Dr Manan Vora, an orthopaedic surgeon and sports medicine specialist, has been seeing a rise in patients suffering from DBS ever since the Covid-19 pandemic. Short for dead butt syndrome, DBS is clinically called ‘gluteus medius tendinopathy’ or ‘gluteal amnesia’. This weird-sounding term means exactly what it sounds like. It is when your gluteal muscles, which support the pelvis and ensure the body’s alignment, forget their purpose. And a sedentary lifestyle is the main culprit.
“The primary cause of DBS lies in the tightening of hip flexors, which happens due to long sitting hours. And if you do not stretch these muscles enough or exercise and work out, it can lead to a kind of tendinopathy of the gluteal muscles, and that is what DBS is,” Dr Vora explains.
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Citing studies, Dr Sonal Gupta, director and HOD at Fortis Hospital, Shalimar Bagh, New Delhi, says, the pain caused by the syndrome varies from moderate to severe and disabling. “This affects the quality of life and can be well compared with end-stage osteoarthritis of the hip,” she says. “People with DBS experience numbness, tingling, muscle tightness, muscle weakness and even pain in their buttocks region,” explains Dr Ramneek Mahajan, senior director and head of the joint replacement unit (knee and hip), Max Smart Super Speciality Hospital, Saket, New Delhi.
However, not only those leading a sedentary life, but DBS can affect even athletes. “Muscle imbalance may also occur in highly active people who have strong quads or hamstrings if they sit for hours at a time,” explains Dr Mahajan.
Who’s at risk?
Obese individuals and those leading an inactive lifestyle are at a higher risk of DBS, doctors say. Desk and other long-sitting-hours jobs are among the primary culprits. “But it is most prevalent in women over 40 years of age and is the commonest tendinopathy of lower limbs,” says Dr Gupta. “Among athletes, it is more common in runners,” she adds.
Certain deficiencies such as that of vitamin D and B12 can also increase the risk of a dead butt, and so does heavy alcohol consumption. “You should immediately seek medical advice if you experience symptoms such as consistent pain in the lower back, pelvic pain while walking or sitting and balancing problems while standing,” says Dr Mahajan.
Those suffering from dead butt syndrome “come with pain and tenderness over the lateral side of the hip. This pain can radiate up or down and mimic sciatica too. It is, in fact, the commonest cause of non-radiating local lateral hip pain. Symptoms are of insidious onset and tend to get worse over time. It can affect sleep as sleeping on the affected side causes severe pain. It can also cause significant pain while trying to rise up. So, nearly every movement for most of the tasks becomes painful. That’s why DBS is debilitating,” explains Dr Gupta.
This syndrome can also lead to other painful issues such as hip and lower back pain and sciatica-like symptoms with pain radiating through the back of your thigh and calf, explains Dr Vora. “It can then lead to gait-related problems and other issues. It can even lead to the inflammation of the hip bursa,” he says. A fluid-filled sac, the hip bursa, eases movement within the hip joint.
Tests & diagnosis
If experiencing DBS symptoms, an orthopedist or a sports medicine specialist can help with diagnosis and treatment. Some tests are done to clinically diagnose DBS. “Ultrasound and MRI are the modalities of diagnostic tests for glutei tendinopathy. The tendon may be just swollen, there may be a partial tear or complete tear. Ultrasound has 70-75% sensitivity and more than 95% specificity to diagnose DBS. MRI has an equal degree of accuracy with the added advantage of being able to differentiate the degree of tendinopathy,” explains Dr Gupta.
“Just like any other tendinopathy, dead butt syndrome is treated with a little bit of rest, a little bit of icing and the inflammatory medication followed by an entire exercise and physical rehabilitation protocol,” says Dr Vora. “In certain cases, where there is no relief even after trying out all these conservative measures, a PRP injection can be given in that area. PRP is platelet-rich plasma injection, which is a form of regenerative therapy to help reduce the tendinopathy and treat it at its root cause,” he adds.
Surgery is also an option but is “reserved for only recalcitrant cases”, says Dr Gupta. “However, over 50% of patients get relief with lifestyle modifications and exercises to reduce the muscle spasm and swelling,” she adds.
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The way forward
Like in any health-related issue, prevention is better than cure when it comes to DBS. According to Dr Vora, “The prevention for DBS lies in avoiding sitting at a particular position and place for long hours. Get a timer on your phone or watch and get up frequently.” He recommends the one-minute every-hour rule. “We aim to prevent the stiffness of muscles, and for that, set an alarm to get up from your chair, for one minute once every hour and go for a walk in your office or around your home,” he explains. “What it does is that when you stand and walk around, your back gets extended, and legs and glute muscles activate. You can also twist your neck in multiple directions to avoid cervical pain in the future so that your cervical muscles do not get stiff,” he adds.
The simple act of getting up and walking protects your health and reduces your risk of serious health conditions, says Aminder Singh, a fitness expert and founder of Team Aminder. “Also, avoid sitting cross-legged. It is because of the way your skeleton is, crossing legs can cause misalignment of the spine and shoulders. Also, whenever you get up from the chair, try to stretch your leg. It will help you to light up the muscles and release the tension which has been built on the legs,” he adds.
Here are some other preventive tips:
- Avoid sitting for too long, especially in the wrong posture. Move around and stretch.
- Use stairs rather than elevators. It helps strengthen the butt muscles.
- As advised by the doctor, do squats. It keeps the lower portion of the body active.
- Consume enough vitamin D and B12 and protein.
- Have a balanced diet and refrain from binge eating.
You can also incorporate yoga into your lifestyle.
If you are an athlete, run in the right manner to avoid tendinopathy.
Apart from these, doctors recommend some exercises to prevent DBS. These include squats, glute bridges and lifts, hip thrusts, hamstring stretches and curls, pelvic lifts, etc.
“But the primary prevention is not sitting at one place for a long time. So, get up and take frequent walks,” says Dr Vora. “Standing up for a minute every hour of your work is the bare minimum you should do,” he adds.
SIMPLE EXERCISES THAT CAN HELP
Hamstring stretch
- Sit straight with your legs extended in front
- Next, extend your arms by bending at the waist. Try touching your toes while keeping your knees straight
- Hold the position for 10-15 seconds
- Relax and repeat a couple of times
Squats
- Stand straight with your feet a little wider than hips-width distance apart
- Start bending from your knees while driving your hips back
- Strive to reach further back such that your thighs are parallel to the floor
- Stay for a few seconds and rise back. Repeat
Glute bridge
- Lay down on your back with your legs extended
- Bend your knees and place your feet flat on the ground, such that they are near your palms
- Leaning on your feet, push your hips up. Ensure that in this position, your knees are above your toes
- Maintain this position for a few seconds before bringing the hips down slowly
- Repeat the exercise a few more times
