‘Lazy Butt Syndrome’? Part 2 – Fixing With Exercise

Last time I wrote an intro about how Lazy Butt Syndrome can cause low back pain.  As a recap, recall that the pain you might be experiencing in the lower back, hips or legs may actually be a consequence of GLUTE INHIBITION…lazy butt muscles that are not doing their proportionate share of the work in moving you or supporting your body.  Read that article first if you have’t yet.

This month I will introduce 4 key exercises for you to awaken those lazy glutes.

1. Hip square exercise – Get on your hands and knees on the floor.  Position your hands so they are directly under your shoulders and your knees directly under your hip joints.  Keep your head and neck in a neutral posture while looking straight down at the floor.  Extend one leg back with the knee locked straight and point your toes back too.  From there, imagine your leg is a pen and you are drawing a square.  Move the leg out, then down, back in and then up.  Those are the 4 corners of your square.  Perform at a moderate speed, don’t rush it.  Repeat 15-20 times, then switch legs.  Your glute muscles will be burning at the end of the set.

2. Hip bridge exercise – Lie on the floor with your knees bent and feet hip width apart.  Press through your heels and push your hips up off the ground until your body is flat and straight from your knees down to your upper chest.  Squeeze your glute muscles HARD and hold this position for 5-10 seconds.  Drop back down slowly and rest for 5-10 seconds.  Repeat this 10 times.  As a more challenging progression, you can perform this exercise with one leg extended forward…this will isolate one glute at a time while also working core stability/balance.

3. Monster walk – You will need a strength band to perform this as shown in the video.  Alternatively, a latex loop band placed around the knees is another option.   With both feet, step on the strength band with feet about shoulder width apart.  Pull up on the other end of the band with your arms and get into a half squat position.  From there, take 15 side steps to the right then take 15 side steps back to the left.  You should feel the muscles in the side of your hip working.

4. Single leg deadlift – Start in a standing position and slightly lift one leg backwards off the ground.  From there, hinge forward at the hip and try to bring your arms down toward the floor.  Try to have only a slight bend in your knee (unless you are like me and have tight hamstrings!).  Slowly return to standing position and squeeze your glute at the top.  This is a challenging exercise because it requires good balance to do it properly.  Perform 10 repetitions and then switch legs.  As your technique improves, you can add weight by holding light dumbbells in each hand.

Other simple things you can do during the course of your day are:

  • actively contracting your glute each time you push off your back leg while walking
  • squeezing and contracting your glutes for a few seconds repeatedly while you quietly wait in line at Starbucks!

Not sure if you have inhibited glutes but sure you have back pain, hip pain or knee pain?  Come in for a full assessment and find out!

Saying good bye to summer!

Dr. Keith

Do You Have ‘Lazy Butt Syndrome’?

Lazy Butt Syndrome (or you could substitute the word ‘Butt’ with a different word starting with the letter ‘A’)…it’s probably something associated with your teenage kids or maybe your spouse, right?

While that certainly may be true of some of your family members, I am actually talking about Lazy Butt Syndrome in the context of how your butt or gluteal muscles may not be working properly and consequently causing aches and pains in your lower back, hips, or legs.

Believe it or not, your glutes can become ‘lazy’ in that the muscles do not fire or contract in a timely or efficient manner to do the muscular work required of them during normal daily activities or strenuous activities at work or athletics.  Chiropractors, physiotherapists and other manual medicine practitioners refer to this as Glute Inhibition.

As a result of gluteal inhibition, other muscles in your body will frequently have to take up the slack and work extra hard to make up for the deficiency.  The glutes do a less than proportionate share of the work while the other muscles such as your low back and hamstrings perform an increased share.  In simplistic terms, if you had 4 workers digging a 50 foot deep hole in the ground and one of those workers decides to go take a nap under the tree instead, then the remaining 3 workers have to take up the slack for the 25% work reduction by Mr. Sleepy Head.  Over time, one or maybe all 3 of the other workers doing overtime could get injured from the increased strain.  Solution: Wake up Mr. Sleepy Head and make him pick up his shovel!

I find that people with low back pain often have gluteal inhibition and will include tests during my physical examination to assess whether that is the case.  I’d say it is pretty common…probably close to 70% of the time, the patient will have one or both glutes inhibited.

How does one develop Lazy Butt Syndrome?

The main cause of LBS is prolonged sitting.  Many people sit at their jobs for 6-10 hours per day.  Many people commute to work in their cars or GO Train for 1-2 additional hours per day.  Many of these same people then do very little activity once they get home.  Some of these people might do 1 hour of ‘exercise’ on most days of the week but it still may not be enough to counteract the effects of the cumulated hours of sitting on their butts.

