Buttock Pain in Athletes
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Questions and Answers

What is a potential clinical benefit of training the transversus abdominis muscle?

  • Increased flexibility in the hip joint
  • Improved strength of the psoas muscle
  • Reduced laxity in the sacroiliac joint (SIJ) (correct)
  • Decreased range of motion in the lumbar spine

What treatment may be administered into the region of the SIJ?

  • Local anesthetic and corticosteroid agents (correct)
  • Muscle relaxants
  • Systemic anti-inflammatories
  • Hydrotherapy

What is one of the precipitating factors for sacroiliac joint disorders?

  • Overuse of pain medications
  • High-impact cardiovascular exercises
  • Excessive weightlifting
  • Muscle imbalance between hip flexors and extensors (correct)

Which technique may help reduce psoas tightness?

<p>Muscle energy techniques (C)</p> Signup and view all the answers

What has not been shown to be particularly helpful for sacroiliac joint dysfunction?

<p>Sacroiliac belts (D)</p> Signup and view all the answers

What type of joint dysfunction should be considered when planning an exercise program for the lumbar spine?

<p>Pelvic or sacroiliac joint dysfunction (D)</p> Signup and view all the answers

Which condition may involve the use of sclerotherapy as a treatment?

<p>Sacroiliac joint hypermobility (B)</p> Signup and view all the answers

Which muscles are commonly found tight in unilateral anterior tilt?

<p>Psoas and rectus femoris (A)</p> Signup and view all the answers

Which of the following movements is classified under active movements of the hip joint?

<p>Abduction (C)</p> Signup and view all the answers

Which passive movement involves flexion, adduction, and internal rotation?

<p>Hip quadrant (A)</p> Signup and view all the answers

In resisted movements, which of the following is NOT typically assessed?

<p>Hip flexibility (C)</p> Signup and view all the answers

Which anatomical structure is commonly palpated during a hip joint examination?

<p>Ischial tuberosity (B)</p> Signup and view all the answers

What is the purpose of the slump test in relation to hip assessments?

<p>To evaluate neurological function (D)</p> Signup and view all the answers

Which of the following is an example of a resisted hip joint movement?

<p>Hip external rotation (B)</p> Signup and view all the answers

During an examination, which observation technique may reveal prominent signs of lumbar lordosis?

<p>Observation from the side (B)</p> Signup and view all the answers

Which of the following structures provides support to the sacroiliac joint?

<p>Iliolumbar ligament (C)</p> Signup and view all the answers

What is a common treatment method for tight piriformis muscle?

<p>Muscle stretching (B)</p> Signup and view all the answers

What is nutation of the pelvis?

<p>External rotation and out-flaring of the innominates during forward flexion (D)</p> Signup and view all the answers

What type of injury can occur instead of a hamstring tear in adolescents?

<p>Avulsion fracture of the ischial tuberosity (D)</p> Signup and view all the answers

What is the effect of bending forward on the lumbar spine and sacrum?

<p>The lumbar spine extends while the sacrum flexes (C)</p> Signup and view all the answers

In what position should the hip be placed for effective muscle stretching of the hip external rotators?

<p>Flexion, adduction, and external/internal rotation (B)</p> Signup and view all the answers

What symptom is characteristic of inflammatory pain in sacroiliitis associated with spondyloarthropathy?

<p>Improvement with light exercise (B)</p> Signup and view all the answers

What does SIJ dysfunction refer to?

<p>Hypermobility or hypomobility of the sacroiliac joint (D)</p> Signup and view all the answers

Which of the following is NOT a typical symptom of compartment syndrome?

<p>Sudden weight gain (A)</p> Signup and view all the answers

How long does morning stiffness last in cases of inflammatory pain due to spondyloarthropathy?

<p>At least 30 minutes (C)</p> Signup and view all the answers

What is commonly used as part of the treatment for muscle tightness?

