A Real Pain in the Butt

So we are talking about butts today. Yes, butts. We all have one and it’s not something to be ashamed of. I will guarantee that many of you have never had proper massage through the area.

Why are we diving into a subject that lends itself to soooo many buns…I mean puns?

We are taking a closer look at the butt because most of us do not appreciate all the work your posterior does for us. Aside from sitting on it, do you have any idea what those muscles do ifor you on a daily basis? Do you know about the havoc they cause when they are are being overworked and/or mistreated.


Yes, no, maybe? None of the above?

Your butt is composed of three muscles. In order from largest to smallest: Gluteus Maximus, gluteus medius , and gluteus minimus.

These muscles work in concert to extend your torso into an erect position. They extend your leg from a flexed position and hyperextend the leg behind you. The glutes also abduct your leg, rotate it medially and laterally, stabilize the pelvis, and via the iliotibial tract [maximus], stabilize and rotate the knee.

Hold it poindexter, whats with all the sciencey words? You are losing me.

Okay, the glutes are the motor of the body. And as muscles go they are pretty interesting in both form and function.If you are standing up, bending over, walking, running, jumping, or kicking someone in the shin, the glutes are working hard to make that possible.

Glute Max kind of steals the show. It’s the badass of the ass. It’s Mad Max if you will. This muscle is one of the biggest and strongest that you have. It can produce an incredible amount of force and readily adapts to many forms of training.

So with this muscle group it’s all fairy tales and awesomeness right? Powerful, keeps me standing up, makes you look appealing to the opposite sex, lets you kick people.

Unfortunately,  this muscle group has a dark side. Aside from being an endless source of insecurity or unwanted attention from other gym goers the glutes can also can also be the source of back pain.

Yes, back pain.

The back is a glorious piece of physiology, but it can be VERY finicky. For that reason we will all have bouts with back pain. You can tweak it while helping a friend move, twist the wrong way making dinner, subject yourself to yoga, do a bad squat, or  just sleep wrong.The resulting pain can be an inconvenience or it can be debilitating. The pain can start as one and transition to the other too. And back pain comes in a surprising number of flavors. It can be sharp, dull, achy, hot, persistence, intermittent, bright, or just annoying.

Most people come at muscoskeletal complaints with foam rollers, stretching, or some sort of over the counter pain reliever. Obviously, I’m partial to massage and bodywork.

You may have even tried massage. You feel pretty good while you’re on the table and perhaps for a short while after. However for an many unlucky folks the pain and stiffness returns. That’s because the underlying cause of the issue has not been touched on.

And I mean this both literally and figuratively. The therapist likely worked your back like a pro, but that is not where the issue is rooted. You may have noticed that a surprising number of massage therapist gloss over the glutes.


Bodyworkers (a broader term for massage therapists) often have their own hangups about working on a clients butt or they believe their clients have hangups about having their butts touched.

The former is unprofessional while the latter can be legitimate concern. Let’s just clear this up real quick for all parties involved. Work through the glutes is amazing.


You do not have to expose your bare buns if you do not want to.  No therapist should mandate or expect that of you. Any therapist worth their salt, can work with the glute muscles while you are in clothes or alternately through the draping sheet.

Bare skin does offer some small benefits because it lets your therapist work the low back, hip, and glutes with long connected strokes and makes finding specific muscular locations easier.  Believe me it does not matter to me what your butt looks like (hairy, boney, plump, whatever). I’m there to work the muscle underneath all the superficial skin.

So how is it something in your glutes can have cause problems  that reach all the way up your back?

The simple answer is that the glutes are anatomically part of your back. By that I mean their fascia, the saran wrap that surrounds your muscle is fused directly in to the back extensors. The fascia of the glutes also connects to a GIANT tendinous aponeurosis that connects and transfers forces through the back and pelvis.


Forces are transferred via the fascia and the aponeurosis that connect the glutes to the low back

It’s easy to see why the low back and the butt form a “perfect storm”. Both regions are large powerful muscles that are bound together and in many cases pulling on one another or even use each other for leverage. This structural system is also shared by nerve pathways that allow pain and tightness to be referred to region far away from it’s origin.

So what should you do if you have back pain that does not seem to let up or is irritated by activities such as sitting, walking, squatting, or running? Well the first thing you can do is do a little home testing.

For this you’re going to need a friend that you are are good terms with OR a tennis ball that you know really well.

1.) Lay face down on the floor. If you have recruited a friend assure them that you will be in your clothes.

2.) Have this friend find your sacrum and the crest ridge of your hip (indicated in GREEN).

3.) Have your friend press gently into the soft tissue lateral to the sacrum and below the crest of your hip (your butt cheek) using a balled up fists.

4.) Have them move in slow arc like patterns (indicated in BLUE) that move out and down toward the top of your femur (the long bone of the leg). It’s like a game of muscular minesweeper!

5.) Please note the sciatic nerve (indicated in YELLOW). If you feel an electric sensation down your leg your friend is pressing on it. Tell them to stop doing that.

6.) You are looking for spots that illicit a sweet ache or feel meaningful ( learn more about trigger points here). If they find a spot that feels meaningful experiment with direct pressure, kneading, or pushing up toward your pelvis/sacrum while hooked into the tissue.

