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The patient's medical history gives some clues as to the pain-producing
structure. For instance, in what position does the athlete
sleep? The athlete who does not sleep on his/her side most
likely has a problem around the greater trochanter, where
the tendons and the muscles of the hip joint attach, because
sleeping on the side would compress these structures and
cause pain.
Patients with sacroiliac relaxation or ligament injury typically sleep on their
sides or abdomens, but very seldom sleep on their backs. Rolling onto the back
during sleep, in these cases, will frequently wake the person from a sound sleep.
Often the difficulty of finding a comfortable position makes sleep nonrestful
and the person arises tired. When a person has sacroiliac ligament injury, it
is presumably the straightening of the lumbar spine and flattening of the back
with posterior rotation of the sacrum that is so painful that sleep is difficult
in a recumbent position. In this condition, difficulty is also experienced while
sitting and rising from a chair.
Sitting puts a lot of pressure on the structures that attach to the ischial tuberosity.
The hamstring muscle and sacrotuberus ligaments attach there. The person who
complains of pain while sitting and does not have excruciating pain while running,
but more of a dull ache that comes and goes, most likely is suffering from sacrotuberus
ligament sprain. Hamstring muscle syndrome has a characteristic complaint of
pain while in the sitting position. The pain is often relentless, causing the
person to change position or stand up for relief. The athletes complain of pain
at the buttock, caused by stretching while running or performing gymnastics.
The pain is typically induced by forcibly driving the leg forward, as in sprinting
or hurdling. The pain is seldom felt while running slowly or lying down. Endurance
athletes feel the pain of hamstring muscle syndrome during sudden spurts and
while trying to increase speed. Kicking the ball with maximal force causes pain
for soccer players with this condition. The physical examination reveals
significant tenderness around the ischial tuberosity in both sacrotuberus and
hamstring muscle strain.
Hip ischiofemoral ligament sprain typically causes a reflex inhibition of the
gluteus medius and gluteus minimus muscles. This is one of the main reasons that
ligament injuries cause a decline in an athlete's performance. Often ligament
injuries cause a reflex inhibition of the muscles that surround the joint that
the ligament is designed to protect. The body protects the joint by allowing
the muscles to become weaker (reflex inhibition) when the joint ligaments are
injured. This weakness is evident to the person, especially the athletes. The
person usually sees that there is a problem and seeks medical attention so that
further injury is prevented.
Any change in performance, such as a subtle weakness or a new pain, needs to
be checked out as soon as possible. Often a simple ligament sprain can be detected
and adequately treated with no loss of training time.
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