Individuals dealing with pain in the buttocks can make life difficult to sit, walk, or perform simple, everyday tasks. Can understanding the anatomy, location, and function of the gluteus maximus muscle help in muscle rehabilitation and avoid potential injuries?
Gluteus Maximus
The gluteus maximus is the largest human body muscle responsible for hip extension, external rotation, adduction, and abduction, as well as the ability to stand upright. The primary muscle extends laterally and keeps the body upright by supporting the bony pelvis and trunk. (Neto W. K. et al., 2020) When the gluteus maximus is strained, injured, or weak, it can lead to pain and inflammation.
Common symptoms can include:
Stiffness in the buttock
Discomfort while sitting
Difficulty standing up from sitting
Difficulty bending over
Pain when walking, especially upstairs or on a hill
Pain in the lower back and/or tailbone
Anatomy and Structure
The muscles that comprise the glutes are the gluteus maximus, gluteus medius, and gluteus minimus. The gluteus medius runs underneath the gluteus maximus, and the gluteus minimus is underneath the gluteus medius.
The gluteus maximus is one of the strongest muscles. Fibers from the muscle connect to different body parts, including the femur/thighbone and the iliotibial band, which comprises connective tissue that runs up the thigh. The superior gluteal artery transports blood from the heart to the glutes.
Nerve Supply
The inferior gluteal nerve, part of the sacral plexus branch, innervates the maximus muscle. The sacral plexus nerves support motor and sensory function in the thighs, lower legs, feet, and pelvis. The sciatic nerve runs under the gluteus maximus, from the lower back down to the leg, and is often the cause of nerve pain in and around the area. (Carro L. P. et al., 2016) The main nerve of the perineum is the pudendal nerve, which runs under the gluteus maximus muscle.
Location
The gluteus maximus muscle defines the buttocks. It can be called a superficial muscle, sometimes referred to muscles that help provide shape. The origin of the gluteus maximus connects to the sacrum, the ilium, or the large upper part of the hip bone, the thoracolumbar fascia tissue, and the sacrotuberous ligaments attached to the posterior superior iliac spine. The gluteus maximus has a 45-degree angle from the pelvis to the buttocks and then inserts at the gluteal tuberosity of the femur and the iliotibial tract.
Variations
Sometimes, a duplicate muscle may originate from the gluteus maximus muscle in rare cases. However, it is more common that the gluteus maximus muscle fibers may be inserted into different body parts than where they are typically inserted. (Taylor, V. G., Geoffrey & Reeves, Rustin. 2015) This can cause a condition called greater trochanteric pain syndrome or GTPS. Inflammation of the gluteus medius, minimum tendons, and bursa inflammation can also cause GTPS. Individuals with GTPS will have tenderness or a pulsing feeling on the outer side of the hip and thigh when lying on the side, along with other symptoms.
Function
The gluteus maximus extends and externally rotates the hip joint, stabilizing the body. It is highly engaged during running and hiking activities. Regular walking does not typically target gluteus maximus strength training. However, the gluteus maximus promotes balance when walking and other activities by helping keep the pelvis and posture upright.
Conditions
The most common condition associated with the gluteus maximus is muscle strain, and deep gluteus maximus syndrome is another condition that can cause pain and involves the muscles.
Muscle Strain
A muscle strain can result from stretching and working the muscle too much that it becomes overstretched or tears. (Falótico G. G. et al., 2015) This can happen from not warming up or cooling down properly, repetitive use injury, and over-exercising. Alternatively, not exercising and not utilizing your gluteus maximus can weaken it, leading to lower back pain, hip pain, and stability and posture issues. (Jeong U. C. et al., 2015)
Deep Gluteus Maximus Syndrome
This syndrome causes pain in the buttocks when the sciatic nerve becomes entrapped. (Martin, H. D. et al., 2015) The location of the pain can help healthcare providers determine where the nerve is trapped. Those with deep gluteus maximus syndrome may experience various types of discomfort, including (Martin, H. D. et al., 2015)
Numbness and tingling in the leg
Pain when sitting
Pain when walking
Pain that radiates down the back and hips and into the thigh
To diagnose the condition, a healthcare provider may perform a physical examination and various tests to rule out other conditions that can cause similar symptoms.
