Lower Back and Buttock Pain
- The muscles of the lower back
- The muscles of the buttocks
- The muscles of the abdomen
- The muscles of the back of the thigh and lower leg
- The joints of the spine, the hips, and the pelvis
The Imbue Pain Relief Patch temporarily relieves minor aches and pains of muscles and joints. In the diagrams below, the X’s show the locations of common trigger points (localized muscle strain), and the colored shading shows the pain pattern each trigger point produces. This pain is often several inches (or more) away from the trigger point at which it originates. If application of the Imbue Patch directly to the knee does not significantly improve your pain, applying the Imbue Pain Relief Patch at the site of strain in nearby muscles sometimes yields better results.
Pain in the lower back and buttocks afflicts a huge number of people at some time in their lives. This area often takes the brunt of the burden of too much sitting, poor posture, and improperly lifting heavy items. It is also a place we tend to contract when we are stressed; thus, stress management is an important component of long term management of chronic lower back and buttock pain.
Most lower back and buttock pain is due to muscles nearby, but the pain rarely originates entirely from the place where it hurts. Therefore, effective treatment of lower back and buttock pain always requires a thorough examination of all the muscles that may be contributing.
Lower Back and Buttock Pain Due to the Muscles of the Lower Back
Several muscles in this area may be implicated in low back pain. There are the deep paraspinal muscles (semispinalis, multifidus, rotatores – together known as the transversospinalis group) located right alongside the spine. There are the more superficial paraspinal muscles (iliocostalis, spinalis, longissimus – together known as the erector spinae group) located a few inches away from the spine. Then there is quadratus lumborum, which covers the lower back more broadly; and serratus posterior inferior, which runs over the lower few ribs. All of these muscles are capable of producing pain in areas several inches away from where their trigger points occur, including down into the buttocks.
Unless you have a particular interest in anatomy, there is no need to learn the names or specifics of these muscles. By simply feeling this whole area methodically, you should be able to identify where the problem is coming from. Let’s look at a few examples of trigger points in this area so you can see how misleading they can be.
In the diagram on the left, we see three trigger points in the superficial paraspinal muscles, indicated by X’s. The blue X also indicates the general area of the primary trigger point of serratus posterior inferior. On the right, we see trigger points in the deep paraspinal muscles. Each region of colored shading indicates the pain pattern produced by the trigger point at the X of the same color. (The deep paraspinal trigger points may also refer pain through to the abdomen.)
Here we see two of the trigger points of quadratus lumborum (QL for short). The trigger point at the red X produces pain mostly along the crest of the pelvic bone and the trigger point at the blue X causes pain lower down, near the hip socket. Deeper trigger points in this muscle (which tend to occur somewhat closer to the spine) can cause pain over the sacrum and at the lower portion of the buttock.
Rather than hunting for specific trigger points, just methodically feel the whole lower back as indicated in the diagram on the right. For this, you will need the help of a friend, or the use of a ball (a lacrosse ball or tennis ball is the right size) or a Thera Cane. If using a ball (tennis ball or lacrosse ball), lie on your back on the floor with your knees bent and feet flat, place the ball under your back and roll on it. Alternatively, you can place the ball between your back and a wall (see diagram), and then slowly roll it over the target area. Start a few inches above the narrowest part of your waist (you should be over the lowest few ribs). First follow the red line, working slowly downward, inch by inch, right next to the spine. Then move slightly outward and work down the yellow line, along the incline of the ridge of muscle that runs parallel to the spine. Then move slightly more outward to work down the green line, right on top of the ridge of muscle. Then move slightly more outward to work down the blue line, along the downward slope of this muscular ridge. Then move slightly further outward to work down the pink line against the outermost edge of the bulky back muscles. If you find pain anywhere, do some gentle self-massage and apply the Imbue Pain Relief Patch.
