What are the symptoms of pain referred from the back?



An aching in the buttocks that is difficult to pinpoint.

The slump test may reproduce buttock pain which is eased when the neck is relaxed back (extended).

Areas of the lumbar spine may be tender and have poor mobility.

Tight gluteal muscles and other muscles of the buttocks.

What can I do?

See a Physical Therapist who can identify the problems in the lower spine.

Begin an exercise programme that will stretch and strengthen the muscles supporting the lumbar spine.

Stretch the gluteal muscles and hip rotator muscles.

What can a Physical Therapist professional do?

Manipulate and mobilize the segments of the lumbar spine. This is a good way of assessing whether the lumbar spine is a cause of buttock pain. If it is then symptoms will be relieved.

Deep tissue sports massage techniques can be applied to the lower back and buttocks to release muscle tension, particularly in chronic conditions.

Acupuncture or dry needling can also help reduce chronic tension in muscles.

What other injuries are related or similar?

Piriformis syndrome

Sciatica

Sacroiliac joint pain.

What is the Sacroiliac joint ?

The Sacroiliac Joints are located at the bottom of the back. You have one either side of the spine. The Sacroiliac joints help make up the rear part of the pelvic girdle and sit between the sacrum and the ilia.

There are torsional or twisting forces applied to the pelvic girdle when the lower limbs are moved. These limbs act like long levers and without the sacroiliac joints and the pubic symphysis (at the front of the pelvis) which allow movement, the pelvis would very likely be subject to a fracture.

These joints can often get stuck or in some cases one half of the pelvis can glide forwards or backwards, which is often referred to as a twisted pelvis. When this occurs it often irritates the Iliolumbar ligament which results in Inflammation. This is usually indicated by tenderness around the bony lumps which you can feel if you place your thumbs either side of your lower back.

Inflammation of the sacroiliac joints and associated ligaments are very common, especially following pregnancy where the hormone relaxing is released and this results in the relaxation of ligaments in preparation for childbirth. In most cases the causes of sacroiliitis are mechanical, however there may be other medical inflammatory conditions present such as Ankylosing Spondylitis as well as others which will need attention.

Symptoms include:

Pain located either to the left or right of your lower back. The pain can range from an ache to a sharp pain which can restrict movement.

The pain may radiate out into your buttocks and low back and will often radiate to the front into the groin. Occasionally it is responsible for pain in the testicles among males.

Occasionally there may be referred pain into the lower limb which can be mistaken for sciatica.

Classic symptoms are difficulty turning over in bed, struggling to put on shoes and socks and pain getting your legs in and out of the car.

Stiffness in the lower back when getting up after sitting for long periods and when getting up from bed in the morning.

Aching to one side of your lower back when driving long distances.

Specific assessment tests:

The Stork test - to assess weather the sacroiliac joint is moving correctly.

Leg length difference measurements - both straight leg and bent leg assessments.

Ilia rotation - this assesses weather the ilia is rotated on one side creating imbalance.

What can a Physical Therapist or GP do?

Use diagnostic tests to discover the cause of the problem.

Eliminate medical diseases such as Ankylosing Spondylitis..

Treat the cause as well as the symptoms.

Prescribe anti-inflammatory medication (e.g. ibuprofen) and rest.

Use electrotherapy equipment to treat affected tissues.

If indicated and safe to do, level the pelvis via manipulation.

Articulate sacroiliac joint and restore normal function.

Sports massage will help relieve any soft tissue tension in the area.

Use injection therapy.

Advise Ice and cold therapy to reduce inflammation.

What are the similar or related injuries and conditions?

Ankylosing Spondylitis

Myofascial pain

Low back pain

Terry O'Brien

BackTrouble.co.uk