Treatment and Rehabilitation
If there is pain in the buttocks and/or lower extremities, it’s important to consult a primary doctor, chiropractor, or physical therapist. They will evaluate the strength of the gluteus muscles to diagnose any strain or weakness. From there, they will develop a personalized treatment plan to help heal the injury, strengthen the muscles, and restore function. Treatment will include stretches once the strain is rested and improves.
Recommendations can include taking a few days off to rest the muscle or, at the very least, stop performing the work or activity that caused the strain.
Ice and over-the-counter medication like ibuprofen can help reduce inflammation.
For weak gluteus maximus, a physical therapist will strengthen and retrain the muscle with a tailored program of exercises. (Jeong U. C. et al., 2015)
Treatment for deep gluteus maximus syndrome may include conservative treatment, such as chiropractic decompression and realignment, physical therapy, medications for pain and inflammation, and injections.
If conservative treatments do not relieve the pain, a primary healthcare provider may recommend surgery. (Martin, H. D. et al., 2015)
Working with a chiropractic physical therapy team can help individuals return to normal function and expedite healing. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment program through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility to relieve pain and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
The Science of Motion and Chiropractic Care
References
Neto, W. K., Soares, E. G., Vieira, T. L., Aguiar, R., Chola, T. A., Sampaio, V. L., & Gama, E. F. (2020). Gluteus Maximus Activation during Common Strength and Hypertrophy Exercises: A Systematic Review. Journal of sports science & medicine, 19(1), 195–203.
Carro, L. P., Hernando, M. F., Cerezal, L., Navarro, I. S., Fernandez, A. A., & Castillo, A. O. (2016). Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles, ligaments and tendons journal, 6(3), 384–396. https://doi.org/10.11138/mltj/2016.6.3.384
Taylor, Victor & Guttmann, Geoffrey & Reeves, Rustin. (2015). A variant accessory muscle of the gluteus maximus. International Journal of Anatomical Variations. 8. 10-11.
Falótico, G. G., Torquato, D. F., Roim, T. C., Takata, E. T., de Castro Pochini, A., & Ejnisman, B. (2015). Gluteal pain in athletes: how should it be investigated and treated?. Revista brasileira de ortopedia, 50(4), 462–468. https://doi.org/10.1016/j.rboe.2015.07.002
Jeong, U. C., Sim, J. H., Kim, C. Y., Hwang-Bo, G., & Nam, C. W. (2015). The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients. Journal of physical therapy science, 27(12), 3813–3816. https://doi.org/10.1589/jpts.27.3813
Martin, H. D., Reddy, M., & Gómez-Hoyos, J. (2015). Deep gluteal syndrome. Journal of hip preservation surgery, 2(2), 99–107. https://doi.org/10.1093/jhps/hnv029
Can chiropractic treatment alleviate pain and correct swayback posture, a postural deformity that can cause lower back pain and mobility issues, for individuals experiencing it?
Swayback Posture
Swayback posture is a common dysfunction involving the pelvis and hip joints tilted forward in front. This causes the pelvis to shift forward, which exaggerates the curves in the lower and upper back, known as lordosis and kyphosis. The pelvis may tilt backward relative to the upper half, causing the buttocks to tuck under. The pelvis coordinates the movements of the head, shoulders, and trunk with those of the feet, legs, and thighs. A neutral pelvis, the ideal position, generally supports a mild curve/normal lordosis in the lower back. The small arch helps the body balance the skeletal parts as they work together to support and move the body’s weight. When a postural deformity occurs, one or more bones may shift from their ideal position to compensate for any pain or loss of balance caused by the original deviation. This deviation can lead to muscle strain, ligament sprain, and/or pain. (Czaprowski, D. et al., 2018)
Postural Deviations
Swayback posture causes the thoracic spine to move backward and round over into kyphosis. At the same time, the pelvis is tilted forward, resulting in an exaggeration of the normal lumbar lordosis. (Czaprowski, D. et al., 2018)
Healthcare providers, chiropractors, and physical therapists use exact measurements to define and treat postural deformities.
A neutral pelvis is a position of balance the entire body uses to help it stay upright, move, and be pain-free.
The ideal or neutral pelvic tilt is a 30-degree angle between the vertical and the plane that passes through the top of the sacrum and the axis of the hip joint socket in the front.
Swayback posture causes the pelvis to tilt forward another 10 degrees.