<p>Ice application (B)</p> Signup and view all the answers

Which factor can contribute to sacroiliac joint dysfunction?

<p>Tightness in the gluteal muscles (B)</p> Signup and view all the answers

What type of stretches should be included in a program for lumbar spine support?

<p>Stretching and strengthening of supporting muscles (A)</p> Signup and view all the answers

What is an associated condition that strongly suggests spondyloarthropathy?

<p>Achilles tendinopathy (C)</p> Signup and view all the answers

What does the management of an ischial tuberosity avulsion fracture generally involve?

<p>Conservative treatment (B)</p> Signup and view all the answers

Which method is used for soft tissue therapy of the piriformis muscle?

<p>Passive internal rotation with sustained pressure (A)</p> Signup and view all the answers

Which test is important for differentiating between local and referred pain during examination?

<p>Slump test (B)</p> Signup and view all the answers

What is the opposite motion of nutation called?

<p>Counternutation (D)</p> Signup and view all the answers

Which of the following correctly defines sacroiliac joint dysfunction?

<p>Abnormal function leading to pain in the buttock or groin (C)</p> Signup and view all the answers

What is the result of muscle traction in adolescents with ischial tuberosity injury?

<p>Avulsion fracture of the ischial tuberosity (B)</p> Signup and view all the answers

What aspect of the lumbar spine should be carefully examined?

<p>Hypomobility of intervertebral segments (C)</p> Signup and view all the answers

What is a common symptom associated with sacroiliac joint dysfunction?

<p>Pain in the buttock, hamstrings, or groin region (A)</p> Signup and view all the answers

Which of the following features is NOT associated with spondyloarthropathy?

<p>Neck pain with tingling (D)</p> Signup and view all the answers

In which position should observation be carried out during the lumbar spine examination?

<p>From behind and from the side (A)</p> Signup and view all the answers

What is the primary characteristic of referred pain when using the slump test?

<p>May not have a positive result in all cases (B)</p> Signup and view all the answers

What is one common treatment recommended for ischiogluteal bursitis?

<p>Dry needling (A)</p> Signup and view all the answers

Which symptom is common to both ischiogluteal bursitis and hamstring origin tendinopathy?

<p>Pain aggravated by sitting or sprinting (B)</p> Signup and view all the answers

What may ultrasound examination reveal in cases of bursitis?

<p>A fluid-filled bursa (D)</p> Signup and view all the answers

What is an important factor to consider in diagnosing ischiogluteal bursitis?

<p>Response to deep friction therapy (D)</p> Signup and view all the answers

Which demographic is most frequently affected by sacral stress fractures?

<p>Female distance runners (A)</p> Signup and view all the answers

What leads to hamstring muscle weakness associated with pain-induced muscle inhibition?

<p>Pain from underlying conditions (C)</p> Signup and view all the answers

Which muscles are most commonly associated with trigger points that may cause pain?

<p>Gluteus medius and piriformis (D)</p> Signup and view all the answers

What should a clinician be mindful of when addressing trigger points?

<p>They are a secondary phenomenon (B)</p> Signup and view all the answers

Flashcards

Morning Stiffness

Pain that is worse in the morning and improves with light exercise, lasting at least 30 minutes.

Sacroiliitis

Inflammation of the sacroiliac joint, often part of a spondyloarthropathy.

Spondyloarthropathy

A group of inflammatory diseases affecting the spine and joints.

Enthesopathy

Inflammation of tendons and ligaments at their attachment points, commonly seen in spondyloarthropathy.

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Referred Pain

Pain that originates in one area but is felt in another part of the body.

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Slump Test

A test used to assess for nerve root irritation or referred pain in the lower back, hip, and leg.

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Hypomobility

Limited movement of one or more vertebrae.

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Observation from behind (Fig. 22.2a)

The examination of the back from the rear, providing a view of the spinal alignment and muscle symmetry.

