Dead Butt Syndrome and other fairy tales affecting those who run

A few weeks ago, I read an article that was posted on the NY Times website regarding something called Dead Butt Syndrome (http://well.blogs.nytimes.com/2010/12/21/when-the-diagnosis-is-dead-butt-syndrome/).  Apparently, this is a problem with the gluteus medius (one of the larger muscles in the butt) which is this person. The person who wrote this article is a veteran runner and as she said “For people who have persistent pain, it’s healing gone wrong,” Dr. Bright said. “That gluteus medius isn’t firing the way it’s supposed to. You’re getting an inhibition of the muscle fibers. It’s kind of dead.”

The problem with this all-encompassing diagnosis of Dead Butt Syndrome is the same with many of the attempts to globally diagnose and then come up with a cure without fully understanding the mechanisms involved.  These problems begin with the fascial system and develop into poor firing patterns which encompass the legs, feet, core, and even the upper body.

Thomas Meyer’s book on Anatomy Trains (available through Amazon.com) shows that myofascia actually controls motion, not the muscles making this diagnosis a part of the problem rather than the solution.

As many of our patients know, I diagnose through active evaluation, treat the fascial restrictions, and then retest the firing patterns involved.  Sometimes my first impressions are right on but I do a number of maneuvers until I figure out how to restore a more normal firing pattern.  Often, tight hip capsules (fibrous tissue surrounding the hip) can cause this problem, as well as foot overpronation and gait asymmetry.  It does not just happen to nice people like this author.  The Fascia surrounding the muscles tightens, causing the gluteus medius to recruit in other muscles such as the obliques, hamstrings, other gluteal muscles, and erector spinae, and even affects the upper back as the problem worsens.

Dead butt is a symptom, not a syndrome, although the idea gets a lot of attention.

This type of piecemeal diagnosis only addresses the symptom of poorly stabilizing glutes, which is really a gait issue symptom.  This person was over and under-striding, (one leg is tight in the back, the other tight in front causing a short stride on one side and a longer stride on the other) way before the symptoms appeared and likely ran and stretched through it.

Like most things mechanical, you can run it until it dies or fix it so it won’t. The net effect is torsion of the pelvis, causing a loss of leverage, and tight legs with a shorter stride.  As your stride shortens, you may easily pull muscles, have problems in the calves, and mechanically have issues increasing ground impact resulting in many of the most common running injuries.

To fix this, you need to understand that a diagnosis of dead butt is just a symptom, rather than the cause.  You cannot, as many runners have learned, fix this without understanding the mechanisms behind it. Unfortunately, most healthcare providers offer treatments or diagnoses based on where you hurt rather than why you hurt.

There is no such thing as a dead butt but it gets a lot of attention anyway.  There is a thing called foot overpronation or supination or asymmetric gait which will cause this type of problem. The torsion caused by asymmetrical gait patterns worsens over time due to poor adaptations of the musculoskeletal system and torsion in the lower body will also affect how your upper body moves as well.   The DNA spine idea is an easy way to understand it.   You are trying to run all twisted but have no idea that you are other than feeling kinked up all the time and having many of your joints pop constantly and not understanding why.

Nor can you endlessly train the core when it is affected by tight shoulders and legs.  The core is merely a conduit that we move the forces through from the ground up as we walk.   This is why symmetry is the most important thing for runners, and a good running style is symmetrical regardless of whether you are mid-foot or heel strike in your approach to running.

Solving running problems often requires looking outside the symptom box and understanding what is unique to you.  One size fits all solutions often fail because they are not addressing your unique problems.  Often a good sports chiropractor is your one-stop shop for running-related problems.

It is quite common during an office visit to evaluate the patient, the shoes, and body symmetry, and often, a treadmill is a great tool for understanding difficult-to-diagnose running issues.  This is why a holistic primary care approach is essential for understanding why problems such as dead butt continue to exist.   Often the solutions are simple and practical.   Your running depends on it.

Looking for a solution to your running-related problems? Book online here for either our Scotch Plains or North Brunswick offices.