As a result, the spine compensates, exaggerating the curves in the lower back/lordotic curve and in the mid and upper back/kyphotic curve.
When viewed from the side, individuals can see a backward movement of the thoracic spine.
In front, the chest tends to sink in.
Muscle Group Imbalances
Healthcare providers look at different contributors or causes of postural deviations. Swayback can sometimes be associated with strength imbalances between muscle groups that move the hips, spine, and pelvis and hold the body upright. This includes:
Weakened hip flexors and overly strong or tense hip extensors/the hamstrings.
Tight upper abdominals, weak lower abdominals, and weak mid-back muscles may also contribute.
A corrective exercise program after seeing a physical therapist will help address some or all underlying muscle imbalances.
Risk Factors
Because weight in the abdominal region pulls the pelvis forward, pregnant women and obese individuals can have an increased risk of developing a swayback posture. (Vismara, L. et al., 2010)
Symptoms
The symptoms of swayback posture often include:
Severe lower back pain
Difficulty sitting or standing for long periods
Difficulty performing certain physical activities.
Tightness in the hamstrings and hip flexors
Tightness in the upper back muscles
Headaches or migraines
Chiropractic Treatment
Chiropractic adjustments are a common treatment used to correct swayback posture and can be corrected through various treatments. These include:
Spinal adjustments: The doctor applies pressure to specific spine areas to realign them and help restore proper spinal function.
Non-surgical decompression
Massage therapies
Muscle Energy Technique, or MET, improves muscle strength, flexibility, and function.
Acupuncture
Exercises to strengthen and stabilize the core muscles
Lifestyle adjustments to help reduce stress on the spine
Posture exercises
Biomechanics training
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized care plan for each patient through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to optimal function. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
How I Gained My Mobility Back With Chiropractic Care
References
Czaprowski, D., Stoliński, Ł., Tyrakowski, M., Kozinoga, M., & Kotwicki, T. (2018). Non-structural misalignments of body posture in the sagittal plane. Scoliosis and spinal disorders, 13, 6. https://doi.org/10.1186/s13013-018-0151-5
Vismara, L., Menegoni, F., Zaina, F., Galli, M., Negrini, S., & Capodaglio, P. (2010). Effect of obesity and low back pain on spinal mobility: a cross sectional study in women. Journal of neuroengineering and rehabilitation, 7, 3. https://doi.org/10.1186/1743-0003-7-3
For individuals who sit at work for long hours, can years of practicing unhealthy posture be corrected through a step-by-step approach to ensure optimal body position while sitting?
Sitting Posture
Sitting up straight with a healthy posture requires the conscious alignment of the hips, pelvis, lower back, upper back, shoulders, neck, and head. Learning or retraining oneself to maintain correct sitting posture can relieve lower back pain, improve respiration and digestion, and reduce tension in the neck and shoulders. (Albarrati, A. et al., 2018) It starts by paying attention to posture throughout the day and correcting it whenever forward head posture, leaning, or slouching develops. Targeted exercises can also help build upper-body strength, and stretching can stabilize and strengthen the core muscles, lower back, and pelvic joints. (Albarrati, A. et al., 2018)
Sit Up Straight Guide
Sitting up straight can be uncomfortable because it is not a natural position for the body to be in for an extended time. Nowadays, work, school, appointments, and other activities require us to sit much longer than intended. The muscles also have to work against gravity, leading to muscle exhaustion, slouching, and slumping, which can cause chronic back, leg, neck, and/or shoulder pain. (Jung, K. S. et al., 2020)
Sitting up straight may seem simple, but the focus tends to be on straightening just the lower/lumbar spine. This posture is unsustainable and exhausts and stresses the upper and lower back. (Jung, K. S. et al., 2020) The whole body needs to be considered when protecting the stability and balance of the spine. Learning and maintaining the ability to sit up straight is a process that requires practice. Find a comfortable chair to sit in, and follow these steps to achieve the optimal postural alignment (Canadian Centre for Occupational Health and Safety, 2022)
Knee Spacing
The hips should be at a roughly 90-degree angle.
Knee Position
The knees should be at a 90-degree angle level with the hips.
Use a pillow to achieve the right knee position if the seat is too low.
Keep the Feet Flat on the Floor
If feet don’t reach the floor, place a footstool, box, book, or other flat object underneath them.
