New Mysteries to Solve with the Gluteus Medius – Post 6/Month 6

glute medius

Guest Post by Dr. Caroline Withall

At the end of last month I was beginning to finally be able to do some strengthening exercises. Unfortunately, even going at a tentative pace for just a couple of weeks I began to slide again, which has been a source of great frustration.  Reviewing my exercises, I pondered, “why is it that I have been able to progress with glute maximus work through step patterning, yet keep faltering every time I try to consistently do glute medius or core work?”  

I can do this work on occasion, but as I approach a higher frequency of a few times per week seems to cause major flares. Even just deep breathing exercises can be very painful.  It is always in the same region, and I began to realise it is where several nerves pass through.  Essentially from the pubic bone across to my ASIS (anterior superior iliac spine) and it is home to a LOT of trigger points.  

For example, I have several trigger points near the iliacus that not only refer along this area to the pubic bone, but when practising myofascial release techniques on them, I also feel a deep tug towards my glute medius.  However the glute maximus sits completely outside of this web, which may be the reason I am able to work that muscle without pain flares.  

Seeking Help to Solve the Puzzle of Glute Medius Pain

It seems there is some sort of restriction impeding the nerves, perhaps scar tissue? Although I have done a lot of work on external scars, that does not mean there are not some internal ones. Or could it be fascial restrictions? Given I had already adapted my program to include indirect myofascial release work which greatly benefitted my trip to Venice, I sensed this was the direction requiring deeper exploration.  Healing the body can feel like a giant and complicated puzzle. Time to book another intensive trip to Dr. Ginger in person for some help with this puzzle, and I was happy to secure an early spring date.

Neural issues can be hard to deal with mentally as well as physically. It starts with the structural problem that causes it to flare, but if you get stressed about it (and who wouldn’t!) it only exacerbates the situation.  I have gotten so much better at recognising this, however. So while rest definitely has its place, if I have done too much driving and wound up the nerve, I try to avoid doing it for a few days if I can and take more rest. 

Distraction is Still a Powerful Tool

But after the initial recalibration, it is important to keep gently moving and try to distract yourself. What better way to do this than attend an Elvis memorabilia exhibition! I had a lovely fun afternoon with my best friend attending this in London, it was exactly what I needed; not too vast, around 45 minutes to tour it fully, a nice lunch after and only 20 minutes home on the train, so a perfect little outing. 

A bigger expedition this month was a trip to my hometown of Liverpool.  This was a monumental achievement as I have been unable to go home for a proper visit since Autumn 2019! Pre-injury I would travel up several times a year, thinking nothing of the 250 mile drive to get there.  It has been beyond reach for so long, not least because even as a passenger I get very uncomfortable with more than an hour or two in the car, and driving such a distance myself would be too painful.  

Although it was challenging, the benefits to the soul outweighed discomfort and it was so lovely to see family again.  I decided to try train travel to get there, but it didn’t agree with me too well. I found the seat very uncomfortable and it actually flared up my better hip! 

Mercifully all the tips and tricks I have learned from Dr. Ginger enabled me to be comfortable by the following morning, so the next day was not a write off.  For the journey home I decided to go back by car – my hack was to recline the passenger seat right back and use lots of pillows, and to my surprise that, combined with a few stops to walk around, was pretty tolerable.  It was an incredibly powerful psychological boost to know it can be done.  

Always Count Your Wins

Another surprising and unplanned success was how well my hips coped in a crisis.  My husband was away on business and my daughter felt very unwell, yet I was able to manage increased driving taking her to multiple medical appointments as well as playing nurse, all without too much discomfort – another distraction, albeit this one not of the welcome kind! There was little time to keep up dedicated rehab work but I made sure every evening to do the necessary myofascial releases to keep me fit for service.  Two decent victories under my belt to head into Spring with.

I am excited to see Dr Ginger again next week and hopefully unravel the neural and fascial mysteries connected to my glute medius.  It is very much a collaborative experience, and it is enjoyable doing the detective work together – due to our efforts so far, I have become incredibly body aware and literate. Such that I can quite accurately describe the sensations I feel and pinpoint problem areas. This allows her to work out how best to treat and formulate a revised program.  I can’t wait to get stuck in!

“It is very much a collaborative experience, and it is enjoyable doing the detective work together – due to our efforts so far, I have become incredibly body aware and literate. Such that I can quite accurately describe the sensations I feel and pinpoint problem areas.”

– Dr. Caroline Withall

Not getting the results you had hoped after your hip arthroscopy and therapy for hip labral tear, repair, and/ or hip impingement or dysplasia? Are you also female and wondering if hormones or GI function is related to your pelvic pain?

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