The gluteus medius is one of the main buttock muscles that are responsible for holding the pelvis stable and supporting your body on your legs when standing, walking, or running. It also helps control the sideways movement of your legs. If the gluteus medius is strained in some way, it can become tender and tight and less able to function normally.

Gluteal Muscles

Causes for Gluteus Medius Dysfunction

Stress or tension alone, if it continues with some intensity over a long period of time, can make your gluteus medius tighten up. Apart from the pain this causes, the muscles may become shortened and less flexible. In addition, referred pain from the spine or hip can cause dysfunction in the muscle. However, the most common cause of  injury to the gluteus medius is overworking or stretching them beyond their normal range. Athletes, particularly runners, hurdlers, and long jumpers, frequently overuse their gluteus medius and soometimes cause them to tear from failing to adequately stretch or warm up before any activity, particularly in cold weather. A less common cause of gluteus medius trauma is a direct impact, such as a heavy fall onto the buttocks, which usually leads to bruising and irritation of the underlying bursa (a protective fluid-filled sac).

Symptoms and Diagnosis for Gluteus Medius Dysfunction

Apart from buttock and hip pain on one or both sides of your body, and possibly leg pain, you may feel stiff, be slightly unstable when standing, and find moving your hip awkward. Your doctor will carry out a physical examination to establish the cause of your problems.

Risks and Recovery for Gluteus Medius Dysfunction

Minor strains and bruises will usually heal on their own within a few weeks, but if action is not taken fairly promptly to rehabilitate overtight or stretched muscles, recovery may be slower. Muscles held in a state of tension for too long will fail to regain their former range of movement and response.

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Pain or soreness occurring in and around  the coccyx – the three to five fused vertebrae at the base of the spine that are often referred to as the tail bone – can vary from general discomfort to bouts of sudden sharp or nagging pain. Also known as coccygeal pain, this condition tends to be brought on or made worse by sitting down.

Taibone Pain (Coccydynia)
Taibone Pain (Coccydynia)

Causes for Coccydydynia

A number of very different sets of circumstances appear to be responsible for trigger episodes of tenderness and pain in and around the coccyx region. Muscle spasms that have been brought on by prolonged tension and stress might be a trigger, for example, as might a damaged ligament that has been caused by a heavy blow or fall. In a large number of cases, coccydynia is he result of sitting in more or less one position for a very long period of time. Many women also suffer bouts of pain around the coccyx after giving birth. It is always important to have these symptoms checked by a doctor.

Symptoms and Diagnosis for Coccydynia

You will find it uncomfortable and often very painful to sit down, with the pain getting worse the longer you stay in one position. There may also be some inflammation and bruising in the coccyx area. Occasionally, bowel movements can be painful. Your doctor will make a diagnosis by performing a physical examination, and may order X-rays if he suspects you have broken bones.

Risks and Recovery for Coccydynia

Coccyx pain can be difficult to treat, so it needs an expert eye and awareness of the full range of related conditions that can occur; as such, the main risks stem from inadequate treatment. If your pain persists for several months and is consistently severe enough to make daily life difficult, a local injection of cortisone may reduce any inflammation and alleviate your symptoms. In extreme cases, where a fall or blow has damaged the coccyx, you may need surgery to remove any loose bone fragments and possibly the last few segments of the coccyx, but this is usually a last resort.

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Pain often occurs when one of the facet joints that link the vertbrae in your spinal column is suddenly twisted or jerked. A joint that is damaged in this way may stick or “lock”, making movement difficult as well as painful. Facet joint strain can occur throughout your spine.

Facet Joint

Causes for Facet Joint Strain

Awkward twisting or bending of your neck or back can injure the ligaments, muscles, or the capsule of a facet joint. Whiplash from a car accident is a good example of this type of injury, but it can also result from failure to warm up before exercising or playing sport, or from lifting heavy objects. Even simply turning over in bed or sleeping awkwardly can have the same effect. Your muscles may then go into an uncontrollable spasm, making the joint stiff and immobile. Facet joints are more vulnerable to strains from middle age onwards, when osteoarthritis may flare up, the discs in your spine have degenerated significantly, and the ligaments that are supporting the joints become more slack.