Sitting Bones
Also known as the ischial tuberosities, these are two knobby bones on the underside of the pelvis.
Feel around to find them.
Pelvis Adjustment
Shift the body so that the sitting bones are directly under the pelvis rather than situated too far back, stressing the lower back or too far forward, leading to slumping.
Spine Check
There should be a slight spinal curve, and one should be able to slip a hand between the lower back and the back of the chair.
Shoulder Check
The shoulders should be level and vertically aligned with the hips.
If the shoulder blades are pulled back or the shoulders are lifted or curled forward, relax them into a neutral position.
Head Positioning
The head tends to tilt too far forward while sitting as work and the day progresses.
Adjust the head position to align the neck with the upper spine.
The head should be slightly tilted forward, with the ears aligned with the shoulders.
Check for Pain and Discomfort
Pain may be due to structural imbalances of the spine, pelvis, or hips.
Use a lumbar chair support or place a rolled-up towel or cushion at the lower back to keep the back straight.
Added Tips
Tools and tricks to help prevent and avoid back, hip, and neck pain.
Chairs
All the bells and whistles for an ergonomic desk chair are unnecessary.
Focus on features like adjustable seat height and lumbar support. The correct seat depth recommendations are deeper if tall and shallower if short. (van Niekerk, S. M. et al., 2012)
Cushions
If sitting on a cushion or using one to bolster the back or hips, recommendations are not to go too soft.
Cushions that are too soft allow the ability to shift from one hip to the next, often without realizing it.
They usually eventually flatten and lose support.
Monitor Position
There is no point in sitting straight if the monitor is too high or too low.
The monitor should be at eye level to maintain the proper head and shoulder alignment.
If the monitor is too low, place a box or book underneath it.
If it is too high, raise the chair’s height and place a footrest under the feet to keep them flat.
Avoid Crossing Legs or Feet
Crossing the legs or feet places stress on the opposite hip, thigh, and knee and wears the body out faster.
If the hips or legs are tiring prematurely, the individual is not sitting correctly or in the wrong chair.
Use Comfortable Footwear
Maintaining flat feet on the floor while sitting is imperative.
This is not possible in high heels or platform shoes.
Change into a comfortable pair of flat shoes while sitting.
Take Regular breaks
Even with an ergonomic desk chair, the body is not meant to be sitting for hours and hours.
Get up at least every hour, walking and stretching to reactivate the muscles and circulation.
Sitting up straight requires body alignment awareness, stable core muscles, and balanced pelvis, hips, spine, shoulders, neck, and head positioning. It may take some time before these steps become normal, but they will become second nature with perseverance and practice. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution that fully benefits the individual to get back to normal. Using an integrated approach to treat injuries and chronic pain syndromes to improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Posture and Mobility
References
Albarrati, A., Zafar, H., Alghadir, A. H., & Anwer, S. (2018). Effect of Upright and Slouched Sitting Postures on the Respiratory Muscle Strength in Healthy Young Males. BioMed research international, 2018, 3058970. https://doi.org/10.1155/2018/3058970
Jung, K. S., Jung, J. H., In, T. S., & Cho, H. Y. (2020). Effects of Prolonged Sitting with Slumped Posture on Trunk Muscular Fatigue in Adolescents with and without Chronic Lower Back Pain. Medicina (Kaunas, Lithuania), 57(1), 3. https://doi.org/10.3390/medicina57010003
Canadian Centre for Occupational Health and Safety. (2022). Working in a sitting position – good body position. Retrieved from https://www.ccohs.ca/oshanswers/ergonomics/sitting/sitting_position.html
van Niekerk, S. M., Louw, Q. A., & Hillier, S. (2012). The effectiveness of a chair intervention in the workplace to reduce musculoskeletal symptoms. A systematic review. BMC musculoskeletal disorders, 13, 145. https://doi.org/10.1186/1471-2474-13-145
For individuals who sit regularly for work and are slumping forward, can strengthening the rhomboid muscles help prevent posture problems and relieve pain?
Rhomboid Muscles
The rhomboids are a group of muscles in the upper back. A rhomboid major and minor muscle on each side of the upper back forms the shoulder girdle, which, along with other muscles, helps maintain the stability of the shoulder and shoulder blade. The rhomboid muscles control:
Pulling
Lifting
Rotating the shoulder blade.