Another cause of LBS is overuse through work or exercise without sufficient recovery.  In this case, because the glutes are excessively tense due to activity, the brain will sense that they are over-stressed and at risk of injury and send nerve signals to turn the glutes off.

Thirdly, muscle imbalances in the hip and pelvic region can also cause glute deactivation.  For example, people who have short and tight hip flexors often develop elongated glutes that are inhibited.

Finally, a traumatic fall on your back side will also trigger deactivation of your glutes.  Also, folks who have suffered ankle sprains often exhibit glute inhibition.

Some patients often say to me that their glutes can’t possibly be inhibited because they do alot of squats or lunges or deadlifts or run for distance 4-5x per week.  It is possible to have ‘strong’ glutes that don’t fire properly.  In fact, it may be the excessive amount of exercise that caused the brain to turn them off.  Muscle inhibition is different than muscle weakness.  When a muscle is inhibited, the neurological firing of the muscle is disrupted causing it not to contract sufficiently or at the right time.  In contrast, a weak muscle is firing normally, but is lacking in strength.

If you have any of the following issues, it may be due in large part to Lazy Butt Syndrome:

  1. Low back pain
  2. Hamstring strain
  3. Anterior knee pain
  4. Anterior hip pain
  5. Poor alignment of the hips, knees or ankles
  6. ACL sprains/tears, ankle instability, IT band pain

We can’t help you with the Lazy Butt Syndrome that you see in your family members!  But we can help with Lazy Butt Syndrome that may be causing your aches and pains.

Next month, I will talk about home exercises that you can do to combat LBS.

Until then, pray for better summer weather!

Dr. Keith

Your Knee Pain Is Coming From Your Foot and Hip!

Now that I have your attention you may want to read on. If you answer yes to any one of these questions there is a very good chance your knee pain is a symptom of something else that is weak or tight or flat.

Do you have pain when jogging?

Do you have knee pain when going up stairs?

Do you have knee pain from jumping?

Do you have knee pain when you play sports?

Chances are that if you answered ‘yes’ to any of these questions then your pain is either an indirect or direct response from something else in your body that is not working functionally or mechanically.

So you may be asking yourself now, “What is actually causing my knee pain?”

In my experience in assessing and treating knee injuries for the past 25 years, knee pain arises from either muscle issues at your hip or problems with your feet.

The knee joint is like a hinge. It is the midpoint between the hip and the foot. Anything that happens to either the foot or the hip will have a direct effect on the knee.

If you have flat feet there is very good chance that right now you suffer from knee pain unless you wear inserts or orthotics in your shoes. Without the inserts the foot becomes flat when you walk. This causes the knee to turn in more which leads to more load on the knee joint.

To correct this inserts or orthotics give support to the foot minimizing the flattening of the arch of the foot when you take a step. Sometimes this all you that you need to correct this problem.

Next, if the muscles at your hip are weak that will lead the thigh bone to rotate inward more causing more force on the knee joint. This may lead several areas of pain at the knee:

  1. Pain on the inside of the knee
  2. Pain on the underside of the knee cap (Chondromalacia patella)
  3. Pain below the knee (Patellar tendonitis)
  4. Swelling behind the knee (Housemaid’s knee)
  5. Pain above the knee (Jumpers knee)

What is the solution?

As with most injuries I put you through a full assessment that includes both postural observation and gait analysis followed by specific testing at the ankle knee and hip.

Once this testing is completed I create both a clinical plan and a home exercise program. The home exercise program focus is on exercises that strengthen weak muscles and lengthens shortened muscles.

If you truly want to get rid of this knee pain I would suggest that you make the time to do your “homework” on a daily consistent basis. Exercises may include the “clamshell” and/or the “monster walk”.

Be aware that any treatment that solely focuses directly on the knee may give you short term relief but not resolve your knee pain long term.

Your friendly neighbourhood Athletic Therapist!

Michael Wolfe Grafstein

B.Ph.Ed, RMT, R.Kin, SMT(C), CAT(C)

When Your Low Back and Hip Pain is Really Sacroiliac Joint Pain…

Often times, patients come in complaining of low back pain and/or hip pain but after their consultation and assessment, I discover that the true problem is in the sacroiliac joint or SI joint for short.

SI-JointThe SI joint is where the large ‘tailbone’ (sacrum) and the pelvic bone (ilium) connect.  You have a left SI joint and a right SI joint.

As a simple guideline, here’s how to tell if you have a SI problem.

