The Pain in your A$$ : Experiential Anatomy

Congratulations! I am pleased to announce that we have now arrived at the base of the spine, the seat of our civilization, the source of endless fixation and root of so many of our issues ( physical, emotional, spiritual, you name it). Yes, we have hit... the Pelvis. 

 

As a child of the 70's and 80's, I was raised with an ingrained aversion to even using the correct terms for many of the parts contained here, and even to this day, I have colleagues who will simply refer to this region as " the hips" in order to avoid making anyone feel "queasy". Granted it does contain a number of parts covered by bathing suits, as well as others that are heavily featured in adult film content, but unless we can get over our misguided modesty, it becomes difficult to get a clear picture about what's going on in this oh so critical of areas. 

 

(Rest assured, this blog is completely safe for work)

 

As always, let's start with the bones: In the center, we have the Sacrum, which is often referred to as the " cornerstone" of our body. On either side, the hip bones, which were first released as a trilogy: the Ilium ( the entire upper portion, including the crest you rest your hand on when it's on your hip)  the Ischium ( better known as your sitting bones), and the Pubis ( you know where that is) and had fused in to a full length feature by the time you learned to walk. Supporting this structure on either side are the Femur Bones, aka the thigh bones, which are shaped like a number 7 in order to perfectly fit in to the Acetabulum, otherwise known as your " hip socket". 

 

If you consider the Pelvis' mobility needs, the bone structure makes a lot of sense. The Sacrum hangs between the hip bones, connected at the SacroIliac Joint ( which is mobile in certain ways but not others) where it translates spinal movement in to and out of the pelvis while providing an anchor for the " pelvic bowl". The hip bones themselves have a greater potential for movement, both tilting forward and back, side to side, and rotating, and the thigh bones have even larger range, able to swing our legs forward and back, in and out, and twisting. 

 

Of course, all this mobility requires an orchestra of muscles ( 45 in all) both to create the movements we need, and to ensure that there is enough space and support for the bottom of our digestive system, reproductive organs, and systems of elimination to function without accidentally blowing out ( sneeze while pregnant and you'll know what I'm talking about), not to mention to allow for the nerves that exit off our spine and head down our legs to have a free ride all the way down to our feet.   ( Sciatica anyone?) 

 

As usual, I am writing a blog, not a book, and will name a few while grandly sweeping over others, but first, allow me to present to you this week's metaphor. 

 

Please imagine your tent poles as the bones, the ligaments as the elastic that allow the poles to intersect, and your muscles as the tent fabric itself, stretched over the frame, with multiple zippered entrances, etc. 

If the frame gets out of balance, so do the tent and the elastics. If the elastic at the intersections gets too stiff or too loose, the frame is affected, and if the tent fabric is bunched up or ripped anywhere, it will also affect the integrity of the frame, perhaps putting additional strain on those elastic intersections. Oh, yes, and this tent is the type that also runs marathons, goes out dancing, stays bent at a 90 degree angle for hours on end, and typically stands with one side jutted way out and the other side falling into a hole. 

So no wonder so many humans complain of lower back pain, or a dull ache deep in their butt. As always, instability in one area will cause tightness in others, and muscles become " locked short" or "locked long" when asymmetry is present. Either way, the operative word is "Locked" and the process of unlocking is a process of restoring balance. 

The first muscle that I'd like to shine a spotlight on is the Piriformus.

If you practice yoga, or work out, you've certainly heard of this one. It's the one that you'll stretch when you cross one leg over the other, turn that knee out, and then pull the opposite leg in to your chest. It gets that good stretch deep under your butt. Recently, the yoga world has turned on "Pigeon Pose" as the new Bikram; once beloved, it has now developed a reputation as potentially damaging to the hip socket when held, unsupported, for long periods of time, and I would have to agree. The Piriformus originates deep within the sacrum, and slips out to attach to the top of the thigh through the same "doorway" as the Sciatic nerve. It serves both to externally rotate the leg, and to balance the spine via the sacrum. If the spine leans to one side then the Piriformus will need to contract on the opposite side in order to maintain balance. A stressed out Piriformus can result in " Piriformus syndrome" which manifests as a chronic, dull ache in the buttock region, possibly mimicking the pain of sciatica ( burning pain down the leg to the foot).

 

And well, now that we mentioned the "S' word, let's take a brief detour and explore the Sciatic Nerve, which begins as a collection of nerves that exit the lumbar spine, coalesces in to one giant nerve ( the largest and longest one we have) around the L5S1 junction ( where your lumbar spine meets your sacrum), slips under the Piriformus muscle to head out to the thigh bone, and runs all the way down the back of your leg to your toes. If there are problems with the discs in the lumbar spine, they can often push on these nerves causing pain to radiate down that same line causing what is known as "Sciatica". This differs from Piriformus syndrome, as the problems causing the pain are originating in the spine as opposed to muscle, although the suffering is equal. 

