Gluteus Medius and back pain: The Muscle that may cause your back pain

Buttock Muscles

Gluteus Medius

Location 

The gluteus medius muscle is one of the three gluteal muscles in the buttock. The other two gluteal muscles are gluteus minimus and gluteus maximus. Gluteus medius is located more in the outer part of the buttock and for the most part, it is covered by much larger Gluteus maximus. Gluteus medius is not covered by gluteus maximus at the upper outer portion of the buttock. This is the area where injections are usually administered.

Function

Gluteus medius is not a very big muscle, but it is a thick and strong muscle that plays an important function in allowing us to walk upright. With each step, the gluteus medius muscle on the supporting leg has to contract, to keep the opposite side of the pelvis from dropping down when we lift the opposite leg to make the next step. That translates to generating a force twice the bodyweight every time we take a step. It is not hard to imagine that this muscle tends to get severely overworked when we carry additional weight for prolonged periods of time. This is one of the reasons why many people present with worsening of their back pain after hiking with a heavy backpack or when ruck marching with full gear without proper train up. While it is not intuitive to associate buttock muscles with back pain, this muscle is one of the most important players in the low back pain.

 

Gluteus Medius and back pain

When gluteal muscles get severely overworked, they become tight and develop trigger points. At this point many people begin to waddle to transfer their body weight fully over the supporting leg when taking a step. This is simply a protective and compensatory mechanism since the gluteus muscles cannot fulfill their function of contracting and relaxing when walking.  The reason why we may feel back pain when gluteus medius is affected, is because the trigger points in the gluteus medius refer pain into the lower back. (please see the images). Certainly, gluteus medius is not the only muscle responsible for back pain. More frequently than not, another muscle called Quadratus Lumborum is affected along with gluteus medius. These two muscles work in tandem and the referral pattern from their respective trigger points overlap. Therefore it is important to always check for presence of trigger points in both of these muscles. Quadratus Lumborum will be discussed in a separate section, but you may remember that one of the hallmarks of involved Quadratus Lumborum is pain when turning in the bed, when coughing or sneezing.

Most characteristic pain caused by trigger points in Gluteus Medius

The pain referred from trigger points in the gluteus medius is mostly felt right above the beltline, but strong sensation can be also felt in the sacral area (please see images). In many cases, pain in the outer part of the hip, known as trochanteric bursitis, has a strong component of involved gluteal muscles, and gluteus medius being one of the main muscles involved.

 

 

 

Location of trigger points & Acupressure tips

To locate the trigger points in the gluteus medius, please refer to the detailed description below. In general, however, they can be found along the iliac cress which is the top part of the pelvic bone. The best way to deactivate the trigger points in the gluteus medius is by leaning against the wall and using a baseball or a tennis ball. Alternately, you can place the ball on the floor and lay down on top of the ball to create more pressure. Using a foam roller is not the best method to address these trigger points, because the foam roller cannot deliver the specific pinpoint pressure through the layers of the fat tissue in the buttock muscles.

Summary

Symptoms

Pain in the lower back just above and below the beltline

Pain often extends into the buttock and hip

Pan in the hips can make it hard to find a comfortable sleeping position

Pain in both the hips & lower back can make walking almost impossible

 

Location of trigger points

Find the bony prominence above your groin (ASIS)

The first trigger point is about 2” behind ASIS

Locate the 2nd trigger point about 1 hand breath behind the 1st one

Find the 3rd trigger point next to the sacrum

 