These muscles also contribute to arm movement and enable lifting the arms above the head.
The rhomboid muscles support healthy posture and upper back. (Yoo W. G. 2017)
Sitting for an extended time, slumping forward, overstretching the arm above the body, sleeping on one side, repeated throwing motions, and sports like volleyball can affect the rhomboid muscles and cause pain symptoms.
Anatomy
There are two rhomboid muscles. The major originates on the thoracic spine from the second through the fifth vertebrae and inserts on the side of the shoulder blade facing the spine. The minor is superior to the major and inserts on the C7 and T1 vertebrae. The muscles connect between the spine and each of the shoulder blades. When they contract, they pull the shoulder blades together. The muscle fibers run diagonally. They affix the scapula against the torso, allowing a stable base from which the arms can move.
Symptoms
When rhomboid muscles are overused or strained, symptoms can include the following:
Tenderness around the shoulder blade.
Limited range of motion in the shoulder.
Pain around the shoulder blade.
Upper back pain.
Neck pain.
Arm fatigue when performing repetitive overhead movements.
A crunching sound when moving the shoulder.
Weakness in the arm.
Chest pain.
Muscle Building
The action of the rhomboid is to bring the shoulder blades together, lift them or elevate them, as when shrugging, and rotate them so they face downward, away from the head. Bringing the shoulder blades together or scapular retraction builds the rhomboids to support the upper back.
To improve or prevent posture problems or mild, muscle-related upper-back and/or neck pain, 10 to 15 repetitions of scapular retraction performed one to three times every day are targeted exercises that could be recommended to help strengthen the muscles. However, consult a primary care provider, physical therapist, or chiropractor for serious medical conditions that affect posture to develop a personalized exercise program specific to the individual’s condition or injury. Everybody is different, and there is no one-size-fits-all when incorporating exercise to manage back pain. The physical therapy team may recommend other exercises to help manage or reverse any postural issues. (Kim, D. et al., 2015)
Overstretched Muscles
The human body has a unique and challenging relationship with gravity, which creates a downward pull on its structures, including the spine, head, and shoulders. As gravity pulls, the shoulders roll forward, and the chest can sink in. (Harvard Health, 2022). The rhomboid muscles may become overstretched, or the pectoral muscles and soft tissues in front may tighten up and constrict. Strengthening the rhomboids can help release the pectoral muscles.
Forward Head Posture
Unhealthy posture can lead to chronic pain and back problems. (Kripa, S. et al., 2021) Over time, unhealthy posture can also cause a forward head posture. (U.S. National Library of Medicine Clinical Trials, 2020) Forward head posture can lead to soft tissue strain, a kink in the neck, and fatigue in the muscles holding the head up, which can cause chronic neck pain. Maintaining strong extensor muscles in the lumbar and thoracic spine can help prevent back and neck problems as the body ages.
Injury Medical Chiropractic and Functional Medicine Clinic
We passionately focus on treating patients’ injuries and chronic pain syndromes and develop personalized care plans that improve ability through flexibility, mobility, and agility programs tailored to the individual. Using an integrated approach, our areas of chiropractic practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols to relieve pain naturally by restoring health and function to the body through Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them, as Dr. Jimenez has teamed up with the top surgeons, clinical specialists, medical researchers, and premier rehabilitation providers to provide the most effective clinical treatments. We focus on what works for you and strive to better the body through researched methods and total wellness programs.
Functional Healing
References
Yoo W. G. (2017). Effects of pulling direction on upper trapezius and rhomboid muscle activity. Journal of physical therapy science, 29(6), 1043–1044. https://doi.org/10.1589/jpts.29.1043
Kim, D., Cho, M., Park, Y., & Yang, Y. (2015). Effect of an exercise program for posture correction on musculoskeletal pain. Journal of physical therapy science, 27(6), 1791–1794. https://doi.org/10.1589/jpts.27.1791
Harvard Health. (2022). Is it too late to save your posture? Exercise and Fitness. https://www.health.harvard.edu/exercise-and-fitness/is-it-too-late-to-save-your-posture
Kripa, S., Kaur, H. (2021). Identifying relations between posture and pain in lower back pain patients: a narrative review. Bulletin of Faculty of Physical Therapy, 26. https://doi.org/https://doi.org/10.1186/s43161-021-00052-w
U.S. National Library of Medicine Clinical Trials. (2020). Strengthening and stretching exercise to improve forward head posture and rounded shoulders. Retrieved from https://clinicaltrials.gov/study/NCT04216862
For individuals with back pain, can sleeping with a pillow between or under their knees help bring relief during sleep?
