• Katie O'Bright, DPT

Part 2: Butt Pain & Nether Regions

Note: this post is not for those uncomfortable with nether regions and/or knowing more about me than they really want to. TMI? I don’t see it that way - important things to bring awareness to. The pelvic floor PTs are really going to love me for this one... 🙃

Anywho. I wrote in the last post about my hip and butt pain issues. As stated previously, the FAI surgery was a godsend for me. I am leaps and bounds better than I was pre-op. So what is this pain I’ve been having? My current pain is in location #3 in the picture above. Hmmm... kind of unusual right? Especially for the hip joint. This is where I’m going to stress the importance of identifying the most precise location that you can for your therapist or healthcare provider. The areas or patterns of areas, really do make a difference. Moving on...

Over the course of about 3 months, I noticed that this pain would come in waves; i’d have the pain for about 2 weeks and then it would go away. It was hard for me to provoke, reproduce or relieve with various movements or exercises. Sometimes I would get some good relief with deep, end-range hamstring/trunk flexion stretching, with my left knee bent (think a modified forward fold - pain was on the right). Think about, and even practice that position and see what you feel...

So this got me thinking about what structures are in this spot. And after flipping through my anatomy atlas and thinking differentials, I realized that I was missing a major component of the pelvis - it’s not even pictured in this drawing! As if it doesn’t exist! .... and all the pelvic floor therapists are like “Mmmhmmm, we’re always forgotten”.

The pelvic wall/floor muscles! If you look back at the picture above, X #3 is actually covering the levator ani/iliococcygeus, which forms the posterior/posterolateral aspect of the pelvic wall/floor! These muscles are incredibly important, if you like keeping your genitourinary and GI tract inside of your body, that is. Watch this 3D video for a good visual representation of this area:


Before I go on a pelvic organ prolapse tangent, I’ll come back to what happened with my pain investigative work. When I do a PT evaluation, the vast majority of my differential diagnosis decision making is going to occur in the interview. This is when I am asking the patient about various factors related to their complaint or injury. Some of the most important things that I ask about includ

- how long had this been going on?

- how did it start?

- where is the pain and what does it feel like?

- what activities/positions make it better or worse?

- is there a time of day when symptoms are better or worse?

After working with a few stellar pelvic floor therapists, and after having 2

babies myself, I began to appreciate the importance of pelvic floor ‘screening’. I started asking my patients with primary Hip, low back, pelvic symptoms about their menstrual/pregnancy/childbirth history. I also started asking more questions about bowel/bladder habits and sexual function. Here’s what I found in many female patients with fluctuating, unpredictable symptoms in the parasacral region - many of them had their worst symptoms in the days surrounding their menstrual period. When I actually looked in the mirror (figuratively speaking, 🙃!), I realized that this was exactly the case for me. When I finally put the pieces together, I decided to make an appointment with a pelvic floor therapist. My thoughts? After an ultrasound ruled out anything wrong with my

lady organs, I’m thinking that my right pelvic floor muscles are short and tight and maybe weak and angry 🤷‍♀️ ... pretty scientific self diganosis - hence why I’m going to be evaluated! I would encourage anyone having similar issues to do the same.

This amazing group of specialized physical therapists are underrecognized and underappreciated, so this is my tribute to them! Ladies (and gents... they treat ALL pelvic floor issues), let it be known that it is NOT normal to:

- leak urine

- have pelvic pain

- feel like your body is falling out

Also, Kegels are not always the solution to the complaints above - sometimes, control of the pelvic floor actually requires certain muscles to relax rather than engage. This is what a pelvic floor therapist can help you determine. If this resonates with you, please visit the following webpage to find a PF/women’s health therapist near you.


I am available to answer any questions that you might have about hip joint and low back pathology (and literally anything else!), but if you think you fall into the pelvic specialty and are located in Pittsburgh, go see my super duper new friend @physio_412 Dr. Kira Steele. Kira is an orthopedic therapist, also a crossfit coach! She is perfect for this population! https://www.physio412.com/

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