Yes, I said dormant butt syndrome, DBS for short! I see it all the time in the clinic. In athletes and people of all ages. The cause of DBS is usually tight hip flexors, again, which most people have. This is due to repetitive hip flexion from walking, running, sitting, driving and sleeping in the fetal position.  Other causes include injury and inactivity.   If you remember back to previous posts the gluteus maximus generally attaches proximally to the sacruum, and illiac crest and wraps around the hip to distally attach to the greater trochanter (the big bony bump on side of hip).  Although we think of the gluteus maximus as a powerful hip extender it is actually built for rotation.  Just look at the fiber orientation (yes, you may have to crack open the old anatomy book).  So, functionally its main function is to eccentrically control internal rotation of the femur in the transverse plane during the loading phase of gait or running, eccentrically control hip flexion in the sagittal plane and assist the gluteus medius in stabilizing hip adduction in the frontal plane.  The ability to appropriately load enhances their ability to concentrically contract during the unloadong or propulsive phase.  If the gluteus maximus is inhibited (which V. Yanda taught us) from a tight hip flexor, then the hamstrings and erector spinae group  become overactive to compensate.  This leads to the possibility of hamstring strains, low back pain, knee pain and possibly even plantar fascia.  A simple way to check for DBS is to have patient lie prone and ask them to do a leg lift.  Palpate the gluteus and the hamstring and see which contracts first.  Many times I feel the hamstring contract then the gluteus.  It should be gluteus then hamstring.  Sometimes ive seen people have a 5/5 manual muscle test and not even fire the gluteus.  They used all their hamstring and erectors to lift/hold the leg up.  Some general strategies include a basic muscle re-education of laying prone over table or bed and actively squeezing butt then lifting leg.  Sequence can also be done with bridge exercise.  Stretching the tight hip flexor, of course, and functional hip dominant exercise like single leg balance w/ arm reaches, multi planar lunges, sled walks, various step up and downs.  So now get moving and wake that sleepy butt up!

Get Strong! Stay Strong!

Chris

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Comments
  1. Chris-

    I couldn’t agree more with this article. I work in sports health as a PT at the Cleveland Clinic and we have joked that in addition to our sports programs like “Jump Right” for basketball/vball players or “Match Fit” for soccer players, we need to have a Squeeze Right” program to accomodate all the people/athletes we work with that require neuro re-ed and strengthening of their glutes. I have a hip presentation coming up and I’m showing a screen shot of your blog with this article (I hope that is OK with you). I will be giving you credit for the idea of “DBS”
    I also like the point of squeezing the glutes first before mobing the hip when doing the prone leg lift. We often have people do the leg lift with the knee at 90 degrees to try to get some active insufficiency of the hamstrings. Your way may be a nice pregression.
    Keep up the good work on the blog!
    -Michael

    • chriskolba says:

      Thanks for checking me out. Glad you found info useful and are seeing sinilar things. By all means reference. I appreciate that.
      Good luck
      CK

  2. chriskolba says:

    Thanks for checking in. I am not in Cleveland in Feb. I dont teach in cleveland until fall. I think my name may have accidentally been placed on the Seniors Course which I do not teach.
    Take care
    CK

  3. Steve says:

    Hi Chris. I believe I suffer from DBS but was never diagnosed with such. It progressed from tight hams and hip flexors to low back pain, to sciatic pain from herniated disk. Now I am recovering from surgery and am starting to experience the same symptoms after being back to work for a week. I am trying to limit my sitting and the doctor thinks I need to recover longer before stretching or exercising. What is your opinion on what I should be doing and when to mal sure this doesn’t happen all over again? Thank you.

    • chriskolba says:

      DBS is not an actual diagnosis, Its just a phrase I use when I’ve identified that a persons glutes are not working as efficiently as they should. This is just one piece of the overall puzzle but a significant one. I can’t diagnose or treat someone without seeing them and when your Dr says its ok to start stretch/ex you need to see an experienced PT to get evaluated and given the proper stretch/ex for your situation.
      Thnx

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