are getting to the root cause of your problem and setting yourself up for success!

If any of this sounds familiar to you, you may benefit from working with a specialist physical therapist who can help you get back to the activities you love – without pain pills or unnecessary procedures. You can click right here to request a FREE Discovery session with one of our specialists. We’d love to help you figure out the root cause of your knee problem so that you can get back to doing everything you love – instead of spending time in the doctor’s office 🙂

Tag Archive for: hip

Got a Pain in Your Butt? Here’s what to do first.