Lower Back and Buttock Pain Due to the Muscles of the Buttocks
The powerful muscles in the buttock region have a major role in leg and hip movement. They are also capable of producing pain, not just in the local area, but also into the lower back, the hip joint, deep into the pelvis, and down the thigh. These muscles include the three gluteals – gluteus minimus, medius, and maximus – and the piriformis. The lowest portion of the deep spinal muscles is also found in this area.
Let’s look at the underlying bone structure of this region. This diagram shows the pelvis from the back. At the center, in yellow, is the sacrum, a plate of bone (actually five fused vertebrae) at the base of the spine. It is held in place by the ilium on each – the largest bone of the pelvis, which forms most of the butterfly shape. The curved upper surface of these bones, shown in red, is called the iliac crest. It sticks up most prominently in the back at the posterior superior iliac spine (PSIS), shown in green. This is right next to the sacro-iliac joint, where the ilium and sacrum come together. This joint is often involved in pain in this region, as it can become injured by heavy lifting or jumping down from a high place. Just above the center of the crease where each buttock meets the thigh is a bony prominence called the ischial tuberosity, shown in pink. It is on these bones that we sit when we have good posture. Hence, it is sometimes called the sitz bone. (When we slump, we end up more on the sacrum, which can contribute to pain in this area.) The widest point of the hips is usually at a knob on top of the thigh bone, shown in blue, called the greater trochanter of the femur (thigh bone). You can usually feel this bone at the side of the upper thigh.
When trying to discern the origin of pain in this region, there are a few key areas to feel. In this diagram, the blue and red X’s indicate example trigger points in the deep paraspinal muscles over the sacrum. The colored shading shows the pain patterns they can produce. People tend to avoid pressing where bone can be felt beneath, but this area can be rich in trigger points, and may even have a “gummy” consistency when the muscles are bound up.
The next diagram shows common locations of trigger points in gluteus maximus. This is the largest of the muscles covering the buttocks and its trigger points tend to occur right along the edges of bones: the outer edge of the sacrum (see the red and yellow X’s) and against the ischial tuberosity (see the blue X). The yellow X indicates a trigger point that forms beside the very tip of the coccyx, the “tailbone” at the end of the spine. Trigger points at the red and blue locations can produce pain patterns that encompass most of the buttock.
Similarly, trigger points that occur in gluteus medius (which makes up part of the upper, outer portion of the buttock), are also right along bone. They occur just beneath the iliac crest. As you can see, the outermost trigger point (yellow X) can produce pain directly over the sacrum. The middle point (red X) can produce pain near the back of the hip socket. The innermost point produces a vertical region of pain along the outer aspect of the sacrum. To find these points, first locate this bony arc, then go slightly downward. Press deeply inward, as if trying to get under the lip of bone. The innermost point (near the blue X) is just to the outside of the sacrum and PSIS. Following the curvature of the bone as you work outward, there are often numerous tender points here.
Of the three gluteal muscles, gluteus minimus is found most toward the side of the body. Trigger points in this muscle are found just above the hip socket and slightly below those of gluteus medius. These trigger points are especially interesting in that they can produce pain not only in the buttock but all the way down the leg.
The piriformis is a muscular band that runs from the edge of the sacrum outward to the top of the thigh bone (the greater trochanter of the femur). Besides being often responsible for pain in the buttock area (which can potentially radiate into the pelvis), it can cause a lot of problems because of its relationship to the sciatic nerve. The sciatic nerve is a long, thick nerve that runs through this region and then travels down the leg. The piriformis is located on top of it, and in some cases the sciatic nerve runs through the piriformis. This means that when the piriformis is tight, it can clamp down on the sciatic nerve, causing nervy pain down the thigh, lower leg, and even the foot. (The Imbue Pain Relief Patch does not specifically address nerve pain, but it may benefit the strained pirifomis muscle.) The two primary trigger point regions of the piriformis are just to the outside of the edge of the sacrum and just inside the back of the hip joint (see X’s in diagram).