Pain radiation

To the sacrum

The outer part of the hip

Buttock and lower back above the sacrum

Occasionally along the IT band & back of the thigh

Causes for development of trigger points

Obesity or pregnancy

Carrying heavy weight while walking

Weight lifting

Sitting on a wallet in the back pocket

Habitual weight bearing on one side

Carrying a child on the same hip

Trigger points self-acupressure

Locate the 1st  trigger point

Place the ball between the wall & the buttock

Move the ball horizontally over the tender spot

Find a new tender spot  behind the 1st spot

Repeat rolling over the tender area

Find the 3rd spot next to the sacrum & repeat

General recommendations

Move ball over the tender area 15-20 times

Find a new spot & repeat the process

Apply this massage at least 2-3 x a day

Several short daily sessions are preferable

Do not apply very strong pressure

Follow up after trigger point massage

The benefits of acupressure can be greatly enhanced with a few additional techniques applied after completion of acupressure. One of the most important modalities in the treatment of myofascial pain is heat. Application of moist heat to the area of trigger point after trigger point massage will dilate local blood vessels and improve blood circulation. Improved blood circulation helps to flush out the inflammatory substances which irritate local nerves and cause pain. Improved blood circulation will also promote healing and loosen up tight muscle tissue.  Apply heating pad for 10-20 min, take a hot shower or bath. After massaging and warming up the muscles, you can gently stretch them. Stretching is another essential aspect for recovery from and prevention of muscle injuries. Lastly, apply topical analgesics such as Bengay or Tiger balm.

Acupressure

Stretching Exercises

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Fatty Liver: The Surprising Health Risk of a Sedentary Lifestyle

Medicine Corner with Dr D 

Fatty Liver: The Surprising Health Risk of a Sedentary Lifestyle

Fatty liver, also known as hepatic steatosis, is a condition in which excess fat accumulates in the liver. The liver is responsible for filtering toxins and producing essential substances such as bile, which helps in the digestion of fats. However, when there is too much fat in the liver, it can lead to inflammation and damage, ultimately affecting the liver's ability to function properly.

Fatty liver is becoming increasingly prevalent, with recent studies suggesting that it affects up to 25% of the global population. The condition is often associated with other health problems such as obesity, type 2 diabetes, and metabolic syndrome. In fact, fatty liver is often considered a manifestation of metabolic syndrome, which is a cluster of conditions that increase the risk of heart disease, stroke, and diabetes.

 

The impact of fatty liver on overall health cannot be overstated. The liver plays a vital role in many bodily functions, and its impairment can lead to serious complications. Fatty liver is often asymptomatic, but it can progress to more severe forms such as nonalcoholic steatohepatitis (NASH), which is characterized by inflammation and scarring of the liver. NASH can eventually lead to cirrhosis, liver failure, and liver cancer.

 

In addition to the liver-related complications, fatty liver has been associated with an increased risk of cardiovascular disease. This is because fatty liver is often accompanied by other risk factors such as high blood pressure, high cholesterol, and insulin resistance

II. Causes of Fatty Liver

There are several factors that contribute to the development of fatty liver. These factors can be broadly categorized into lifestyle factors, genetic and metabolic factors, and underlying medical conditions.

 

Lifestyle Factors:

Diet, exercise, and alcohol consumption are all significant contributors to the development of fatty liver.

 

Diet: A diet high in fat and sugar can lead to an increase in fat accumulation in the liver. This is because excess calories from these foods are converted to triglycerides and stored in the liver.

 

Exercise: Physical activity helps to burn excess calories and reduce fat in the liver. A sedentary lifestyle, on the other hand, can increase the risk of developing fatty liver.

 

Alcohol Consumption: Excessive alcohol consumption is a well-known cause of fatty liver, and can lead to a more severe form of the condition known as alcoholic liver disease.

 

Genetic and Metabolic Factors:

Several genetic and metabolic factors can also contribute to the development of fatty liver.

 

Insulin Resistance: Insulin resistance is a condition in which the body's cells become resistant to the effects of insulin, a hormone that regulates blood sugar levels. This can lead to an increase in the production of triglycerides in the liver, which can contribute to the development of fatty liver.

 

Genetics: Some people may be more susceptible to developing fatty liver due to genetic factors. Certain genetic variations can affect the way the body processes and stores fat.

 

Link Between Obesity and Fatty Liver:

Obesity is a significant risk factor for fatty liver. Excess body fat, particularly around the abdomen, increases the risk of developing fatty liver. Obesity is also closely linked to insulin resistance and metabolic syndrome, both of which can contribute to the development of fatty liver.

III. Complications of Fatty Liver

Fatty liver can lead to several complications, some of which can be life-threatening. The most common complications include:

 

Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH):

NAFLD is the most common form of fatty liver disease and is often associated with obesity and insulin resistance. It is a relatively benign condition that does not typically cause significant liver damage. However, in some cases, NAFLD can progress to NASH, a more severe form of fatty liver disease. NASH is characterized by inflammation and scarring of the liver, and can eventually lead to cirrhosis, liver failure, and liver cancer.

