Gluteus Medius Minimus Syndrome

About

Body parts don't give up when they're overworked or tired, so much as they just keep working until they give out. The gluteus medius and minimus muscles in the buttocks are no exception. When overworked, these muscles react by becoming tight, going into a constant state of contraction in order to perform their job, similar to a student staying awake all night to cram for an exam.

Eventually, however, the work catches up. They become exhausted and can't perform as well, or become limited in what they can do. When this happens, people can develop gluteus medius muscle syndrome or gluteus minimus muscle syndrome. Because the two muscles are so anatomically and functionally related, healthcare practitioners often refer to either syndrome as gluteus medius/minimus muscle syndrome.

People with this syndrome often describe their pain as a deep, dull ache in the buttock that often radiates to other areas of the body. Rest or activity doesn't determine the level of this pain, however. Instead, people with the syndrome often feel the most pain when they're startled or make sudden movements.

A number of things can cause or contribute to tight gluteus medius or gluteus minimus muscles. Muscle imbalances, poor posture and poor spinal or foot mechanics can be a factor, as can anything that overworks the muscles. When overworked, the muscles develop minor strains, which causes an inflammatory response. This inflammation is what causes the pain.

Because excess work can cause the syndrome, it's very common among runners, who use these muscles extensively. But runners aren't the only people susceptible, as generally anyone who is active and overuses their gluteus muscles can be affected. For this reason, it's important for people with gluteus medius/minimus syndrome to avoid activities that put pressure on the gluteus muscles until their healthcare practitioner says it's okay.

But inactivity isn't the answer either. To care for gluteus medius/minimus syndrome, your healthcare practitioner may recommend a treatment plan to help relieve tight muscles. Regular rehabilitative exercises are important.

Anatomy

The structure of the gluteus minimus, medius and maximus muscles looks very similar to the layering of an onion. The maximus, which is located close to the surface of the buttocks and is large, thick and wide in size, covers the medius. The medius covers the minimus, which is the smallest muscle of the three.

The gluteus medius and minimus muscles both begin at the ilium, the ear shaped ridge of bone that's at the side of the pelvis, and stretch across to the greater trochanter, which is the bony bump on the outside of your hip. The muscles help stabilize the pelvis and as a team are responsible for two main actions: pointing the toes inward and pushing one leg away from the body, as if you were performing a karate side kick.

If you frequently perform such movements or others that involve the gluteus muscles, you put a lot of stress on them to perform. Day-to-day overuse of these muscles, including overuse that comes from maintaining poor posture, can be as traumatic as one hard blow to the area, by causing the muscles to become overworked and tight.

This tightness can cause trigger points or knots, which are tight areas within a muscle that are reacting to stress and are usually hard and sensitive to the touch. These trigger points can then refer pain to other parts of the body. If they're in the middle of the gluteus medius muscle, they can refer pain over the sacrum (lower part of the spine), along the outside of the iliac crest (top of the ear-shaped ridge of bone that's at the side of the pelvis) and possibly down to the mid buttock and upper rear part of the thigh (right under the buttock). If they're in the middle of the gluteus minimus, on the other hand, they can move pain down into the lower part of the buttock, to the outside and back of the thigh, and possibly to the calf while bypassing the knee.

If you don't receive care for gluteus medius/minimus syndrome, such pain can become chronic, and because some people react to pain by becoming inactive, the condition can lead to muscle atrophy (shrinkage). Your chiropractor can help you avoid these problems, by offering conservative care that will restore the health of your gluteus muscles and the health of associated joints.

Chiropractic Care

The gluteus medius muscles and gluteus minimus muscles are so closely related that chiropractors care for gluteus medius syndrome and gluteus minimus syndrome with similar techniques. As mentioned in the About section, that's why they simply refer to these syndromes as gluteus medius/minimus syndrome.