While the muscles explored in this section mostly produce pain in the buttock, it is always worth checking them even if your pain is only in the lower back. Rather than hunting down the trigger points shown in these diagrams, we recommend you simply feel the entire area. Feel over the sacrum itself; feel the whole region from the crest of the pelvis (iliac crest) down to the crease at the bottom of the buttock, and all the way out to the side. Feeling this area is best done with the help of a friend or the use of a Thera Cane or a ball. If using a ball (tennis ball or lacrosse ball), lie on your back on the floor with your knees bent and feet flat. Place the ball under your buttock and roll slowly on it. Alternatively, you can place the ball between your buttock and a wall (see diagram), and then slowly roll it over the target area. If you find an area of pain, do some gentle self-massage here and apply the Imbue Pain Relief Patch.
Lower Back and Buttock Pain Due to the Muscles of the Abdomen
There are two likely culprits of lower back and buttock pain in the abdomen – the iliopsoas, which connects the lower spinal bones to the inside of the pelvis, and the rectus abdominis, which forms the most prominent “six pack” appearance to the central abdomen.
The iliopsoas (or psoas for short) is a unique muscle. At its upper end, it is attached to the bones of the lower spine. From there it comes forward through the abdomen and connects to the inside of the pelvis and (through its associated muscle, iliacus) to the top of the thigh bone. When it contracts, it brings the thigh toward the torso. It’s also instrumental in helping us sit up from a lying down position. In this diagram, the uppermost X shows the common location of the (right side) primary psoas trigger point. If present, it usually occurs about an inch or two to each side of the navel and sometimes slightly below it. The trigger point at the lower X is found just inside the most prominent portion of the hip bone. Either of these points can produce pain in the red shaded region of the back (and also pain in the groin, genitals, and upper thigh).
You can access this muscle most easily if you lie on your back with your knees bent and resting together on one side (see picture). This allows you to feel the psoas on the side opposite from where your knees are lying. Use all your fingertips together to press deeply at the uppermost X first (you may want to trim your fingernails for this). Start an inch or two to the outside of your navel, and search a few inches in all directions. If you raise your head, this will contract the more superficial rectus abdominis muscles. Keep in mind that you need to feel outside and underneath these muscles to get to the psoas. If the psoas is overly rigid, it will feel like a firm vertical band, roughly like a banana, and it will be tender. If this is the case, do some self massage here (you will likely need to repeatedly work on it to encourage the muscle to really let go) and apply the Imbue Pain Relief Patch where it is most painful. If you are feeling the psoas on the left and notice a strong pulsation in our abdomen, this is probably your descending aorta (a major artery) and you should move your fingers just slightly outward (toward your side) to find the psoas.
Next, you can follow the psoas downward and outward to its lower attachment inside the pelvis. You’ll be feeling along the inside edge of the bone that sticks up prominently in the lower abdomen (the PSIS). Imagine this bone is the rim of a bowl, and you’re trying to feel along the inside of the rim. Feel a few inches up and down, along inside edge of this bone. If you encounter a very tender point that produces (or alleviates) the pain you have been experiencing in your lower back, do some gentle massage. You may apply a small piece of the Imbue Pain Relief Patch here (being careful to stay away from the genital region).
Sometimes lower back and buttock pain can be referred from the front by trigger points in the “six pack” muscles of the central abdomen (rectus abdominis). A point of Irritation or strain in these muscles may produce a band of pain across roughly the same level of the back. These muscles are prone to developing trigger points especially when we suddenly become inspired to do a thousand sit-ups (or some other intense abdominal exercise) after not exercising for months. Trigger points in the lower abdomen can also antagonize or mimic all kinds of internal problems, such as digestive upset, groin and pelvic pain, and reproductive disorders. (If you suspect you have any of these issues, see your doctor first, before investigating the possibility of a muscular origin.)
