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Lower back and buttock pain


Lower back and buttock pain, often accompanied by restriction of movement, is a frequent presenting symptom to GP’s and physiotherapists. It can occur in individuals with a sedentary life style, and can often present in the “aging athlete”. Paul Carter, specialist physiotherapist at Physio2go in St. Albans, explores the role of general fitness and Pilates in the prevention of lower back injuries.

Causes of Buttock Pain

Pain in the lower back and buttock region is most often caused by minor injuries to the muscles and ligaments of the lower back. Causes include sports injuries, standing or sitting for prolonged periods, poor posture, lifting in awkward positions and a sedentary life style. Disc injury (prolapsed colloquially known as “slipped” disc) in the lower back can put pressure on the spinal nerves, this can cause buttock and leg pain (sciatica). Osteoarthritis or more serious pathology in the spine can also cause referred type pain into the buttocks and legs.

Initial Assessment

Your GP or physiotherapist will first ascertain the nature of your pain and its onset. This is important to help them determine the cause of the problem and establish a working diagnosis. They will try to establish how your pain started, for example was it one specific injury or has the pain been developing over weeks or months. If the symptoms you describe cannot be explained as having a mechanical cause, that is an injury or an over use type problem, or if other medical issues are relevant to your pain, you may be referred for further investigations such as an X-ray, MRI, CT scan, bone density or blood tests. In most cases further investigation is unnecessary, as the majority of low back pain cases will come under the mechanical heading, these can normally be managed by your physiotherapist and GP.

Acute Injury: Treatment Strategies

With an acute injury, that is an injury which has happened recently, for example from a fall, bending and lifting, or even just sneezing, the following advice is useful to help return to normal activity as soon as possible.
• Keep active! Try to lead as normal a life as possible, avoid sustained positions for long periods. Over the counter pain medication can be used if required. Gradually build up to more active pursuits over a period of time. Most back pain will improve within the first few days and be gone within six weeks.
• Return to exercise? Generally, returning to moderate exercise is a good thing. Be sure that the exercise is well within your capability and that you avoid any impact type exercise or heavy lifting initially. Concentrate on mobility and stability training. Increase your training regime over a period of weeks, back to your normal routine.
• Role of physiotherapy – If your back pain persists or you are in a lot of pain you should seek the expert advice of a physiotherapist. A physiotherapist will be able to provide you with a thorough assessment and examination, they will be able to develop a working diagnosis and a treatment plan specific to your needs. If required their treatment approach may include manual therapy techniques, the use of electrotherapy, specific exercise prescription, acupuncture and advice on posture and ergonomics.

Pilates and Prevention

It is important to prevent an acute injury from becoming a chronic condition. Research shows that Pilates based training can help to ensure long term strength and stability of the core and back muscles. Pilates based exercise for core stability especially helps those who do little normal exercise and those who have chronic back pain. Pilates concentrates on “strengthening and lengthening of specific muscle groups to improve functional flexibility, strength and posture”.
The Pilates technique has been modified to be appropriate for all individuals with different levels of fitness. A sedentary life style can cause abdominal muscles to weaken, muscles in the back and legs to shorten, spines to slump and shoulders to round forward. All of these changes can lead to lower backache, chronic neck and shoulder pain.
Pilates has been shown to help with stubborn back issues as it focuses on the ‘powerhouse muscles’ between the base of the ribs and the pelvic floor. Traditional abdominal exercises, focusing on the ‘six pack’ do not target the weaker deeper abdominal muscle groups. Pilates training starts with the deeper layers of muscle, then moves on to the more superficial muscles. Focusing on core stabilisation will help to support the lower back. This means strengthening your back, buttocks, hip flexors and pelvic floor.
At physio2go our highly qualified physiotherapists have many years of experience treating this type of back pain. We have found the most successful approach for back pain is being able to give the patient a thorough understanding of their particular problem, the type of treatment they may need and the type of exercise that will benefit them. This enables the patient to start to self manage and return to normal function as soon as possible. There is no “quick fix”. With back pain, in most cases it takes time and persistent work for both therapist and patient. Often patients will have to do exercises for their back, for weeks and months after finishing with therapy. This not only helps with the problem at hand but will help to prevent the same problem from recurring.

For further information please contact:
Physio2go Ltd.
York Lodge,
St. Peters St,
St. Albans,
AL 1 3HD

Telephone: 01727 850925