The first clue is pain directly over the joint, usually only on one side.  You will find the SI joint in the area around the ‘dimple’ on your backside.  If the pain is greater when you bend back­wards, inflammation of the joint is the probable cause of your symptoms.

If the pain is greater when you bend forward, then you’re probably experi­encing strained ligaments around the joint. However, low back pain in general has been associated with SI joint problems in a large number of patients. In one research study, close to 30% of patients x-rayed with lower back complaints showed either degenerative or inflammatory conditions affecting their SI joints.

Local pain is not the only way you can tell you have an SI joint problem. Referred pain from these joints is often felt in the groin, and can also travel into the buttocks and down the back of the leg, mimicking sciatica or a lumbar disc herniation.  Furthermore, if the SI joints are not functioning properly, this can lead to disturbances in your gait, which may cause hip, knee or feet problems.

Although these are crucial weight-bearing joints important for their part in the stability of the pelvis, they also move slightly for proper mechanics when walking or running. The SI joints can be affected by overex­ertion and injury. Often times a simple adjust of the SI joint will alleviate pain.

Too much strain is what leads to SI pain.  As mentioned, the SI joint helps to maintain pelvic stability. The SI joints are surrounded by tough, fibrous ligaments but if one or more of your SI joint ligaments become strained, you’re likely to feel pain directly over the SI joint.  You can cause strain to these ligaments from a fall on the buttocks, trauma from a car accident, lifting something heavy or repetitively, excessive sitting.  Women, and especially pregnant women are more susceptible to SI problems also.

When they get strained repetitively, these ligaments can lose some of their structural integrity, making your SI joints more prone to subluxate or shift out of position. Since the two joints work in unison, if one of the SI joints becomes unstable, the other joint can become restricted. Regular chiropractic adjustments may be needed to maintain a proper balance between mobility and stability.

Alignment of the spine is dependent on the function of the SI joints. When an SI joint is improperly positioned, it is possible that the sacrum is also out of its normal position. When this happens, the lower lumbar vertebrae can subluxate, leading to a greater chance of an abnormal lumbar curve and appearing as conditions like scoliosis and hyper- or hypo-lordosis (ie. overarching lower back curve or a flat back)

Any time the spinal curves are altered, it leaves you vulnerable to painful conditions in the lower back, such as facet irritation, disc herniation or muscle strain.


What should you do about an SI joint problem?  First, you should get a chiropractic assessment. As a joint specialist, a chiropractor is uniquely positioned in the healthcare field to assess and treat any joint in the body.

For the first 2-4 days after the onset of pain, you should attempt to limit your activities that cause soreness and apply ice to the affected area for 5-10 minutes at a time to decrease inflammation.  Alternatively, a great topical ointment instead of the often prescribed Voltaren, is a natural product called Lymphdiarial.  Low intensity laser therapy is also very helpful in quickly resolving pain and inflammation of the SI joint.  At Meridian, we use the Meditech Bioflex laser.

Restoring normal joint mobility is the next goal. If your chiropractor discovers that SI joint restrictions are part of the problem, chiropractic adjustments will be used to restore alignment and function.  Also, if joint instability is suspected, it may be necessary to temporarily wear an SI belt – a supportive device that wraps around the pelvis to stabilize the SI joints.

Finally, it will be necessary to perform specific stretching and strengthening exercises, combined with regular chiropractic adjustments, to balance the alignment of your pelvis in the long term.

What’s The Root Of Your Pain?

Both patients and doctors are frequently guilty of thinking that the pain and injury to a particular body part are simply due to a “problem” specifically at that body part.

For example, your lower back pain is due to a strained low back muscle…or an arthritic lumbar spine…or a disc herniation…etc, etc.

Or your knee pain is due to patellar tendinitis…a MCL sprain or tear…a mensicus tear…

Sound familiar?

The reality is that the above examples are the symptoms of a person’s problems and not necessarily the root of the problem.

In the realm of physical rehab, there is a concept called the KINETIC CHAIN.  Remember this old song?

The foot bone connected to the leg bone,
The leg bone connected to the knee bone,
The knee bone connected to the thigh bone,
The thigh bone connected to the back bone,
The back bone connected to the neck bone,
The neck bone connected to the head bone…

Our body is connected in more ways than you might think.  In fact, you will only be as strong as your weakest link.  If there is a long standing problem somewhere in your body, chances are the problem is connected in some way to another area of your body. If your ankles or knees hurt just from walking, I would guess that you may have some issues with your feet. Even if your feet are hurting, there may be an issue with your calves. Tight calves can lead to problems in your knees, hips and lower back. This in turn can cause problems in your upper back, shoulders, neck and even head. You see, everything is connected, a kinetic chain. When a part of this chain is weak or damaged, it will affect other parts of the chain.  Those parts affect other parts and so on.

