“I’m sorry to have to tell you this, your butt is dead.”
Unfortunately, I’ve had to “call it” in my practice on more occasions than I would like. While it sounds funny, gluteal amnesia (more affectionately referred to as “dead butt syndrome”), is no laughing matter. It’s a problem that can onset without direct pain or injury and progress slowly over time, usually without a person even knowing it is happening. In a lot of cases, this makes the problem difficult to recognize until it is already causing pain and functional limitations. Gluteal amnesia is usually a secondary manifestation of a combination of issues with body mechanics that results in reduced strength, limited mobility, and balance issues.
However, there is a cure! A sort of resurrection, more appropriately. If properly diagnosed and treated, most patients’ butts can be brought back from the dead – so to speak.
Jokes aside, before we discuss the solution, we must first understand the problem. The biggest issue that contributes to gluteal amnesia (along with a whole myriad of other health issues)…is sitting. Yes, sitting is literally killing your butt. Data from the Center for Disease Control and Prevention (CDC) shows that, in a survey of about 6,000 people, about 1 in 4 people sit over 8 hours per day. Also, about 44% of people report not engaging in any moderate to vigorous physical activity during the day.
How is sitting a problem though? I mean you’re not doing anything to cause a problem, right? Well, that’s exactly the problem. Just because a muscle isn’t doing anything, doesn’t mean that it isn’t changing. But the changes that come with a muscle not being activated are usually never beneficial.
Back in the late 1980’s, Dr. Vladimir Janda introduced the concept of “lower crossed syndrome” (LCS) to define a combination of alternating areas of tightness and weakness in body mechanics that commonly contribute negatively to one another and compound over time. In short, LCS is mainly characterized by tight low back muscles, weak gluteal muscles, tight hip flexor muscles, and weak core muscles.
The more we sit, the less we use our muscles. When muscles don’t get used, they get weaker, and the muscle fibers change into fat within the muscle (think of a really over-marbled steak). This is called fat atrophy. Also, the muscles that are shortened (such as the hip flexor muscles when we sit), become tighter as they weaken. Muscles prone to tightness usually have a “lower irritability threshold,” which means that they activate improperly under lower load. These changes lead to a biomechanical pattern that continues to generate more tightness, more weakness, and so on.
So how do we fix it, Doc?
The answer is multifactorial, but the essence of treating the problem effectively is first diagnosing the problem effectively. Gluteal amnesia can arise from a multitude of different medical issues, but a good musculoskeletal specialist (such as myself) should be able to effectively diagnose the majority cause and arrange an effective treatment plan. Recent research in the journal Clinical Anatomy from November 2019, does show a direct correlation in lateral hip pain with atrophy and fatty change seen in the gluteal muscles. Sometimes, it’s a “chicken or the egg” effect, where multiple issues may be contributing to the same problem in different ways, and vice-versa.
Sometimes, the largest hurdle in recovery is the willingness to admit that there is an issue. Often times, the underlying mechanical problems get overshadowed by a patient’s own bias toward a diagnosis they have already been given, maybe by another specialist or maybe just a friend mentioning something in passing. Secondary manifestations of gluteal amnesia include low back pain, hip pain, bursitis, piriformis pain, knee pain, leg pain, pelvic pain, and sciatica (just to name a few). It can often be confused with spinal stenosis, degenerative disc disease, arthritis, or other pathologies that may or may not actually contribute to the pain.
Appropriate education of the patient is key to appropriate recovery. Patients recover better when they are more aware of why they hurt and what they can expect. It’s a complex issue that requires a detailed understanding of body mechanics, but that’s my job. I always take time to explain the problems to patients so that they understand why different issues are affecting them.
Together, we can work to bring all butts back to life. Let’s fight the good fight.