Download What A Pain In The Bum (Oct 2014)

Witty, Pask & Buckingham
Chartered Physiotherapists
56 Billing Road, Northampton, NN1 5DB
Tel / Fax: 01604 601641 Email: [email protected]
www.WPBPhysio.co.uk • Twitter.com/WPBPhysio • Facebook.com/WPBPhysiotherapy
Witty, Pask & Buckingham, in conjunction with Northamptonshire Sport
Is your sport just a pain in the bum?
The spot between the top of the hamstring and the bottom of the buttock can make it so....
The spot at the top of the hamstring where the buttock
ends can be the site of much pain. Or is it tightness?
It is often difficult to tie down what it is and thus it
is difficult to know how to treat it. There are several
common options:
• Tear or strain of the hamstring
• Tendinopathy of the hamstring
• Gluteal strain – not common
•
•
Nerve irritation
Sacro iliac joint dysfunction
The self-managed way to assess for a strain of the
hamstring or glut is to stress the muscle and see if it
hurts. If there is pain on stretching the hamstring or
gluts especially sharp pain, there is likely to be some
tissue damage.
Testing and stretching
Glut stretch
Glut bridge
Hamstring stretch
Complete the glut and hamstring stretches and test your pain level. If
you then have further pain when contracting the hamstring or glut, as
shown in the glut bridge and hamstring contractions, especially sharp
pain, then it is likely that you have a tear in the tissue.
This needs to be rested and treated with easy stretching and massage,
and you should only begin to load the muscle once the above tests are
clear. This can take five to 10 days. There is usually a sudden onset, say
during sport, but not always.
Tendinopathy of the hamstring is more difficult to assess yourself.
There is rarely pain on the tests described above but there is a tender
spot just down from the bone that you sit on. The tendon feels thicker
and stringier than the other side. The history is of a gradual onset of
pain and is often associated with pelvic dysfunctions as described later.
The presentation is of more of a dull ache and stiffness in the hamstring
when running which warms up a bit but generally is just there!
All of the above are associated with Sciatic nerve irritation. The
Sciatic nerve passes through the gluts and into the leg at the top of
Hamstring contraction
Produced in conjunction with TimKeayDesign.com and SteveWalshMedia.co.uk
Witty, Pask & Buckingham
Chartered Physiotherapists
56 Billing Road, Northampton, NN1 5DB
Tel / Fax: 01604 601641 Email: [email protected]
www.WPBPhysio.co.uk • Twitter.com/WPBPhysio • Facebook.com/WPBPhysiotherapy
the hamstring. Issues in this area have the effect of
upsetting the nerve and causing protective tightness.
This can last longer than the actual strain or
inflammation because nerves are slow to settle down.
There are ways to specifically test nerves but all are
difficult on yourself. However using simple lower
back and nerve stretches as shown will help in the
mobilisation of the nerve. By putting yourself in the
position below with a straight leg and doing small
movements with the foot – pulling the foot up and
down - 20 repetitions for three sets, four times a day
will help to mobilise the nerve.
Muscle tear
To treat a fresh tear of the muscle requires four to six
days of rest and the previously painful tests need to be
pain-free.
Once this has
settled then
you can start
to mobilise the
sore areas with
a ball or roller
as shown. Try
to do a couple
of minutes
twice a day but not too hard as it is repairing tissue
and you just want to mobilise it not break it.
In an older, more chronic problem which is
comfortable to perform the tests on but sore to touch
and to run, then a more aggressive approach is
required. These need a lot of mobilisation of the stiff
and grotty tissue. These need around two minutes,
four times a day, every other day and hard!
Further, the hamstring needs to be strengthened with
a combination of work in the gym and at home. The
simple hamstring machines are a good place to start
as they provide basic concentric and eccentric loading
of the tissue and therefore strengthening. You need
to work it hard though and five sets of eight reps at
a weight that is fatigued at eight reps is the normal
protocol.
Other things to do are bridging with your foot on a
gym ball and slowly straighten and bend the knee –
single legged, three sets of 15 reps is fine.
Chronic issues
The final note
here is that many
of these chronic
issues have a
pelvic or Sacro iliac
joint dysfunction
at their core. It
is worth trying
to mobilise this
yourself by using
the Push exercise
on the right. Grip
your knee and
press as hard as
possible into your
hands. The object is to try to straighten the hip not
the knee. Repeat 10 lots of five-second presses hourly
through the day.
The deep glut muscles
also always become
very tight and using
a ball as shown to
work into the muscle is
helpful. 2 minutes a few
times a day.
However if the
tightness does not
settle then it is time
to seek help from a
Sport Physio with good
experience in running issues. This set of problems is
complex and experience is helpful!
Mark Buckingham is director of Witty, Pask &
Buckingham Chartered Physiotherapists, based on
Billing Road, Northampton. Call 01604 601641 for
an appointment or visit www.WPBphysio.co.uk
Produced in conjunction with TimKeayDesign.com and SteveWalshMedia.co.uk