Therefore, it’s vitality important to have not only the area of pain assessed but related areas above and below that area assessed for dysfunctions.  These dysfunctions can take the form of poor movement patterns, decrease range of motion, instability and poor soft tissue quality.

Frequently, you can treat a person’s pain area and get them feeling better very quickly.  In fact, they might go away feeling great for a long time but the underlying issue(s) may not have been addressed and the person may have recurrent problems months or years later.

Other times, the pain does not resolve at all because the root of the pain has not been addressed.  This is where the interesting detective work of a good doctor or therapist takes place.

I think the greatest offense that takes place in doctors’ offices is the heavy reliance on x-rays, MRIs, CT scans, blood tests and so on.  It is based on an old-school paradigm that looks at health problems in isolation from the rest of the body.  And it neglects the holistic connectivity of the human body.

Until next time…

Dr. Keith


Graston Technique for Injuries and Pain

No significant blog writing for me this week…just a link to a news segment re: Graston Technique that I use here regularly at our Richmond Hill chiropractic clinic!

For more information regarding Graston technique, click here.  Also read more at the Graston website.

Chiropractic ‘Self-Defense’ Tips for Your Hips

After a brief hiatus from blogging, I’m back this week to discuss the HIP!  First, some important background information.  The hip joint is a complex, integrated system of muscle, joint and bone and in recent years, doctors and therapists have changed the way to diagnose and treat problem related to the hip.  Two key questions emerged: 1) why was there such a high prevalence of well-conditioned athletes straining or tearing their abdominal and groin muscles? and 2) why were so many older folks losing their hip function and needing hip replacement surgery?

A newly understood source of hip pain is called femeroacetabular impingement.  This is where the head of the femur (a ball shape), can’t move around smoothly because of bony bumps on the femoral head resulting in excessive friction in the hip socket.  The result is that it forces people to move differently often affecting one’s midsection in particular and hence straining the abdominal and groin (adductor) muscles and making them more susceptible to tearing.  Over a prolonged period of time, impingement can tear the supporting labrum (a fibrous cartilage ring around the hip socket), leading to bone-on-bone contact and arthritic processes to occur…and in the worse case scenario the need for a hip replacement.

Patients come into our Richmond Hill chiropractic clinic with hip pain problems all the time.  The acute hip injuries are easy to diagnosis because they are often associated with a recent traumatic incident due to an activity.  Groin pulls, hip pointers, bursitis and sacroiliac joint sprains seem to be most common.

The chronic hip pain problems typically require more investigation.  These are the ones where the patient complains of ongoing pain that is dull or achy and deep within the hip joint.  It is sometimes more sharp depending on what he/she does and there is usually limitations in hip range of motion.  It is complicated because it involves looking at the 27 different muscles that control the hip and assessing what limitations exist and are provoking the pain.

In the end, what I will usually find is that there are 1 to 3 key hip muscles that are tight and inhibited in function which causes an imbalance within the integrated hip system.  The muscles themselves could be the pain generator or the excessive pulling of the tight muscles may cause excessive pressure within the joint capsule and cartilage structures.  The result is the aforementioned femeroacetabular impingement.  Properly ‘releasing’ the inhibited muscles will often quickly restore movement of the hip as well as alleviate the pain.

So what can you do to keep your hips healthy?  Try these Self-Defense Tips…

  1. Don’t sit in a position where your hips are lower than your knees for prolonged periods.  In particular, most people do not have their office chairs adjusted properly to account for this.  As well, if you drive alot, the design of most car seats promotes this bad sitting posture.  Why is it so bad?  It puts your hip flexors in a contracted state for too long, causing it to tighten up and result in either front of the hip pain or even low back pain.
  2. Don’t cross your legs.  Crossing your legs in a Figure 4 position causes a outward twisting pressure on the hip.  Meanwhile crossing on thigh over the other causes an inward twisting pressure.  Both are bad so don’t do it.  I know…old habit die hard.
  3. Sleep with a pillow between your knees to put your hips in neutral alignment.  This way the top hip is not twisted inward while you sleep.
  4. Add some stretches to your hip flexors, glutes, piriformis and adductors to your exercise regimen.  The majority of people only know to stretch their quads and hamstrings.  Add the others for a more complete approach to flexibility for good hip health.  See your chiropractor, physiotherapist or trainer for some good stretches.

Like I always say, Prevention is the best medicine!

If you know anyone who has ever had a hip replacement surgery, you’ll know how crappy it is…be proactive now and save yourself the aggravation later!

Dr. Keith