Sleep With A Pillow Between The Legs
Healthcare providers may recommend that individuals with back pain due to pregnancy or conditions like a herniated disc and sciatica sleep with a pillow between their legs. Sleeping with a pillow between the legs may help relieve back and hip pain, as the position helps maintain pelvis and spinal alignment. Proper spinal alignment can help relieve back stress and pain.
The Benefits
Some potential benefits of sleeping with a pillow between the knees.
Reduce Back and Hip Pain
When sleeping on the side, the spine, shoulders, and hips may twist to maintain the position because the center of gravity is elevated, causing instability. (Gustavo Desouzart et al., 2015) Placing a pillow between the knees may help maintain stability and reduce back and hip pain. (Gustavo Desouzart et al., 2015) The pillow neutralizes the position of the pelvis by slightly elevating the leg on top. This decreases the pressure on the lower back and hip joints, which may help reduce pain and allow for improved sleep.
Reduce Sciatica Symptoms
Sciatica nerve pain travels from the lower back down one leg due to a compressed spinal nerve root in the lower back. (American Academy of Orthopaedic Surgeons, 2021) Sleeping with a pillow between the knees may help reduce symptoms and sensations. A pillow between the legs can help prevent twisting the back, rotating the spine, or tilting the pelvis during sleep.
Reduce Herniated Disc Symptoms
A herniated disc can pressure the spinal nerves, leading to pain and numbness. (Penn Medicine. 2024) Sleeping on the side can worsen herniated disc pain; however, placing a pillow between the knees keeps the pelvis in neutral alignment and prevents spinal rotation. Sleeping on the back with a pillow under the knees can also help reduce pressure on the disc. (University of Central Florida. N.D.)
Improve Posture
Maintaining healthy posture while sitting or standing is important to neuromusculoskeletal health and injury prevention. Proper alignment during sleep can help improve posture (Doug Cary et al., 2021). According to one study, individuals spend more than half of their time sleeping in a side-lying posture. (Eivind Schjelderup Skarpsno et al., 2017) Sleeping on the side with the top leg frequently falls forward, bringing the pelvis into a forward tilt that places added pressure on the hips and spine connective tissues. This position disrupts the body’s natural alignment. (Doug Cary et al., 2021) Placing a pillow between the knees improves sleeping posture by lifting the top leg and prevents forward shifting. (University of Rochester Medical Center. 2024)
Increased weight leads to increased pressure on joints.
Significant change in the center of gravity.
Hormonal changes make connective tissues more lax.
Pregnant women with hip or back pain are often recommended to sleep with a pillow between their knees to relieve pain and discomfort. Doctors agree that lying on the left side is the best sleep position during the second and third trimesters. This position ensures optimal blood flow for the mother and baby and helps kidney function. (Standford Medicine, 2024) Placing a pillow between the knees can help reduce the pressure on the joints and also help maintain the left-side lying position. (O’Brien LM, Warland J. 2015) (Standford Medicine, 2024) Larger maternity pillows supporting the abdomen and lower back can provide more comfort.
Consult a healthcare provider about sleeping with a pillow between the knees to see if it is right for you.
What Causes Disc Herniation?
