Dead Butt Syndrome

How to Bring Your Butt Back From the Dead - Contributed by Dr. Darrin Bright

Do you have a dead butt? If so, there’s no need to start making funeral arrangements. Although “Dead Butt Syndrome” is a common malady among runners and walker, your bottom can bounce back with an accurate diagnosis and proper therapy.

The condition takes its name from the gluteal muscles in the buttocks. They not only pad the rear ends of couch potatoes, but generate force and stabilize the hip and pelvis among runners. Consequently, your butt is subject to the same overuse injuries that affect knees, ankles, feet, thighs and groins. In fact, your pains in the posterior often lead to problems in other body parts.

Afflicted individuals typically described Dead Butt Syndrome as a history of nagging or progressive symptoms persisting over months, or even years. In some cases, it lands them on the sidelines. Dead Butt sufferers often have seen several physicians, had numerous X-rays and MRI’s, and explored a myriad of therapies – without much relief.

The four “glute” muscles are part of a complex array of muscle groups surrounding the hip joint. They facilitate the extremes of motion that support running, walking, standing and even sitting.

To function at optimal level, the hip requires a perfect balance of strength and flexibility within its supporting muscle groups. When one of these groups fails, the entire area is affected. Unfortunately, the repetitive act of running invites the development of muscular imbalances.

The butt muscle most often affected is the gluteus medius muscle that lies deep within the buttocks region. This muscle – attached to both the hip and leg – stabilizes the hip and pelvis, and serves to abduct the leg (move it away from the body’s center line), among other functions.

Inflammation in the tendons in this particular muscle recently has been implicated in a number of running-related lower extremity injuries.  When this muscle does not properly activate (or “fire”), it places undue stress on other hip muscles.  Eventually these smaller and less dominant muscles start to break down, resulting in tears, inflammation, the formation of scar tissue and overall dysfunction.

Clinically, runners and walkers describe Dead Butt Syndrome as a pain in the rear that sometimes radiates down the leg. Occasionally, the pain wraps around toward the front of the hip. Running, walking, and oftentimes sitting aggravate the pain.

Weakness frequently will be identified in the affected muscle groups; the area in which the weakness is located will be tender to the touch. Diagnosis is made by an appropriate history and physical examination. Imaging studies usually will be negative but are sometimes necessary to rule out other conditions such as stress fractures, muscle tears and disc problems.

There appears to be a misguided emphasis on stretching the muscles that rotate the hip. Rarely is tightness the issue, but rather a strength deficit within the affected muscles.

Effective treatment depends on finding a physical therapist who understands runners and the unique biomechanics of the hip.

Some individuals may respond very quickly with targeted strength exercises; others may require more extensive strengthening and rehabilitation if their muscles have atrophied and weakened.  In resistant cases, some runners may find benefit from massage and other deep tissue treatments.

Sometimes, it is difficult for runners to focus on the proper conditioning of muscles that seem to have little to do with the act of running. But the right strengthening program, with some cross-training if necessary, can bring your butt muscles back from the “dead” and improve your performance.  If symptoms persist, it is recommended you see a sports medicine physician to help confirm the diagnosis and establish and effective treatment plan.

Darrin Bright, MD, is a family medicine and sports medicine physician with the MAX Sports at OhioHealth in Columbus, Ohio.   He is an avid marathon runner who serves as the director of The Runner’s Clinic and medical director for the Columbus Marathon, Capital City Half Marathon, and Emerald City Half Marathon.