The diagram shows one typical trigger point (X) and the broad pain it produces (shown by red shading). Search methodically across the abdomen at about the same level as where you are experiencing back pain, plus a few inches above and below. Depending on the size of your torso, these muscles typically extend about 3 to 6 inches outward from the navel to each side. Press firmly throughout the muscle, paying special attention to any spots that are quite tender, particularly if they reproduce the back pain you have been experiencing. Do some gentle massage, then place the Imbue Pain Relief Patch here.
Lower Back and Buttock Pain Due to the Muscles of the Back of the Thigh and Lower Leg
Trigger points in two regions of the back of the leg commonly refer pain to the lower back and buttock region. The first is around the midpoint of the back of the thigh, in the muscles semimembranosus and semitendinosus. The second is all the way down in the lower calf, in the soleus muscle.
Semitendinosus and Semimembranosus:
The hamstrings are two strong, thick bands of muscle at the back of the thigh. Both bands originate at the base of the pelvis (the ischial tuberosity or sitz bone). One of the hamstrings, called biceps femoris, runs downward to attach at the outside of the knee. The other, made up of both semitendinosus and semimembranosus, attaches at the inside of the knee. Only the inner hamstring (semitendinosus/semimembranosus) produces pain that goes upward to the lower buttock region. Its trigger points tend to occur somewhere between the crease at the bottom of the buttock and about halfway down the thigh (see X’s in the diagram). These trigger points produce the pain pattern shown in red, which includes the whole back of the thigh and upper calf, but especially the lower portion of the buttock.
To examine this area for trigger points, you will need the help of a friend or the use of a tool such as a Thera Cane or a small ball, such as a lacrosse ball. You can lie face down and have a friend press firmly, following several lines from the crease at the base of the buttock down to the mid thigh, starting first near the inside edge of the thigh and then working outward to the very midline of the back of the thigh. The Thera Cane or ball are also easy to use. With the ball, sit on a hard, flat chair or bench, and place the ball under the crease at the base of the buttock (see diagram). From there, slowly roll the ball to cover the area described above. You may find it helps to lean your forearm on top of your thigh to get more pressure on the ball. If you find any areas of significant tenderness, especially if they produce the same pain you have been experiencing, do some massage here with the Thera Cane or ball, and apply the Imbue Pain Relief Patch here.
Soleus is one of the two main calf muscles. The more visible muscle, which gives a two-lobed bulge to the upper calf when well toned, is the gastrocnemius. Soleus is broader and is found beneath gastrocnemius and protruding to the sides of the calf. This trigger point is found near the lower end of the bulge of the gastrocnemius (about halfway down the back of the lower leg), close to where the back and outside surfaces of the calf come together (se the X in this diagram). This trigger point produces pain all the way up at the side of the sacrum and around the sacro-iliac joint (see red shading). With such a huge distance between the trigger point and its referred pain, it’s easy to see why few people would ever suspect this muscle as being the cause of their lower back pain.
Press thoroughly in the area about halfway down the back of your lower leg, a bit toward the outer surface rather than the middle. If you try to bend your knee while your heel is pressed against something (like the leg of your chair), you’ll feel the gastrocnemius and soleus stand out, and you should find this trigger point (if present) near the lower outside edge. If you discover a painful spot that feels significant and you have pain in the region shown in the diagram, do some gentle local massage and apply the Imbue Pain Relief Patch here.
Although much less common than muscular pain, pain in the lower back and buttock region may also originate from any of the joints in this area, sometimes due to arthritis. These joints include those of the spinal bones (vertebrae); the joint between the sacrum (the plate of bone at the lower end of the spine) and the ileum, the largest of the pelvic bones (the sacro-iliac or S-I joint); and the hip joints. Hip joint pain is usually experienced in the area shown in yellow, which is often experienced deep into the groin. Sacro-iliac joint pain is typically felt around the joint itself, show in red on the diagram. For joint pain in this region, apply the Imbue Pain Relief Patch directly over the affected joint.