The Low-Back-Butt Complex in Posture

In a previous post, we explored a common phenomenon in my practice: the intricate interplay between lower back and hip muscles, establishing a feedback loop that transmits pain signals, resulting in guarding, tension, and eventual dysfunction.

The previous article delved into trigger point theory, elucidating how pain referral patterns create secondary pain patterns. However, it overlooked the crucial postural considerations contributing to the initial problems.

As a pain management bodyworker, my primary objective is promptly alleviating the client's discomfort. Like many practitioners, I grapple with whether to address the cause or the symptom—an age-old question that has sparked debates throughout the history of medicine.

My approach is straightforward: identifying the cause is akin to peeling away layers of an onion. Begin with the basics—the most pronounced issue the client presents. Then, gradually, unravel the mystery behind the problem over time.

In the case of the low-back-butt complex, I understand that hip muscles can refer pain to the lower back, often on the opposite side. If this pain referral pattern persists, it creates secondary trigger points, reciprocally referring pain to hip muscles on the same side. Ergo, my initial goal is to create a treatment plan addressing where the client feels the pain and where the pain likely originates.

After a few sessions with promising results, the focus shifts to understanding the how and why. Often, the answer lies in posture, gait, and body mechanics—how the individual stands, sits, or engages in specific activities of daily living. While I pose many questions, I don't expect immediate answers. Instead, I aim to plant seeds, encouraging clients to embark on fact-finding missions about their daily lives and body habits contributing to the issue.

Now, let's delve into the low-back-butt complex and its manifestations. Often, the key players here are the gluteus medius and minimus muscles. The differential diagnosis involves considering whether the individual spends prolonged periods of sitting or standing, engaging in activities like driving or working at a computer.

When seated, these muscles shorten from two angles of the hip joint —flexion and abduction. Individuals who drive long distances often exhibit both, spreading their legs and maintaining a flexed position. Over time, this conditions the gluteus medius and minimus to become shorter, creating a pull on the pelvis in a standing posture. If these muscles are shorter than they should be, it can result in an anterior tilt of the pelvis.

Also noteworthy is that an anteriorly tilted pelvis creates a more significant lordotic curve in the lower back. This lordotic curvature, in turn, shortens the lower back muscles (e.g., erector spinae lumborum), further contributing to an anteriorly tilted pelvis. Another feedback loop, if you will.

Visualize an anteriorly tilted pelvis as a bowl of water stacked on your thigh bones. If the water is pouring out from the front, that's an anterior tilt. This is, of course, but one way to create an anteriorly tilted pelvis.

When I first started out in this field, my practice was in Dallas, Texas. And, boy howdy, did I see some anterior tilt! This was often caused by high heels. Y'all, it was big hair and high heels! Yes, high-heeled shoes were so popular in the late '90s and early 2000s that my practice saw more low-back-butt complex cases than you could shake a stick at!

Some muscles become locked short, and their antagonists will likely be stuck in an overstretched position. For an anterior tilt to the hip, this might involve the hamstrings, some of the groin muscles (those toward the back of the leg), and in the front, the abdominals. Any one or all of them might be "locked long" and need support to restore balance.

In terms of the low-back-butt complex, this manifests as a pain feedback loop pattern. If muscles are locked short, they tend to create contraction knots known as trigger points. These muscles feel tight, like firm clay that has not yet been kneaded. The locked long muscles feel ropey with taut bands within them. Surprisingly, overstretched muscles also have contraction knots because the constantly overstretched muscle is hanging on for dear life, trying not to tear. So, both groups of muscles have the potential to create pain. Therefore, either group is a potential gateway for the low-back-butt pain pattern.

So, we need to shorten the long ones and lengthen the short ones. Neither of these things happens quickly. It is a series of treatment sessions. But over time, we can get those shorter muscles to lengthen, and we can encourage those longer muscles to shorten.

In summary, the low back butt complex is often related to an anterior tilt of the pelvis. In my approach, the first step in treatment should be to address the client's pain. Once we are sure we are adequately addressing this pain, we need to explore what is causing the anterior tilt.