How did I get back pain?
The 2nd half of my Christmas break involved lots of driving, visiting friends and family and not much exercise! Once I got back to the normal routine of the working week & exercise, I started to notice just a small ache in my R lower back/iliac crest (top of pelvis) and gluteal area. There was no cause at all, but it must have been a combination of factors, which is the case for most back pain complaints.
The Assessment
Self assessing myself, I have pain free back movements, which means that I could move forwards to touch my toes (back flexion), bend backwards (back extension), and move side to side (lateral flexion) without symptoms. Rotation was slightly more difficult. I have no more numbness than I have from a previous issue, and no radicular pain, also known as referred/travelling pain. I notice symptoms when putting shoes and socks on, relaxing/sitting back while driving, and any strong hamstring stretch or abdominal exercise involving my back bending forwards. Symptoms don’t increase beyond 4-5/10, no effect on my sleep, no relieving factors and I only notice symptoms during the aggravations.
What do I think it is?
For ages I knew my L leg, particularly quads, hamstrings and gluteals muscles were not as strong at the R. However, this isn’t the case any more as my R posterior glute (Gluteus Maximus) was very weak, and I noticed this more at Yoga. It’s been difficult to locate the pain, even when I’m on a foam roller or tennis ball, I can’t quite find the area. If I had to give a clinic impression, it would probably be biomechanical dysfunction of my lower back, and R gluteal tendinopathy at iliac origin.
From my own assessment, I know my back isn’t the source of pain, but it’s the insertion of my Gluteus Maximus & Medius, at the top of the back of my pelvis (gluteal surface of ilium). When I flex my back, I’m aggravating the pain because I’m stretching the muscle and tendon, at the insertion with pelvis fixed. I have no pain while lifting weight for example Back Squats, RDL, Single Leg Squat for example, or running. Just when sat down for ages, putting shoes/socks on & sit up type movements.
My Rehab
So far, so good with regards to the rehab. I’m 3 weeks in, I’ve done really well with my 5km time and symptoms are reducing! I’ve focussed on Side Lying Hip Abduction, Single Leg Bridges and Step Ups with a high step, all targeting Glute Max & Med. However, I’ve got a lot more work to do, my main focus will be improving my hip extension, which will focus on the gluteal muscles a lot.
I’m not spending time on stretching, as this is an aggravating factor, I’ll be stretching the area in the same positions as my aggravations. I will occasionally stretch the area, for example at Yoga, just to see my barriers and how the pain responds. Eventually, I’ll incorporate stretching in the form of exercise, not just yet!
As you can see from the video, I’m working very hard during the Side Lying Hip Abduction exercise, I could barely do 15, L 25 very easily. From the issue, I’ve got a bit more lack of range of movement when twisting to the L with my spine, you could say it’s a compensatory movement. Once I see an improvement with symptoms, I’ll start increasing resistance and add exercises in different planes of movement.