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Hip Flexion

A movement where the femur (thigh bone) moves forward towards the abdomen, decreasing the angle between the thigh and the trunk.

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Hip Extension

A movement where the femur moves backwards, away from the abdomen, increasing the angle between the thigh and the trunk.

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Hip Abduction

A movement where the femur moves away from the midline of the body.

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Hip Adduction

A movement where the femur moves towards the midline of the body.

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Hip Internal Rotation

A movement where the femur rotates inwards, so the toes point towards the midline of the body.

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Hip External Rotation

A movement where the femur rotates outwards, so the toes point away from the midline of the body.

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Sacroiliac Joint Test

A test used to assess the integrity and function of the sacroiliac joint. It involves applying pressure to the pelvic region and observing for pain or movement.

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Ischiogluteal Bursitis

Pain and tenderness in the bursa located between the gluteus maximus muscle and the ischial tuberosity (sit bone).

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Hamstring Origin Tendinopathy

Inflammation or irritation of the tendons at the origin of the hamstring muscles.

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Trigger Point

A painful, palpable knot or tight band in a muscle that can refer pain to other areas.

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Myofascial Pain

A painful, localized area of inflammation and stiffness in a muscle or tendon.

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Sacral Stress Fracture

A fracture in the sacrum, a bone in the lower back.

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Osteopenia

A condition where the bone density is lower than normal.

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SIJ Dysfunction

A condition where the sacroiliac joint (SIJ) doesn't function properly, often leading to pain in the low back, buttocks, hamstrings, or groin. This can be caused by either too much or too little movement in the joint.

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Nutation

The movement of the SIJ where the base of the sacrum moves forward and the apex moves backward. This happens when you bend forward.

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Counternutation

The opposite of nutation, where the base of the sacrum moves backward and the apex moves forward. This happens when you extend your back.

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Gluteal & Hip External Rotator Tightness

Tightness in the glutes and hip external rotators can contribute to SIJ dysfunction. This can be addressed through stretching exercises.

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Neural Stretches

Problems with the nerves can also contribute to SIJ dysfunction. The slump stretch can assess for nerve issues.

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Strengthening Exercises

Strengthening the muscles that support the lumbar spine can help improve SIJ function. This can include exercises for the core, back, and abdominal muscles.

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Stretching Exercises

Stretching helps improve flexibility and range of motion in the muscles surrounding the SIJ. This can help reduce pain and dysfunction.

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SIJ Pain Referral

SIJ pain can be directly felt in the SIJ or can be referred to other areas like the low back, buttocks, hamstrings, or groin.

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Transversus Abdominis Training

A type of exercise targeting the deep abdominal muscle that helps stabilize the pelvis, potentially reducing SIJ laxity and pain.

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Muscle Energy Techniques for Psoas

A technique involving manual pressure and movement to release tightness in muscles, specifically the psoas muscle, to improve SIJ function.

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Iliolumbar Ligament Sprain

A common cause of SIJ dysfunction where the ligament connecting the lower back to the pelvic bone is stretched or torn.

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SIJ Injections

A type of injection therapy that involves injecting a mixture of numbing agent and anti-inflammatory medicine into the SIJ area.

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Prolotherapy

A treatment approach where a series of injections are given into ligaments and tendons to stimulate healing and reduce hypermobility.

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SIJ Exercise Rehabilitation

A type of exercise program designed to strengthen and lengthen muscles around the pelvis, aiming to improve SIJ function.

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Muscle Imbalance in SIJ Dysfunction

A common finding in people with SIJ dysfunction where the hip flexors (front of hip) are tight, and hip extensors (back of hip) are weak.

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What are common symptoms of a compartment syndrome?

Pain, numbness, tingling, or weakness in the affected area. It may also feel tight and swollen, and the skin may be pale or bluish.

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How is compartment syndrome generally treated?

It typically involves applying ice to the affected area, limiting activity, and gently stretching the muscles.

