Pain in the back of the thigh under the buttock

Hamstring muscles[edit | edit code]

Anatomy[edit | edit code]

Hamstring muscles

• M. biceps femoris (biceps femoris)'
  . The long head is attached to the tubercle of the ischium, the short one to the lateral lip. This muscle helps in straightening the leg, flexes the shin and rotates it outward in a bent knee joint.
• M. semitendinosus (semitendinosus muscle)
  . It is attached to the side of the tibial roughness on the pes anserinus. Responsible for straightening the thigh of the supporting leg, bending the ankle joint and rotating the bent shin inward.
• M. semimembranosus (semimembranosus muscle)
  . Attached to the medial articular condyle of the tibia. Its functionality is the same as that of the semitendinosus.

Biomechanics[edit | edit code]

The hamstrings are the type of muscle that shortens more often. With the help of a simple exercise you can diagnose your existing shortening. The ability to stretch is considered sufficient if you can, while lying on your back, raise your leg 90 degrees up and fix it in this position without any pain. If you can’t do this, then you should work on stretching. The back surface of the thigh receives the main load when running, specifically when sprinting. This is why athletes involved in straight running and steeplechase often suffer sprains and tears in the biceps muscle.

Also, danger lies in the uneven development of the muscles of the front and back of the thigh. This often happens due to past participation in any sports. You can be sure that your balance is shifted towards the quadriceps if you often play football or do jumping. Conversely, your hamstrings are stronger if you run short distances. Naturally, imbalance can also be caused in the gym. To do this, squat for a long time with your legs wide and below parallel.

In case of imbalance, it is useful to perform some restoration work using unusual exercises, which will be discussed below. Experience shows that in basic exercises it is worth using a moderate number of repetitions per set (8-10).

Now let's talk about exercises that can bring maximum benefit to the muscle group in question.

Muscular structure of the pelvis and their function

Human anatomy is complex, therefore, for convenience and a better understanding of all areas, the entire body of the body was divided layer by layer, that is, each tissue is considered separately.

The muscular elements of the pelvic area are divided into external and internal blocks, each of the muscle fibers has its own functions.

The external block is divided into three layers, one after the other.

Indoor unit

The internal pelvic muscles primarily serve as a kind of wall for the abdominal cavity, their second function is to carry out upright walking and control the femoral region of the limb.

The internal block consists of the following muscles:

1. Greater lumbar. It originates on the outer sides of the vertebrae, starting from the thoracic region, and serves as a kind of fastener for the lumbar region and pelvis.
2. Ileum. It connects to the lumbar major in the area of ​​the iliac fossa and is further called the iliopsoas.
3. Iliopsoas. A wide element attached to the femoral trochanter. Helps bring the leg towards the stomach.
4. Internal obturator. From the obturator foramen it passes through the pelvic area, in the middle it abruptly changes its orientation and strives for the greater trochanter.
5. Bliznetsovs. The twin muscles help in abduction of the femoral area.
6. Pear-shaped. Divides the greater sciatic foramen into 2 parts vertically, next to the femoral neck it enters the tendon structure to the greater trochanter. It moves the limb in the upper zone outward, but the abduction is extremely small.

In addition to these muscle elements, another one is distinguished - the small lumbar, but in 39% of people it is absent and does not have any significant function.

External unit

The external block of the muscular structure of the pelvis is located on the outside of the pelvic region. The entire block is involved in the motor activity of the hip joints.

The outer block is formed by three layers:

• superficial;
• average;
• deep.

The superficial one contains the gluteus maximus, which performs powerful straightening of the limb, for example, during physically heavy loads for a person, and the tensor fascia lata.

Nuance! The tensor fascia lata is able to direct the thigh towards the abdomen and helps in controlling the knee joint.

The middle layer contains parts of the internal pelvic muscle structures:

• pear-shaped;
• internal obturator;
• twins.

This also includes the gluteus medius muscle, which, together with the small gluteus, helps keep a person in an upright position. Another muscle, the quadratus femoris, helps rotate the limb outward.

Exercises[edit | edit code]

• Deadlift
• Squats
• Leg press
• Bend legs in the machine
• Posterior thigh muscle stretch

Deadlift on straight legs[edit | edit code]

The deadlift is one of the best exercises for developing the hamstrings. However, if these muscles are significantly behind in development or you are recovering from an injury, then you need to modify this exercise a little. Now this will be a straight leg deadlift with dumbbells. You heard right: you need to stand on one leg! Dumbbells in lowered hands, free leg goes back. Obviously, you cannot use heavy weights in this exercise, therefore, perform 15-20 repetitions per set.

