Runner Therapy

Runner Therapy: Butt pain, the shin splint of the hip

glutePain in the upper, outer quadrant of your glute? Close to your back, close to your hip…you aren’t quite sure where you hurt but it’s there. Especially on pick-ups and speed work.
Could be your glute medius. The glute medius is not the big butt muscle BUT it is another broad muscle just below the glute. It comes from the top of the iliac crest, the large bone you rest your hands on when you rest your hands on your hips. From here, it dives lower down.
Pain in this muscle is anywhere from the iliac crest down toward the hip and mid-butt. It can often be sharp or just feel like a dull ‘shin splint’. And that’s almost exactly what it is.
Like a shin splint it is generally micro-tearing of the muscle as it attaches to the bone. Think little microscopic tears that add up to the feeling of a pulled muscle. Anything attaching so close to the muscle means some nasty swelling, so pain follows suit.
The best treatment for this, given its difficult etiology, is similar to shin splints. ‘Relative rest’, ice, massage and stretching the surrounding muscles is the prescription.
‘Relative rest’ is what I define as trying to avoid symptomatic movements while keeping active. This may be biking, swimming, weight lifting in a pain-free way, or it may be running a slower pace, avoiding hills or speed work or longer runs as often those are the only painful runs.
Like a shin splint, running through the pain will just cause more inflammation and micro-tearing and can often cause stress fracture in some cases, as too much pulling on the bone can always cause bone injury. Although, like shin splints, running through a small amount of discomfort is not too horrible…it just won’t fix the problem.
Deep tissue massage can help loosen the muscle off the bone and relax the tissue, while ice and anti-inflammatories can lower the inflammation and thus lessen the pain.
Stretching the area is challenging since the glute medius is often difficult to stretch. Most of us won’t feel an effective stretch here. However, stretching the low back, hip rotators (piriformis), rolling the IT Band and stretching the glutes will be of some limited help.
Strengthening is not as advised as gentle stability training of the muscle as it is used in real life. Slow step ups or single leg-type squats can be effective for turning the muscle on and off so it remains active, but should never be done to fatigue or ‘work out’ the muscle. Working out an already tired muscle can cause further fatigue.
This is, in essence, probably where the problem originates. The more tired and/or overtrained we get, the harder it is for this muscle to stabilize the hip during the single leg stance phase of running. Quite interestingly, it is not the leg we are balancing on that has the issue…it’s the opposite…as the glute medius prevents the alternate side hip from dropping!
This is also why it is best to seek treatment. Understanding the details of how the squats and step ups are to be performed is paramount. (They are performed on the side of pain, BUT it’s the opposite side we focus on moving to lift the hip to neutral.)
Preventing this injury is much like preventing any injury due to running….being sure you don’t continue to run when your legs are tired! (I’m quite sure none of us have ever done that, right?!). Having endurance of the glute medius through similar exercises as above and through biking or other weight bearing cross-training exercises may also be helpful.
Have you ever had trouble with this type of injury? What sort of prevention worked for you?  Did you run through it or take a break?
- Marisa

(Marisa, a MS PT SCS ATC, is a member of  iRunnerBlog’s team and writes the Runner Therapy column, she is a physical therapist in private practice in midtown NYC called Dash Physical Therapy.  She one of only a dozen or so physical therapists  in the state of NY to be board certified in sports.)

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