As a physician I winced when I first heard the name “dead butt syndrome”. Actually, I still do.
But, as a lifelong medical researcher who occasionally strays onto the internet, I get it. If you want your work to be noticed, it’s important to give it a catchy name, and “dead butt syndrome” checks that box. I prefer the term gluteal amnesia, because it better summarizes the condition, but let’s go with dead butt syndrome, because it’s what everyone calls it.
And I do mean everyone: here’s what trends.google.com has to say (blue=dead butt syndrome, red=gluteal amnesia, yellow= gluteus medius tendonitis):
Interestingly, the term “dead butt syndrome” has only been around for 15 years, but it does seem to be having a moment now, so let’s dive in.
To fix ideas, here’s a serviceable definition taken from Wikipedia: “Dead Butt syndrome is a lifestyle disease that affects the gluteus maximus muscle characterized by a lack of muscle tone and strength in the buttocks, typically from excess sitting.” But note that this definition is supported only by newspaper articles, not research papers.
And there’s a reason that Wikipedia’s definition is so thinly sourced: “Dead Butt Syndrome” doesn’t actually appear in the title of a single peer reviewed medical or physical therapy article. A quick search of scholar.google.com turns up 100 mentions of “dead butt syndrome”, but only in passing deep in the text of articles. Not one review article is devoted to the epidemiology of dead butt syndrome. Further, no one seems to have studied how the condition might be treated or prevented. Searching on more mainstream medical synonyms for dead butt syndrome (gluteal amnesia, gluteus medius tendonitis) gives the same result. We might wonder at the lack of interest of mainstream medicine in dead butt syndrome, but because it doesn’t result in death or serious disability there seems to be little incentive or grant money available to study what may be a common problem.
But sometimes looking a bit further pays off. I found a very comprehensive, peer reviewed article on dead butt syndrome hiding in plain sight with the title “Assessing and Treating Gluteus Maximus Weakness – A Clinical Commentary” which somehow in the entire text never actually uses the words “dead butt syndrome”. Rather Buckthorpe and colleagues used the simpler, and far more descriptive (if less lurid) term “gluteus maximus weakness”. This wasn’t meant to be push back against the term “dead butt syndrome”, because Buckthorpe’s paper was published in 2019, before the web settled on “dead butt syndrome”. For those wishing to read a terrific, if slightly technical, treatment of dead butt syndrome (AKA gluteus maximus weakness) I highly recommend Buckthorpe’s. And it’s not just me recommending this paper: it’s been cited 74 times in other peer reviewed articles.
Dead butt syndrome is usually ascribed to excessive or incorrect sitting. Importantly, sitting doesn’t damage the gluteal muscle or its innervation. Rather it seems that long periods of sitting create a “tug of war” between hip flexors and gluteal muscles with the flexors tightening and strengthening while the gluteal muscles lengthen and weaken. This imbalance disrupts reciprocal inhibition, resulting in reduced activation of the gluteal muscles, even during targeted exercises.1 As the gluteal muscles weaken the body compensates by relying more on secondary hip extensor muscles like the hamstrings and hip adductors. This phenomenon, known as synergistic dominance, can further contribute to gluteal weakness.2 These changes can predispose to a host of downstream injuries, including IT band syndrome, patellofemoral knee pain, ACL injuries, and ankle sprains. Because the gluteal muscles stabilize the pelvis, weak gluteal muscles may also predispose to back pain. Worst of all, because they are off loading their responsibilities the gluteal muscles may fail to regain strength during day-to-day activities, and may not recover absent a carefully structured rehabilitation effort.
We can summarize by saying that gluteal muscles weakened by too much sitting “forget” how to participate in movements of daily activity, forcing other muscle groups to take up the slack in ways that degrade function and predispose to pain and injury. As Chris Kolba, a physical therapist at the Ohio State University Wexner Medical Center observed, “… eight-hour desk days can cause a delay in the neurons that signal them to activate. Over time, this cycle can cause the glutes to get weaker, which has been linked to lower back pain, especially in active people.”3
Since excessive sitting seems to be the root cause of dead butt syndrome, we might expect that research on how we sit would have discovered the connection between sitting and dead butt syndrome, but here again no peer reviewed articles have been published. This isn’t for want of studying sitting: a search of scholar.google.com finds more than 85,000(!) peer reviewed articles about sitting. This isn’t surprising, of course. We spend most of our waking hours sitting, and because sitting isn’t a normal posture for humans our obsession with sitting has caused quite a lot of mischief. Back pain, metabolic syndrome, obesity, heart disease, culminating in an increase in all-cause mortality, all are strongly associated with sitting. And now it seems dead butt syndrome might also be a consequence of our chair centric lives.
Any dysfunction of the gluteal muscles is likely to have important consequences. The gluteal muscles are not only the largest muscle in the body, but are also responsible for hip extension (required for efficient walking and running) as well for simply maintaining upright posture. Note, however, that the gluteal muscles don’t come into play when seated, and thus it is our chair-centric, seated lives set the stage for gluteal disfunction and dead butt syndrome.
Given the importance of the gluteal muscles, it’s scarcely surprising that if their function is compromised serious problems can ensue. Those with dead butt syndrome complain of discomfort, pain or stiffness in the hips, knees, or low back. Perhaps most problematic, dead butt syndrome may make athletic injuries more likely.
No peer reviewed research has been published on how one might avoid dead butt syndrome. But, because the problem is so closely associated with sitting, we might suppose that sitting less, and especially sitting for shorter periods of time, are important prophylactic strategies. Unfortunately, such advice is easy to give but hard to follow. Building “movement snacks”4 into one’s day such as walking5 while talking on the phone or taking the stairs rather than the elevator has been proposed but requires that people interrupt themselves many times each to get up and move, a strategy that many people find hard to implement.
A solution that may be easier for many people to adopt might be making sitting itself active by changing to a newer generation of office chairs that require constant, slight, movement to stay balanced while sitting. Such chairs make movement an integral part of sitting; indeed, they can make sitting a little like walking. Because these chairs don’t require leaving off work and standing up many times a day, work flow isn’t affected. “Active sitting” alternatives to ergonomic chairs are now widely available, and because active sitting require gluteal activity these chairs may make dead butt syndrome a thing of the past.
But what’s to be done if you suspect you already have established dead butt syndrome? Unfortunately, the diagnosis and treatment aren’t straightforward. It’s probably best to find a physical therapist or trainer to get you started on the road to recovery. For those who want to address the problem on their own as a DIY project, a great place to start is with Buckthorpe’s excellent paper mentioned above: “Assessing and Treating Gluteus Maximus Weakness – A Clinical Commentary”. This paper isn’t intended as a step-by-step treatment guide, but all the steps are included if you’re willing to take the time to work through the details.
In a nutshell then, dead butt syndrome is a lifestyle disease in which excessive sitting weakens the gluteus maximus muscle forcing other muscle groups to take up the slack in ways that degrade function and predispose to pain and injury. Because the consequences of dead butt syndrome can be uncomfortable and hard to treat, the problem is best avoided. Strategies may involve sitting less, sitting for shorter periods, or sitting differently (actively). And, if you think you already have dead butt syndrome, it’s best to find a PT or trainer to help bring your butt back to life.
1 Assessing And Treating Gluteus Maximus Weakness – A Clinical Commentary
2 Assessing And Treating Gluteus Maximus Weakness – A Clinical Commentary
Leave a comment
All comments are moderated before being published.
This site is protected by hCaptcha and the hCaptcha Privacy Policy and Terms of Service apply.