References
Desouzart, G., Matos, R., Melo, F., & Filgueiras, E. (2015). Effects of sleeping position on back pain in physically active seniors: A controlled pilot study. Work (Reading, Mass.), 53(2), 235–240. https://doi.org/10.3233/WOR-152243
American Academy of Orthopaedic Surgeons. (2021). Sciatica. OrthoInfo. https://orthoinfo.aaos.org/en/diseases–conditions/sciatica
Penn Medicine. (2024). Herniated disc disorders. Penn Medicine. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/herniated-disc-disorders
University of Central Florida. (N.D.). The best sleeping position for lower back pain (and the worst). UFC Health Services. https://ucfhealth.com/our-services/lifestyle-medicine/best-sleeping-position-for-lower-back-pain/
Cary, D., Jacques, A., & Briffa, K. (2021). Examining relationships between sleep posture, waking spinal symptoms and quality of sleep: A cross sectional study. PloS one, 16(11), e0260582. https://doi.org/10.1371/journal.pone.0260582
Skarpsno, E. S., Mork, P. J., Nilsen, T. I. L., & Holtermann, A. (2017). Sleep positions and nocturnal body movements based on free-living accelerometer recordings: association with demographics, lifestyle, and insomnia symptoms. Nature and science of sleep, 9, 267–275. https://doi.org/10.2147/NSS.S145777
University of Rochester Medical Center. (2024). Good sleeping posture helps your back. Health Encyclopedia. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=4460
Casagrande, D., Gugala, Z., Clark, S. M., & Lindsey, R. W. (2015). Low Back Pain and Pelvic Girdle Pain in Pregnancy. The Journal of the American Academy of Orthopaedic Surgeons, 23(9), 539–549. https://doi.org/10.5435/JAAOS-D-14-00248
Standford Medicine. (2024). Sleeping positions during pregnancy. Standford Medicine Children’s Health. https://www.stanfordchildrens.org/en/topic/default?id=sleeping-positions-during-pregnancy-85-P01238
O’Brien, L.M., Warland, J. (2015). Maternal sleep position: what do we know where do we go? BMC Pregnancy Childbirth, 15, Article A4 (2015). https://doi.org/doi:10.1186/1471-2393-15-S1-A4
Learning the cause of the problem and how to effectively manage it can help individuals experiencing back spasms to quickly and safely return to previous levels of function and activity.
Back Spasm
Individuals dealing with back pain or sciatica usually describe the symptoms as the back muscles tightening or spasming. A back spasm can feel mild, like a fist pressing into one side of the spine or an intense pain that prevents the individual from sitting, standing, or walking comfortably. Bask spasms can become severe, causing difficulty maintaining normal upright posture.
What Is A Spasm
A back spasm is a sudden onset of back muscle tightness. Sometimes, the tight sensation becomes so intense and severe that it prevents the individual from moving normally. Some individuals have difficulty bending forward because of the pain and tightness.
Symptoms
Most episodes last several hours to several days. Severe cases can last about six to eight weeks, but the spasms and pain subside gradually, allowing the individual to move normally and resume normal activity. Common sensations and symptoms can include:
Difficulty bending.
A tight sensation in the back.
Pulsing pains and sensations.
Pain on one or both sides of the back.
Sometimes, the spasm can cause radiating pain in the buttocks and hips. When severe, it can be accompanied by nerve pain, numbness, and tingling that radiates down one or both legs. (Medline Plus. 2022)
Causes
Back spasms are caused by tight muscle tissue, which often results from some mechanical stress. The stress causes the muscle tissue near the spine to be pulled abnormally. As a result of the pulling, the muscle fibers become taut and painful. Mechanical causes of back spasms may include: (Merck Manual, 2022)
Poor sitting and/or standing posture.
Repetitive overuse injury.
Lumbar strains.
Lumbar disc herniations.
Low back osteoarthritis.
Spondylolisthesis – vertebrae shift out of position, including anterolisthesis and retrolisthesis.
Spinal stenosis
All these can place increased stress on the anatomical structures in the spine. The lower back muscles near these structures may go into a protective spasm that can also cause a tight and painful sensation in the back. Other non-mechanical causes of low back spasms include: (Merck Manual, 2022)
Poor sitting posture or sitting for long periods without back support.
Lack of physical conditioning.
Being overweight or obese.
Psychological conditions – anxiety, depression, and emotional stress.
Family medical history of ankylosing spondylitis.
Smoking
Individuals can stop smoking, start exercising, or engage in positive activities to help manage stress. Individuals dealing with back spasms may need to see a healthcare provider for a proper diagnosis and treatment.
Treatment
Treatment for back spasms can include home remedies or therapies from medical providers. The treatments are designed to relieve the spasms and manage the mechanical stresses that may have caused them. Medical professionals can also show strategies to prevent spasms. Home remedies can include: (Merck Manual, 2022)
If self-care strategies are unable to provide relief, individuals may need to visit a medical professional for treatment. Medical treatments can include: (Merck Manual, 2022)
Most individuals are able to manage symptoms with physical therapy or chiropractic, which includes learning exercises and posture adjustments to relieve tightness.