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What is a compartment syndrome?

A condition where increased pressure within a muscle compartment restricts blood flow and can damage nerves and muscles.

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Describe the symptoms of a tight rectus femoris muscle.

Pain worsened by stretching the affected muscles, difficulty straightening the knee, and a feeling of tightness, especially in the front of the thigh.

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Explain how tight rectus femoris muscle is generally treated.

Involves stretching the muscle, often by performing exercises that involve hip flexion and knee extension, and using manual techniques like soft tissue therapy.

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What is a tight piriformis muscle?

A condition where the piriformis muscle becomes tight and restricts movement in the hip joint, leading to pain and discomfort.

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Describe the symptoms of a tight piriformis muscle.

Pain radiating down the leg, especially during hip extension or internal rotation, and tenderness when pressing on the piriformis muscle.

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Explain how a tight piriformis muscle is generally treated.

It generally involves stretching the piriformis muscle, often by performing exercises that involve hip flexion and external rotation, and using manual techniques like soft tissue therapy.

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Study Notes

Buttock Pain

  • Commonly seen in athletes involved in kicking or sprinting sports
  • Can occur in isolation or with low back or posterior thigh pain
  • Diagnosis can be challenging due to potential sources in the buttock or referral from lumbar spine/SIJ
  • Local or referred pain must be differentiated to identify the source
  • Pain location and nature are helpful assessment clues
  • Examination to pinpoint local/referred structures causing pain
  • Investigation of limited use in diagnosis
  • Common causes include referred pain (lumbar spine, SIJ, hamstring origin tendinopathy, ischiogluteal bursitis, myofascial pain)
  • Less common causes include piriformis conditions, impingement, muscle strain, fibrous adhesions around/sciatic nerve, prolapsed intervertebral disk, chronic compartment syndrome of posterior thigh, etc.
  • Important to consider potentially missed conditions like spondyloarthropathies (ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis, arthritis associated with inflammatory bowel disease), malignancy, and bone/joint infections.

History

  • Deep, aching, variable pain suggests referred pain, potentially from lumbar spine
  • Buttock pain with low back pain indicates lumbar spine issue
  • Buttock pain with groin pain suggests SIJ involvement.
  • Localizing pain easily points to a buttock region source
  • Constant buttock pain at ischial tuberosity often due to hamstring tendinopathy or ischiogluteal bursitis
  • Pain worsened by running (especially sprinting) not specific diagnostic sign
  • Prolonged sitting pain may indicate ischiogluteal bursitis, but lumbar spine issues could also be exacerbated by sitting.

Clinical Approach

  • Identify whether pain is local or referred
  • Clues from the nature and location of the athlete's pain
  • Observe the athlete statically and dynamically
  • Check leg length discrepancy
  • Active and passive hip movements (flexion, extension, abduction, adduction, internal/external rotation)
  • Examination of SIJ, gluteal muscles, ischial tuberosity, sacrotuberous ligament, iliolumbar ligament, anterior superior iliac spines
  • Special tests: slump test, lumbar spine examination
  • Palpation of buttock, considering soft tissue abnormalities or trigger points

Investigations

  • Plain X-ray may reveal stress fracture of pars interarticularis or spondylolisthesis
  • X-ray is not conclusive for SIJ dysfunction
  • Bone scan used for identifying stress fractures
  • Ultrasound/MRI assess for ischiogluteal bursa, chronic scarring at hamstring origin, or other soft-tissue abnormalities
  • Blood tests can detect systemic conditions (e.g., inflammation)

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Related Documents

Brukner 3rd Edition PDF - Chapter 22: Buttock Pain

Description

This quiz delves into the various causes and diagnosis of buttock pain, particularly in athletes involved in kicking or sprinting sports. It highlights the importance of distinguishing between local and referred pain and provides an overview of potential conditions affecting the buttock region. Explore the complexities involved in assessing and diagnosing buttock pain.

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