7.) Deeper is not always better! And if it hurts really bad your not doing it any good. In fact, you’ll likely make it worse. No pain, no gain is not how great massage works!

8.) Repeat on the other side. If they are a true friend have them work up the hip and into the low back itself.

9.) Experience sweet, sweet relief

NOTE: If you use a tennis ball (or other ball) the results may not be quite the same, but it will do for confirming the issue is in your glutes. You will be laying face up and placing the ball under your buttocks. You will be doing a similar sweeping pattern and watching out for the same things. DO NOT GET OVERLY AGGRESSIVE WITH THE PRESSURE. I promise, it can make it much, much worse.

See the instructions above for a game of muscular minesweeper.

That’s the end of the article.


The Skinny on Trigger Point Therapy

If you’re new to getting massage and certainly if your a veteran client, you have heard of term trigger point lobbed about. You may have been given some vague description of the phenomenon that included terms like: knots, toxins, adhesions, lactic acid, sticky muscle fibers, fascia and you probably came out of the conversation still wondering what the hell your therapist was talking about.

Trigger point is one those terms that is often used by therapists to give themselves the air of credibility. Sadly, most massage schools do not teach trigger point in a way that produces competent practitioners. And even continuing education on the topic can be pseudoscientific in nature.

What the heck is trigger point?

Trigger point therapy is a specific mode of muscular therapy that is NOT something I would recommend for your first visit, unless you have experience with this modality. At the very least, I would recommend reading this entire page.

This modality is one of the few that can be described as painful. However, I’d like to qualify, that in clinical massage there is such a thing as good pain. Many clients describe it “the sweet ache” and often enjoy the sensation.

I know, it sounds crazy, but I promise it’s not.


Trigger point is based on the theory that muscle tissue at a cellular level can begin to malfunction. Muscles at a microscopic level are composed of molecular motors composed of proteins (actin and myosin). These protein motors use both chemical and electrical signal from your body to initiate and suspend muscle movement and as we age they can begin to malfunction.

When this happens a small “muscle knot” can develop. Muscle knots are better described as a microscopic cramp or a TRIGGER POINT; it is an area that for an unknown reason is now stuck in a contracted state. Nearly every adult has these, but not all trigger points cause pain or at least they don’t cause prominent pain. Others go on to become monsters. And I truly mean monsters.

As the small area of tissue continues to stay contracted it begins to produces normal, but harmful metabolites like pyruvate, lactic acid, and CO2 in addition the ion gradients of Calcium and Magnesium can be altered causing sustained muscle fiber contraction (this is also what happens in a full on muscle cramp).

These areas can often grow. As the metabolites build up they begin to effect the house next door and then pretty soon the whole block is bad, then the neighborhood, and eventually you get an area of muscle that looks like Detroit.

You’ll notice I don’t use the word “toxin” and honestly you should be afraid of any massage therapist who does. Toxin is a lazy term and has very little meaning in science. It also leads people to try bizarre things that in the end are just really expensive time wasters.

Treatment Method Detail:

In trigger point we are trying to interact directly with tissue that is exquisitely painful and we are going to do so with a great deal of dirc

If you have had trigger point done somewhere else you may also find my methods unique. In my experience, many therapists do not receive in-depth Trigger Point training and there anatomical knowledge may be lackluster as well. This set the stage for a session that feels more like a game of battleship than a targeted treatment.

When you come in for session:

1.) We will have a conversation about what is bothering you. I will ask questions like:

What does the pain feel like?
What makes the pain worse?
What makes it better?
I will do a hands on exam of the area.

2.) We will begin with a tissue warm up, which is part massage and part investigation. I will be asking lots of questions and asking for feedback.

Essentially we are making a map of Trigger Point pain referral zones

True trigger points should present with signs like:

♦  Muscle twitching
♦  Mimics and or intensifies the pain
♦  Causes spasms or cramping
♦  Intense “sweet ache” when pressure is applied

3.) Once we find a true trigger point I will use direct pressure to sink into it. During this process I will be asking about your pain level, referral patterns, etc.. We generally aim for a moderately high (7-8 out of 10) rating of discomfort. Once this is reached the pressure is held for 30 to 120 seconds.

If needed the process will be repeated either immediately or after a short break. Obviously, I will never go past your threshold. We do not push through pain because it is not necessary and it can make the problem worse!

In trigger point we are having a very direct conversation with your nervous system and we want to be direct, but there no need to yell.

4.) Once we have addressed a majority of the trouble spots the session ends with a round of massage that encourages blood flow and will promote localized inflammation. I know inflammation is a bad word these days, but it’s also a necessary and beneficial part of the healing process. 

5.) If I have done my job you will notice a difference as soon as you get off the table. In most cases full results will not be evident for a few hours. The next day you may have some residual pain where pressure was applied. In very rare cases you might see a small bruise, but I do everything I can to minimize this side effect.

For particularly bad trigger points (the monster ones) we may use a tactic known as spray and stretch. This is a local treatment that involves cryotherapy and very specific muscle mobilization.