Squats[edit | edit code]

Barbell squats can and should be performed with a wide stance. You should sit down almost until your gluteal muscles touch the floor. It should be noted that this manner will lead to very rapid growth of not only the hamstrings, but also the gluteal muscle. And hypertrophied buttocks don’t look very good. Especially for men. A much more gentle option is squats with dumbbells in your hands. This option allows you to focus the load on the thigh biceps.

Leg press[edit | edit code]

The leg press in the simulator is an exercise that can be finely adjusted to suit you. If your target is the biceps femoris, then place your feet closer to the top edge of the platform. The distance between the feet is about 35-45 cm. The lower part of the amplitude is important here. Also try to rest on your heels rather than on your entire foot.

Leg curls in the simulator[edit | edit code]

The leg curl machine will also not be forgotten. I recommend performing the movement with each leg in turn - this will allow you to more fully concentrate on the work of the target muscles. At the bottom, the joint does not fully extend; at the top, throw your leg until it touches.

Stretching[edit | edit code]

Stretching plays a big role in developing the hamstrings and preventing injury. Since the target region is very large, some effort must be made to achieve adequate stretching. But there is no need to “tear” the muscle—it is enough to calmly and measuredly increase the amplitude of movement. In addition to the option when you lie on your back and stretch your leg raised at an angle of 90 degrees, you should use deep lunges. Bring your leg forward and sit on it. Ideally, you should be able to touch your chest to your knee. Let us remind you that before training you need to do dynamic stretching, but after training, when the muscle is in a stretched state, it remains for up to 15 seconds. Please note that the stretched muscle should not be strained. This leads to pain and even more stress. Try to breathe calmly and shallowly, then you will be able to catch the moment when the muscle stretches, but does not instinctively tense. It is when working on the back of the thigh that you can feel this best. Following these simple recommendations will allow you to move an unyielding muscle, reduce imbalance in development, and prepare it for more stressful loads.

Source Iron World No. 3

The investigation is being conducted by a vertebrologist

The first and most important part of the diagnosis is interviewing the patient. For example, if a patient told the doctor: “My buttock hurts when I sit,” then the sciatic nerve is probably to blame. If the patient has not had injuries to the hip, pelvis, coccyx area, or unsuccessful intramuscular injections, the doctor will suggest sciatica - pinching of the sciatic nerve somewhere between the 4th lumbar vertebra and the sore spot. The most common culprit is a spasm of the piriformis muscle, through which this nerve passes. But it happens that problems are associated with the 5th lumbar or the first three sacral vertebrae, the hip joint, tumors, or even changes in the pelvic area during pregnancy (including early stages). The same diagnostic algorithms are available for pinched other nerves.

The doctor then examines the patient. He determines which muscles are tight, how the patient reacts when certain points are pressed, and conducts standard neurological tests. Next, an examination is scheduled. Depending on the results of the survey and examination, the following may be prescribed:

1. x-ray in two projections;
2. computed tomography (CT);
3. magnetic resonance imaging (MRI).

Usually they start with an x-ray. A CT scan will be needed if there is a suspicion of a fracture, and an MRI will be needed if it is necessary to exclude herniated discs or changes in soft tissues. Additional studies - blood tests, electrocardiogram, ultrasound and others - are prescribed if the doctor suspects non-neurological causes of pain or wants to make sure there are no contraindications to certain prescriptions.

Intramedullary treatment method

Intramedullary technique is another treatment method in which the femoral neck is fused on special pins - rods/wires, which are installed through the medullary canal of each bone fragment. Most often, locking type systems are used - holes for screws are already provided at its ends, which simplifies fixation. Some designs have special bends that stabilize the implant.

Devices for intramedullary treatment are available in semi-elastic and rigid types. They allow you to fix even multiple bone fragments.

Fixation of the pin is performed with or without perforation (pre-drilling of the channel). Like the titanium plate, the rod is removed after complete fusion. That is, surgery is performed twice. The operation to remove the implant is not accompanied by complications and has no consequences both intraoperatively and postoperatively.