National Institute of Neurological Disorders and Stroke. (2023). Back pain. Retrieved from https://www.ninds.nih.gov/health-information/disorders/back-pain?
Bhatia, A., Engle, A., & Cohen, S. P. (2020). Current and future pharmacological agents for the treatment of back pain. Expert opinion on pharmacotherapy, 21(8), 857–861. https://doi.org/10.1080/14656566.2020.1735353
For individuals dealing with lower back pain, it could be quadricep muscle tightness causing the symptoms and posture problems. Can knowing the signs of quadricep tightness help prevent pain and avoid injury?
Quadriceps Tightness
Quadriceps muscles are in the front of the thigh. Forces that could be creating chronic pain and posture problems could be happening at the same time are:
Quadricep tightness causes lower back pain as the pelvis gets pulled down.
Tight quadriceps lead to weakened hamstring muscles.
These are the opposing muscles behind the thigh.
Stress and pressure on the hamstrings can cause back pain and problems.
The rectus femoris attaches to the pelvis at the anterior superior iliac spine, which is the front part of the hip bone.
The rectus femoris is the only muscle in the group that crosses over the hip joint, which also affects movement.
When the quadriceps, especially the rectus femoris, become tight, they pull down on the hips.
The pelvis tilts downward or forward, technically referred to as the anterior tilt of the pelvis. (Anita Król et al., 2017)
The spine is between the pelvis, and if the pelvis tilts forward, the lumbar spine compensates by arching.
A larger arch in the lower back is referred to as excessive lordosis and often causes tightness and pain in the back muscles. (Sean G. Sadler et al., 2017)
Hamstring Compensation
When the quadriceps tighten and the pelvis gets pulled down, the back has an abnormal lift. This puts the hamstring on a consistent stretch that can cause pain symptoms.
Healthy posture and hamstring muscle tone help maintain correct pelvic positioning in the back.
This is correct because it helps maintain a comfortable position.
Quadricep tightness can set off a reaction as the pelvis tilts down in front and up in the back while overly stretching the hamstrings.
Pain and soreness are the usual result
Lack of hamstring strength and quadriceps stretching can cause the hamstrings to lose their ability to support correct pelvic and spinal positions. (American Council on Exercise. 2015)
Knowing When Quads Are Tightening
Individuals often don’t realize their quadriceps are tight, especially those who spend most of the day sitting.
The more time spent in a chair can cause the quadriceps and lower back muscles to tighten steadily.
Individuals can try a few tests at home:
Standing Up
Push the hips forward.
Push from the sitting bones so you’re at the correct level.
How far forward do the hips go?
What is felt?
Pain could indicate tight quadriceps.
In A Lunge Position
With one leg forward and bent in front of the other.
The back leg is straight.
How far forward does the leg go?
What is felt?
How does the front of the hip on the back leg feel?
Standing Bent Leg
Stand with the front leg bent and the back leg straight.
Discomfort in the back leg could mean tight quadriceps.
In A Kneeling Position
Arch the back
Grab the ankles
Modify the position to adjust for any pain or joint issues.
If you have to prop yourself up or modify the pose to reduce pain, it could be tight quadriceps.
Helping to understand the condition can help in communication with a healthcare provider.
A healthcare provider and/or physical therapist can conduct a posture evaluation examination to test the quadriceps.
Understanding Academic Low Back Pain: Impact and Chiropractic Solutions
References
Kripa, S., Kaur, H. (2021). Identifying relations between posture and pain in lower back pain patients: a narrative review. Bulletin of Faculty of Physical Therapy, 26(34). https://doi.org/doi: 10.1186/s43161-021-00052-w
Król, A., Polak, M., Szczygieł, E., Wójcik, P., & Gleb, K. (2017). Relationship between mechanical factors and pelvic tilt in adults with and without low back pain. Journal of back and musculoskeletal rehabilitation, 30(4), 699–705. https://doi.org/10.3233/BMR-140177
Sadler, S. G., Spink, M. J., Ho, A., De Jonge, X. J., & Chuter, V. H. (2017). Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies. BMC musculoskeletal disorders, 18(1), 179. https://doi.org/10.1186/s12891-017-1534-0
American Council on Exercise. (2015). 3 Stretches for Opening Up Tight Hips (Fitness, Issue. https://www.acefitness.org/resources/everyone/blog/5681/3-stretches-for-opening-up-tight-hips/
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