When pressing on a muscle, the doctor can usually guess how much it will hurt, based on how the person walks, their range of movement and what they have just described. Once in a while, one muscle hurts far more than that guess, while nothing else in the body matches it. When we meet a mismatch like that, we consider the possibility that the muscle is bracing on behalf of another area. The two patients below, one with buttock pain and one with neck pain spreading to the shoulder, agreed to let the clinic share their stories. Both improved clearly once the pelvic area was treated.
Right buttock pain after a long walk
The first patient’s pain started after a long walk. The right buttock hurt, and they could not straighten their back and had to walk bent over. They also told the doctor up front that they were very afraid of needles, and of forceful movements too.
The examination found the right iliopsoas muscle contracted, in keeping with the scoliosis the patient already had. The piriformis muscle was harder to explain: pressing on it was very painful, and the muscle was tight and hard, far beyond what the patient’s general condition and other signs suggested. The doctor examined further using SOT (Sacro-Occipital Technique, a technique working with the sacrum and the occipital bone), combined with Applied Kinesiology muscle testing, and found the pelvis misaligned and not working properly.
The treatment needed no needles and no strong force. With the patient lying down, the doctor placed wedge-shaped blocks under the pelvis following the SOT sequence for the type of misalignment just found; the pressure came from the body’s own weight, with no thrust at all. The patient lay still like that for about 40 minutes. On getting up, they could stand straight and walk comfortably, no longer having to bend over.
The piriformis connects the sacrum to the thigh bone, so when the pelvis is misaligned, it is affected right away. The doctor did not work on the piriformis directly, only on the pelvis. The buttock pain still eased, so we believe the pain in this muscle came from the pelvic area.
Deep buttock pain has many sources
Buttock pain is very common, while deep gluteal syndrome is rare, according to the review by Hu and colleagues (2021). The name is used for pain caused by the sciatic nerve being compressed within the buttock itself, not by a spinal disc; piriformis syndrome is one form of this group. Symptoms are often vague, and imaging is usually not enough to reach a conclusion, so the hands-on examination matters a great deal. Park and colleagues (2020) add that the condition is easily missed or mistaken for something else, and should only be considered after problems in the spine have been ruled out. How to tell the piriformis apart from the lumbar nerve roots and the sacroiliac joint is covered in our article on pain spreading from the buttock down the leg.
Ten days unable to hold the neck straight
The second patient was a middle-aged driver. Ten days earlier, after working in a bad posture, his neck started to hurt with pain spreading down to the shoulder, and his head tilted clearly to one side and could not be held straight. Only by raising one hand and resting it on his head would the pain ease, which made daily life very awkward. Medicine he had bought himself did not help.
Pain that eases when the hand is placed on the head is called the shoulder abduction sign. In him, this sign was positive, suggesting that a nerve root in the neck was being irritated. The review by Rubinstein and colleagues (2007) showed that this test misses quite a lot of patients, but when it is positive, cervical nerve root disease (cervical radiculopathy) is worth considering; the doctor still has to read it together with the medical history and other signs.
The doctor mobilized the lower part of the cervical spine, around the C6 vertebra, then treated the nerve receptors of that section. He felt about half better. Seeing that the pain had only eased that far, the doctor examined down to the pelvis and sacrum and found that this area was not working properly either. The doctor went on to mobilize the junction between the sacrum and the pelvic bone, working at the same time with the nuchal ligament at the back of the neck, and then on to the pelvis and sacrum. By the end of the session, he could move his shoulder, walked almost normally, and his head no longer tilted as it had when he first came in.
When the pelvis is misaligned, the sections above tilt to compensate, sometimes all the way up to the neck. Our article on musculoskeletal pain has a section on this chain of compensation. The neck and pelvis pulling on each other also appeared in the case of long-lasting shoulder pain after a fall.
These two cases do not tell us how quickly other people will improve; some people need many sessions, and some need to be seen together with other specialists.
Which kinds of pain spreading to the arm need a neck scan
The driver had signs of an irritated nerve root in the neck. If neck pain spreading to the arm comes with any of the following signs, you should have imaging and see a neurologist soon, without waiting any longer:
- The arm gets weaker week by week, and you often drop things you hold;
- Muscles in the hand or arm are shrinking;
- Numbness spreading down the arm has not eased after several weeks;
- The hand becomes clumsy at small tasks such as writing or typing;
- You walk unsteadily and often lose your balance.
With buttock pain, numbness or weakness in the legs that keeps getting worse, or problems controlling urination, is a matter for the emergency department: go right away, don’t wait until the next morning. If buttock pain comes with fever, weight loss or a lot of pain at night, read our overview of back pain and get checked early.
How the doctor traces the problem down to the pelvis
When you come in with neck pain, Dr. Dinh Ngoc Duc (MD, MSc in Traditional Medicine) first asks which movement hurts most, whether raising your hand onto your head makes it feel better, and whether your arm is numb. After that, the doctor may ask you to lie on your back with both legs straight to compare your two heels, look at the iliac crests on both sides, and then use muscle testing to choose which spot to treat first. After each step, you repeat the exact movement that used to hurt, turning your neck or standing up straight, so you can both see how far the pain has receded.
Placing the blocks, mobilizing joints with light force and treating nerve receptors are all done by the doctor right in the Applied Kinesiology session. There is no kneading of the muscles, so a person who fears strong force, like the first case, can still lie still throughout the session. For people who don’t mind needles, if the neck and shoulders are still stiff after the neck and pelvis have been treated, the doctor may add acupuncture; if you are afraid of needles, just say so from the start so the doctor can choose another approach.
Worth keeping
- Note what the pain started after: a long walk, sleeping in a bad position, carrying something heavy or a long time driving;
- Notice whether resting one hand on your head makes the neck and shoulder pain ease, then tell the doctor;
- If you are afraid of needles or of being manipulated forcefully, say so at the start of the visit;
- If your arm is getting weaker, muscles are shrinking, your hand is clumsy or you walk unsteadily, have imaging and see a neurologist soon;
- Buttock pain with numb or weak legs or problems controlling urination means going to the emergency department.
References
- Park JW, Lee YK, Lee YJ, Shin S, Kang Y, Koo KH (2020). Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain. Bone Joint J 102-B(5):556-567. https://doi.org/10.1302/0301-620X.102B5.BJJ-2019-1212.R1
- Hu YE, Ho GWK, Tortland PD (2021). Deep Gluteal Syndrome: A Pain in the Buttock. Curr Sports Med Rep 20(6):279-285. https://doi.org/10.1249/JSR.0000000000000848
- Rubinstein SM, Pool JJM, van Tulder MW, Riphagen II, de Vet HCW (2007). A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J 16(3):307-319. https://doi.org/10.1007/s00586-006-0225-6