Rehabilitation after osteosynthesis of the femoral neck

Any method of surgical treatment involves postoperative recovery. Installation of plates for fractures ( osteosynthesis ) is no exception. The doctor who prescribes and carries out the procedure will advise the patient on the rules for this period. Typically, a rehabilitation program includes:

• special mode (reduced loads on the area in which the plate is installed on the femoral neck , control of movements, movement on crutches);
• breathing exercises;
• physical therapy (passive and active exercises, exercise equipment to maintain leg muscle tone and normal functioning of the musculoskeletal system);
• physiotherapy (magnetic therapy, ultrasound, electrophoresis);
• medicinal baths (pine needles, brine, hydrogen sulfide);
• swimming and aqua-gymnastics;
• paraffin wraps;
• therapeutic massage to activate blood supply to the restored area, normal lymph outflow, prevent swelling, congestion in the lungs, and the formation of bedsores.

The rehabilitation period after osteosynthesis of the femoral neck (connecting fragments using a plate) takes up to 12 months and is carried out under the constant supervision of specialists.

Indications for femoral neck osteosynthesis

Femoral neck fractures for 55% of cases of injuries to the proximal region of the femoral apparatus (the second most common injury is the trochanteric part, which accounts for 40% of cases and only 5% of incidents affect the subtrochanteric area). Elderly patients are at risk, since most often injury occurs against the background of age-related changes, including as a consequence of osteoporosis.

The peculiarity of a femoral neck fracture is that it is intra-articular. That is: it requires immediate intervention and involves precise reposition - connection, fixation of bone elements in the correct anatomical position.

A broken bone cannot heal on its own and in 99.9% of cases, recovery involves surgery. Absolute indications for surgery, including osteosynthesis with plates for a femoral neck fracture:

• any displacement of bone elements (including minor ones);
• vertical fracture;
• comminuted fracture if it is necessary to connect 2 bone fragments or more;
• combined injury (connection of fragments to a plate in case of a femoral neck fracture in combination with a dislocation);
• incorrect position or abnormal shape of the bone after fusion;
• pseudarthrosis after an unsuccessful attempt at therapy in the past (conservative or surgical).

Osteosynthesis

The connection of bone elements using a special plate - osteosynthesis of the femoral neck - is prescribed for all types of proximal fractures, except impacted ones. More often, such restoration is prescribed to young people (the bone is better supplied with blood, metabolic processes are accelerated, which contributes to the rapid joining of fragments). The risk of developing complications during osteosynthesis is 10–60%.

For fractures in older people, a more common repair practice is joint replacement. In general, the age and condition of the patient determines many features of the surgical operation for recovery:

• young people are more likely to have cancellous screws with full or partial threads installed;
• elderly people - 3-blade nails;
• weakened elderly patients are also given special titanium screws (spongy), since such manipulation is minimally invasive.

Installation of a plate after a femoral neck fracture is preferable when its line is at an angle of 50 degrees or more. The implant will eliminate the possibility of fragments sliding relative to each other.

Contraindications for plate fixation

Osteosynthesis - installation of plates for a femoral neck fracture - is a complex operation with high morbidity. Therefore, its appointment is treated with great caution, taking into account all the possible risks. Such invasions are contraindicated:

• mental disorders;
• in case of serious condition of the patient;
• coma;
• state of shock;
• severe thrombophlebitis of the legs;
• hematopoietic dysfunction;
• blood clotting disorders (coagulopathy);
• subcapital fractures near the head (function restoration is carried out using an endoprosthesis).

Installation of a titanium plate for a femoral neck fracture is not recommended for people over 70 years of age (it is replaced by endoprosthetics). An absolute contraindication for major surgery is individual intolerance to the general anesthetic drug.

Diseases in which fixation of bone fragments on a plate for osteosynthesis of the femoral neck is not carried out:

• diabetes mellitus (both types, severe stage);
• infections of the damaged area;
• acute inflammatory process and suppuration at the fracture site;
• tuberculosis (active form);
• heart disease, lung disease;
• ARVI.

Osteosynthesis for hip fracture

The femoral neck is the thinnest part of the femur, through which the body of the bone is connected to the head.
Due to its small thickness, given the degree of load that falls on the hip region, this particular section remains very vulnerable. In addition, the location of the bone does not contribute to the rapid healing of bone tissue during fractures. To speed up the process of fusion of fragments, surgical treatment methods are used - installing a plate for a fracture of the femoral neck (its osteosynthesis). Ideally, fixation of such a plate should be carried out on the first day after injury.