 

Increased Risk of Liver Cancer and Liver Failure:

Fatty liver has been associated with an increased risk of liver cancer and liver failure. This is because chronic inflammation and scarring of the liver can lead to the development of cancerous cells and impair the liver's ability to function properly.

Association between Fatty Liver and Cardiovascular Disease:

Fatty liver has been linked to an increased risk of cardiovascular disease. This is because fatty liver is often accompanied by other risk factors such as obesity, high blood pressure, high cholesterol, and insulin resistance. These risk factors can lead to the development of atherosclerosis, a condition in which fatty deposits build up inside the arteries and restrict blood flow to the heart.

 

IV. Diagnosis and Treatment:

Diagnosing and treating fatty liver is essential to prevent complications and improve overall health. The diagnosis of fatty liver is typically made through a combination of medical history, physical examination, and diagnostic tests. Treatment usually involves lifestyle changes, medication, and surgical intervention for more severe cases.

 

Lifestyle Changes:

Lifestyle changes are an essential part of managing fatty liver. These changes include:

 

Diet: A healthy diet low in fat, sugar, and calories can help reduce fat accumulation in the liver. A diet rich in fruits, vegetables, and whole grains can also help improve overall health.

 

Exercise: Regular exercise can help burn excess calories and reduce fat accumulation in the liver. Physical activity can also help improve insulin sensitivity and reduce the risk of other health conditions.

 

Weight loss: Losing weight, particularly around the abdomen, can help reduce fat accumulation in the liver and improve overall health. A weight loss of 5-10% can significantly improve liver health.

Medications and Surgical Interventions:

In more severe cases, medication and surgical interventions may be required to manage fatty liver. Medications such as Vitamin E, pioglitazone, and obeticholic acid may be prescribed to help reduce liver inflammation and improve liver function. However, it's important to note that medication should only be prescribed by a medical professional.

 

In some cases, surgical intervention may be necessary. For example, if fatty liver is causing liver cirrhosis or liver failure, a liver transplant may be required. However, this is a complex and invasive procedure that is typically reserved for the most severe cases.

 

V. Overview of Recent Research on the Mechanisms of Fatty Liver:

 

Recent research has shed light on the mechanisms underlying fatty liver, which may lead to the development of new treatments and interventions. One area of focus is the role of the gut microbiome in fatty liver disease. Studies have shown that imbalances in the gut microbiome can contribute to the development of fatty liver by altering metabolism and increasing inflammation.

Other research has focused on the role of insulin resistance in fatty liver disease. Insulin resistance can lead to the accumulation of fat in the liver by increasing the production of fatty acids and impairing the breakdown of fat.

 

Additionally, recent studies have explored the link between fatty liver disease and cardiovascular disease, suggesting that the two conditions may share common risk factors and pathophysiological mechanisms.

 

VI. Discussion of Potential New Treatments and Interventions:

 

Based on the recent research, there are several potential new treatments and interventions for fatty liver disease. One approach is to target the gut microbiome with probiotics or prebiotics to restore balance and reduce inflammation. Another potential intervention is to target insulin resistance with medications that improve insulin sensitivity or reduce the production of fatty acids.

 

Other potential treatments include novel therapies that target specific cellular pathways involved in fatty liver disease, such as lipid metabolism and inflammation. For example, drugs that inhibit certain enzymes involved in lipid synthesis have shown promise in reducing liver fat accumulation.

 

VII. The Importance of Continued Research in the Field:

 

Fatty liver disease is a growing public health concern, and continued research in the field is essential for developing effective treatments and interventions. There is still much to learn about the underlying mechanisms of fatty liver disease and its relationship to other health conditions, such as diabetes and cardiovascular disease.

 

In addition, more research is needed to develop accurate and non-invasive diagnostic tools for fatty liver disease. Currently, liver biopsy is the gold standard for diagnosing fatty liver disease, but it is an invasive and potentially risky procedure.

 

Overall, continued research in the field of fatty liver disease has the potential to improve the lives of millions of people around the world who are affected by this condition.