 

Another common " pain in the ass" is a little higher up, at the bony dimple that exists on either side of your sacrum ( sometimes framed by poorly chosen tribal tattoos, or " Ass Antlers" as they like to call them in Italian) . Stick your fingers in those dimples and move a leg in and out. Feel that? That's your hip bone and your sacrum interacting at what is called the Sacro Iliac Joint ( or SI joint for short). We are going to explore this a little further so indulge me here for a moment. Stand up, put your thumbs on your hipbones and your fingers on the bony dimples in back. Now pivot on your heels to externally rotate your feet. Do you feel how the hipbones move slightly out and the sacrum moves forward, embraced by the meaty muscles on top? So this is all a good thing until someone's thighs don't pivot all the way back to parallel. If the legs get stuck in an externally rotated pattern, the hip bones get jammed back up against the sacrum, and it causes pain where those two bones meet. If you think this may be you, try grabbing your hip bones all the way around the back and sides and pushing them together towards the front. If that eases your discomfort, then maybe you might want to have someone check on your alignment. 

       So to review, we have one "tent" problem that has to do with an unstable frame, where the poles and fabric got a little twisted around, and it's putting pressure on the A-line at the top ( SI joint issues).  Then we have another problem that has to do with the fabric, where the Weathervane mounted on the top of our tent was leaning too far to one side or a pole was hinting at "ceding from the union" and the fabric began to strain to pull it back to center ( Piriformus Syndrome).  The third problem has to do with the tin can telephone that your daughter rigged up to call her friends, carefully strung between the zipper and the velcro flap that closes the window.  For whatever reason, the zipper got all caught up, there isn't the room for the string to translate vibration, and she's throwing a tantrum. ( Sciatica) 

Ultimately, any restorative approach to these issues will address balance as a large part of creating the physical solution, be it manual, physical, or emotional ( a lot of back pain issues come and go with emotions... it's a thing). And honestly, I'd rather keep on telling you about this tent. 

For this is no ordinary tent.

              For one, it has two beautiful Arial silks that are suspended to the two trees that hover over your campground. These silks attach to the Weathervane before slipping INSIDE your tent for added stability, falling just in front of the back wall ( the Iliacus muscle makes up the inside back wall of your tent, spacing out your hip bones) and then attaching to the side poles, and some of the rebar as well. ( That'd be the 7's of your femurs). Yes, I'm talking about the magnificent Psoas, the muscle of your soul, the source of the hidden codes that control the Universe, or just a kickass muscle that articulates your spine, is totally linked in with your breathing, and brings your knee to your chest towards the midline. The Psoas works best when it's relaxed, breathing with the trees, tied in with gravity, weaving through the tent before grounding it, but any imbalance in the tent's structure can throw it off, and when that fabric is knotted up, it makes camping kinda difficult. 

            As far as the floor of the tent, that's important too. For the sake of argument, we're going to make the pelvic floor a 4 sided hammock that is suspended off the upper poles, and assume that the bottom fabric is made up of the muscles of our inner thighs. If the floor is ripped, that compromises the poles that hold up the walls, and everything else becomes unstable. The inner thighs also play a huge role in maintaining a parallel position of the thigh bones, which we now know are key players in addressing SI joint pain. But let's remodel a little bit to take the analogy even further. Lift your tent up by a story, drive the stakes in to the ground as though they could meet on each side at the rebar, like an upside down pyramid on each side, and stretch the fabric all the way down to the rebar. Now we have your full fledged thighs ( front, sides and back), with the fabric of all four corners at every stake playing a role in stabilizing the floating tent above, and the Psoas silks tied in to this line just beneath the hammock. If the fabric were to rip no matter where, it would force extra work on to other, more connected tissues, and change the shape of our tent in some way. If the inner thighs or the Glutes are weak, that also makes it difficult for the thigh bones to be held up in to the pelvis, and they will begin to slip and lean outwards, putting pressure on the IT band ( why rolling it doesn't help, but attention to alignment does). If the Hamstrings don't work, ( the back fabric) the tent slips forward and the Weathervane has very little to balance it, or in other words, your Hamstrings support your back and without them, collapse is eminent.  Further up, the same thing is true for the Three Gluteal Amigos, which make up the outside back and side walls of your tent, keeping the front entrance from caving in. The next time you walk up a flight of stairs, take a moment to place your hands on your upper thighs, front and back, and feel the fabric as it walks your poles from site to site. 

And so, this week I created a 10 minute experience in balancing the pelvis. Beginning with setting up the structure a little bit, then adding some "weather" in to the picture. 

Please be advised that this workout is designed for healthy bodies, and is not suitable for people suffering from acute issues. Please be mindful of your body while you practice, and if you experience pain, stop immediately. Always consult a physician before embarking on any exercise program. 

 

The creation of my blog is often the source of my inspiration for my group classes. If you would like to experience the full length " Pelvis Stabilization Sequence", you can do so via my full length online classes here

 

 

 

© Domini Anne 2017

 

Credit for images : Visible Body App, Med.uio.no.com, Amazon.com,