When you first seek care for this syndrome, your chiropractor will probably perform spinal manipulative therapy, also known as an adjustment, on your lumbar spine (in the low back) and sacroiliac joint (a joint in your buttock that attaches your ilium to your sacrum). Because the gluteus muscles are close to the sacroiliac joint, they tend to limit its motion when they become tight. This, in turn, can affect other joints in the lumbar spine. When performing an adjustment, your chiropractor will use a quick, strategic thrust with his or her hands or a tool called an activator that will return motion to joints, relax tight muscles in the lumbar spine, increase blood flow and decrease inflammation.

Trigger point therapy is another common form of care for people with this syndrome. When performing this technique, your chiropractor will target trigger points, which are groups of muscle fibers that are in a state of contracture. In this state, the muscle fibers feel like taut bands or nodules, usually across the middle of a muscle, and can refer pain to other areas of the body. With gluteus medius/minimus syndrome, trigger points usually develop in the gluteus medius and gluteus minimus muscles, but can also develop in other surrounding muscles.

To perform trigger point therapy, your chiropractor will apply pressure to a trigger point for about 10 seconds. When he or she releases the pressure, an influx of fresh blood will enter the trigger point and wash away waste products that contribute to muscle tightening. This can help decrease pain, relieve tension, remove trigger points and increase blood flow to tight muscles.

Your chiropractor may also manage this syndrome with physiotherapeutic tools such as ultrasound and interferential current. Ultrasound refers to any sound wave that has a frequency above the range the human ear can perceive. To produce these waves, chiropractors use a machine that channels electricity through a crystal located at the end of an applicator. The crystal vibrates in response to electricity, and the machine allows users to alter the electrical current to affect the waves' frequency. Depending on the frequency, this can increase blood flow, decrease pain, reduce muscle spasm, lessen nerve root irritation, break down scar tissue and speed healing in the gluteus muscles.

Interferential current (IFC) works in a similar fashion, but instead of sound waves it involves a mild electrical current. IFC machines work by sending this painless current through the skin into nerve fibers below, which causes the body to produce endorphins, its natural painkillers. By aiming the current at the buttocks, your chiropractor can cause endorphins to interrupt the flow of pain signals from the affected tissues to the brain. Like ultrasound, IFC also helps decrease inflammation, which helps facilitate healing.

During your rehabilitation program, your chiropractor may also want to address your posture if you have poor postural habits that are affecting the gluteus muscles. Poor sleeping and sitting positions can damage the lumbar spine. The lumbar spine is attached to the pelvis, which is closely associated with gluteus muscles. For this reason, postural problems that affect the lumbar spine can cause dysfunction and postural stress in the low back that can indirectly affect the gluteus muscles.

To improve your posture, make sure you sleep in a good position, such as on your side with a pillow between your legs or on your back with a pillow under your knees. You should also make sure you practice good sitting posture, ensuring that your feet are flat on the floor, that your low back is flat against the back of a chair and that you don't slouch. These positions will hold your spine in its natural curve, ensuring muscles in the low back don't have to bear excess weight.

Practicing good posture is one of the best ways to prevent gluteus medius/minimus syndrome from worsening, but to rehabilitate weak muscles and build strong, flexible muscles you'll need to exercise. An exercise program involving both strengthening and stretching activities can help restore muscle health and prevent future injuries. Strengthening and stretching exercises that focus on your hip rotators and flexors, as well as both the gluteus medius and gluteus minimus muscles, will reinforce muscle balance in the hip region, stabilize surrounding joints, prevent weakening of supporting structures and help remove strain and tension from the affected muscles.

If none of these management techniques offer sufficient relief, your chiropractor may need to examine your feet to determine if abnormal walking patterns are causing dysfunction that's leading to problems in your gluteus muscles. Every time you take a step, your gluteus muscles contract, so if you're not walking properly these muscles will have to work harder. If your feet are contributing to your problem, your chiropractor may prescribe orthotics, which are shoe inserts that offset structural abnormalities to normalize foot motions.

Finally, don't rush back into activities that can exacerbate your condition. Until your gluteus muscles are functioning properly, your chiropractor may recommend that you refrain from activities that involve running and switch to activities such as swimming or biking until your symptoms subside. By giving your muscles time to respond to chiropractic care and reintroducing strenuous activity slowly, you can overcome this syndrome and help prevent recurrences.