Symptoms and Diagnosis of Facet Joint Strain

In the early stages, disabling pain in you neck or back is often accompanied by restricted movement. Pain from facet joint strain in your lower back may also radiate into your buttocks, hips, lower abdomen, and thighs. Movement may be limited for only a few weeks; however, it can last for months, and in some cases years, unless you receive appropriate treatment, which usually involves manipulation or, in chronic cases, an injection. Facet joint strain in your neck may extend down to your shoulders,  making it difficult to bend your neck or turn your head. Your doctor will make a diagnosis by giving you a physical examination.

Risks and Recovery for Facet Joint Strain

There is no serious risk from facet joint strain, but failure to relieve pain or inflammation can lead to permanently stiff joints. Joint strain in the middle of your back, although the least common, may cause pain to radiate around your chest, making it painful and difficult to breathe, especially if the joints between the ribs and thoracic vertebrae become “locked”.

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Weakening of the bones is fairly common in old age and may also occur in younger people who are in poor health. When this loss of structural strength affects the vertebrae of the spinal column, even a slight increase in pressure on them – perhaps due to a fall or sudden vigorous activity – can cause cracks and fractures, especially in the mid – and lower back.

Compression Fracture

Causes of Vertebral Compression Fracture

Osteoporosis is the most common cause of bones (including the vertebrae) becoming weaker and more susceptible to injury. The condition causes loss of minerals from the bones, making them less dense and more fragile. It mainly affects women after the menopause, due to hormonal changes, but men also develop osteoporosis to some degrees as they age. If you are a heavy smoker, alcoholic, do little exercise, or have suffered from an eating disorder (such as anorexia) and are still underweight and very thin, you have a high risk of developing osteoporosis.

Symptoms and Diagnosis for Vertebral Compression Fracture

If you fracture a vertebra, you will feel a sudden, severe pain in he area of your back where the injury has occurred. Damaged vertebra in your lower back may also cause pain around your pelvis and, if any nerves are irritated, numbness and tingling in your legs. In the upper part of your back, the pain may radiate around your chest and make breathing difficult. You may find it hard to move around, and even lying down can cause pain; coughing or sneezing may hurt too. This pain and lack of mobility is likely to take several weeks to subside. Your doctor may arrange for a CT or an MRI scan to assess the extent of the fracture.

Treatment of Compression Fractures

Treating the osteoporosis with medicines and calcium and treating the pain with analgesics. A brace or corset is sometimes recommended, to keep the back stable as the bones heal. Surgery may be needed if there is any loss of function because of bone pressing on the spinal cord or spinal nerves.

Risks and Recovery

Without treatment the shape of your spine and your posture may be permanently affected. While the pain lasts you are likely to find it difficult to perform everyday activities.

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These linked conditions generally affect your lower back but may occur in any part of your spine. Spondylolysis occurs when a defect or weakness in a vertebra is then at risk of slipping out of line with the vertebrae adjacent to it, leading to spondylolisthesis, which can be debilitating and painful, or may be painless and go unnoticed.

Causes

Spondylolysis may start with a minor crack across the narrow arch of bone in a vertebra, known as the neural arch. In some cases, this crack is present at birth, but usually it is the result of a fall or due to strain and overuse. Some sports, such as cricket and football, repeatedly put stress on the arches of the vertebrae, which can lead to minor cracks or breaks. Spondylisthesis generally develops from spondylolysis, with the crack widening to a complete break due to further stresses and strains. This break allows the damaged vertebra  to slip out of line, which can irritate the linked facet joints and ligaments and possibly trap a nerve.

Symptoms and Diagnosis

The pain from a displaced vertebra due to spondylolisthesis depends on the degree of slippage. A slight slip may cause little or no pain, while a greater degree of slippage can lead to more intense pain because of the irritation to the spinal joints and ligaments. If your nerve is trapped, there may be some pain, numbness, or “pins and needles” in one or both of your legs. Your doctor will make a diagnosis is through a physical examination and testing including an X-ray, MRI scan, and myelogram.

Spondylolisthesis

Risks and Recovery

Back-strengthening exercises can help stabilise your posture, but where vertebrae have severely slipped, nerve entrapment can develop that may require surgery. Young people diagnosed with spondylolisthesis should avoid contact sports and activities with a high risk of back injury. A young person who is still growing should be monitored every six months, using X-rays to detect further movements and shifts in the spinal column. Once growth stops, the vertebrae are unlikely to slip any further.

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