 

VIII. Conclusion:

 

Fatty liver disease is a common and potentially serious condition that can lead to liver damage and other health complications. Lifestyle changes, such as diet and exercise, are essential for managing fatty liver, but in more severe cases, medication and surgical intervention may be required.

 

Recent research has shed light on the mechanisms underlying fatty liver disease, which may lead to the development of new treatments and interventions. However, continued research in the field is essential for developing accurate diagnostic tools and effective treatments for this growing public health concern.


Low Potassium Causes Diabetes! OMG Help Me Doc! Is That Really True?

Nutrition Corner with Dr D

Low Potassium Causes Diabetes! OMG Help Me Doc! Is That Really True?

Today we're going to talk about whether low potassium really causes diabetes. Now, I don't want to attack anyone personally, but seeing these various health gurus claiming that low potassium causes diabetes really gets my blood boiling. As someone with a background in nutrition, herbal medicine, and Western medicine, I believe in taking a holistic approach to managing medical conditions. However, I can't endorse claims that lack scientific basis. Unfortunately, some people profit from picking out rare correlations and presenting them as causation. Just because there may be links between potassium and diabetes, for example, it doesn't mean that a deficiency in potassium automatically causes diabetes. Statements like this are taken out of context and serve only to distract us from the real issue. It's frustrating to see these types of videos and articles circulating because they misinform the public and ultimately, they do more harm than good.

So why don't I believe that low potassium causes diabetes?

First things first, believing these claims is like sitting in a room with a huge elephant in the middle, but completely ignoring it. It's just not accurate. Diabetes is a metabolic disorder characterized by high blood sugar levels due to a lack of insulin production or the body's inability to use insulin effectively.

 

While low potassium levels can cause a range of symptoms like muscle weakness, fatigue, and irregular heartbeats, it is not a known cause of diabetes. What these gurus are referring to is the results of several studies that suggest that increasing potassium intake may help improve insulin sensitivity and lower the risk of developing type 2 diabetes.

But that's not only because of potassium by itself. Its largely because potassium is found in foods like fruits, vegetables, and legumes which by themselves can help improve overall quality of someone’s diet by substituting them for junk food which is loaded with sugar and promoting a healthy weight, which are the most important factors in preventing diabetes.

 

In fact, a holistic approach is needed to manage any medical condition, and diabetes is no exception. Diabetes is a complex disease that involves a combination of genetic, environmental, and lifestyle factors.

 

So, what are the major causes of diabetes?

There are many reasons why someone can develop diabetes, but today let's focus on the four most significant ones.

 

First up, obesity. Several studies have found that excess body weight, especially abdominal fat, increases the risk of developing type 2 diabetes. Each 5-kg increase in body weight was associated with a 31% higher risk of type 2 diabetes. That's a huge number!

 

Secondly, a sedentary lifestyle is another significant risk factor for type 2 diabetes. Physical inactivity leads to decreased insulin sensitivity and impaired glucose metabolism. Each 2.5 hours per week increase in moderate-intensity physical activity was associated with a 9% lower risk of developing type 2 diabetes.

 

Thirdly, an unhealthy diet high in refined carbohydrates, added sugars, and saturated fats can increase the risk of developing type 2 diabetes. Each additional daily serving of sugar-sweetened beverages was associated with a 13% higher risk of developing type 2 diabetes.

 

Finally, genetics also play a role. Certain genetic variants can increase the risk of developing type 2 diabetes. However, lifestyle factors, such as diet and physical activity, still play a more significant role in the development of type 2 diabetes than genetics.

So how do I look at the genetic risks that can make people more prone to certain diseases, such as diabetes?

Think of genetics like carrying a loaded gun - just because you possess the genetic predisposition for a disease, it doesn't mean that the genes will automatically trigger it. You still have a significant amount of control over your genetic risks. It's like having a loaded gun in your pocket - you have the choice not to pull the trigger. So don't use your genes as an excuse for giving up. Yes, fighting genetic risks may require more effort, but it's still possible to overcome them. Don't let the fear of genetics hold you back - you have the power to take control of your health and well-being."

 

So, there you have it, guys. Low potassium does not cause diabetes, but a combination of genetic, environmental, and lifestyle factors do. Remember to take care of your body by exercising regularly, eating a healthy diet, and maintaining a healthy weight.