The Pain Isn't Always Where the Problem Is: A Physio’s Guide to Compensation, “Sleepy” Muscles & the Connected Body

Why is it that no matter how much you foam-roll, stretch, or massage that one tight spot in your shoulder, the ache always comes back?

When pain lingers, our first instinct is to push harder—we think we just aren't working the knot deep enough. But here's the plot twist about human biomechanics: you're probably treating the completely wrong spot.

To figure out why pain can be such a misleading map, we recently sat down with Sophie Coombes, a physiotherapist and founder of MatSide Physiotherapy in England. Drawing from her background in competitive powerlifting and Brazilian Jiu-Jitsu, Sophie brings a unique blend of clinical expertise and firsthand athletic experience to her practice, working with everyone from elite athletes to everyday office workers. In our latest conversation for The Movement Lab, she joined us to unpack how muscles become reluctant to contribute, and how we can better support our bodies through dynamic movement rather than searching for a single “perfect” posture.

Continue reading to explore how understanding these connections can change the way we think about movement, compensation, and work-related pain.

 Q1: Let’s start with a phenomenon that affects many people who spend their day at a desk. We often hear the terms “sleepy glutes” or “gluteal amnesia.” What do these terms actually mean?

Sophie: It's an interesting thing that people talk about. You can call them sleepy glutes or gluteal amnesia, but there are multiple ways we describe this as physios. What we're really describing is a change in how effectively your glutes work and how ready they are to contribute to movement.
If we take the average working-age person who sits for eight hours a day, their glutes spend a large portion of that time relatively inactive, with the hips held in a flexed position.
Then, when they stand up, they are immediately asking their body to walk, climb the stairs, squat, lift, or whatever movement they need to do. Those glutes may not be ready to contribute to that movement as much as they ideally could.
The body is very good at finding another way to get the job done. If the glutes aren't contributing enough, other muscles around the hip, pelvis, and femur may start contributing more.

 

Q2: Which other muscles tend to compensate, and what might be some of the effects of that compensation?

Sophie: Normally, it's our glute medius that's used a lot more. This muscle is on the lateral aspect of the hip, and it has a really important role in controlling our pelvis and also our femur, which is our thigh bone.
It is particularly important when we're standing on one leg. Although we don't really think of ourselves as doing much single-leg movement, we actually do a lot of it. Walking, running, and all these sorts of activities involve standing on one leg at a time, as part of a linked chain of movement.
The main thing that matters is that our body works as a whole connected system. What happens at our hip can affect what happens above it and what happens below it. So it's important just to be aware of that.

Q3: So the effects can extend all the way down to the ankle, or even up towards the shoulders?

Sophie: Exactly it. We see individuals who sit for eight hours a day and, let's say, they have lower back pain. But it can stem from the neck, the ankles, or the knees. So it really can be something higher up or lower down the chain that's contributing to it.
This is why I don't think sitting itself is inherently bad. The bigger issue is the lack of movement variety. Our bodies cope better when we change position regularly and ask our muscles to work in different ways throughout the day.
That is why we need to continue putting demand on the body. People can become so used to their normal routine that they don't notice what their body is actually capable of, or how much better they might feel if they changed position, moved more, or asked their body to do something different.

Q4: Could you explain how pelvic stability plays a role in this, especially for people who spend long hours sitting at a desk?

Sophie: As I mentioned earlier, most of our walking is actually a single-leg process. When I take a step and lift my right leg, my left foot is the one on the ground stabilizing me and controlling the position of my pelvis.
If I don't have enough control around that hip, or sufficient glute activation to support the movement, you might see more of a pelvic drop or changes in the way my hip, knee, or ankle moves.
It's all part of that connected movement. If the hip drops, it can affect how the knee and ankle move. The effects can also extend up into the trunk, potentially contributing to the shoulder or neck pain that many desk workers experience.
So it really is a chain reaction, where movement in one part of the body can affect other areas.

Q5: As people get older, they sometimes find that movements like squatting or deadlifting become more difficult, even if they used to lift much heavier weights. Could this be more than just losing muscle mass? Could it also have something to do with changes in our hips and pelvic control?

Sophie: Yeah, exactly. It can definitely come from different factors. But realistically, if someone has been sitting for long periods of time, perhaps because of their job, or they've become more sedentary, their glutes may become "sleepy," as we spoke about earlier. They're simply not putting enough demand on their glutes.
That's why we need to make sure we're moving regularly, changing our positions, and being more aware of how we sit and our posture.
A lot of these individuals feel some pain and reduce their movement, which is actually the last thing we want them to do. We need to make sure we're still preparing the body for load and movement, and taking it through different ranges of motion, even if there's a little pain, as long as the movement is appropriate and tolerable.
We need to continue putting demand on the body. Otherwise, our body may become less able to cope with those demands, which can contribute to knee pain, hip pain, instability, and some of the other issues you've mentioned.

Q6: That's interesting when you say "putting demand on the hips." Are you suggesting that we might be losing awareness of our hips or how to use them? The muscles might still be strong, but we're just not used to moving them in certain ways anymore?

Sophie: Yeah, exactly. I don't know if we're necessarily losing an understanding of how to use our hips, but I think people often aren't even aware of that area.
They think, "I'm going to work for eight hours, sit down, get up for lunch, sit back down, and then watch TV in the evening." They don't really change positions much throughout the day.
I think people aren't always aware of what their bodies actually require in terms of movement and demand, or how much better they might feel if they moved more or changed what they did. They've become so used to their normal routines that they don't necessarily think about how they could feel differently.
One thing I've noticed from my Instagram videos is that whenever I post a loaded hip mobility program, those videos tend to get the most traction.
People often focus on their lower back pain or knee pain, but no one really thinks about their hips. They think about their lower back or whether they can reach the floor, but they don't necessarily consider how important hip movement is.
And as you mentioned, people may simply not be aware of it. The hip is a ball-and-socket joint, so it has a huge range of movement that we need to maintain.
But people tend to either stretch their hips or strengthen them. They don't often strengthen them through their range of motion,which is something I emphasize a lot on my Instagram. I think it's so important, but people often just go as far as they feel comfortable and then stop.

（Note: Want to go deeper?

The concept of the kinetic chain describes how movement at one part of the body can influence movement elsewhere, providing a useful framework for understanding these interconnected movement patterns. (Karandikar & Vargas, 2011) https://onlinelibrary.wiley.com/doi/10.1016/j.pmrj.2011.02.021 .）

Q7: You shared a post about how hip internal rotation can act as a hidden contributor to lower back pain. Could you explain how the two are connected, and why our everyday movement habits might play a role?

Sophie: Yes. Hip internal rotation is when your thigh bone rotates inward. There can be multiple factors that influence it.
Some people might just naturally have slightly more or less hip internal rotation, and that's simply how we're made. For other people, like myself, it can be influenced by certain sports. I did sports that required my hips to be in certain positions, but not in others. So the muscles surrounding my hip area got tighter because I was compensating and using larger muscle groups, which actually caused my hips to lose access to that internal rotation.
Having hip internal rotation isn't a problem, but where it can become quite clinically relevant is when someone either has limited access to it or has poor control when doing particular tasks that require that hip internal rotation.
Let's say I'm sitting at a desk all day. My hips spend hours in this relatively similar, small range of movement. Then I ask my body to walk, run, play a sport, garden, or whatever it is. If I'm not getting enough movement from my hips, my body will compensate and find this movement elsewhere. Sometimes that movement might come from my pelvis or my lower back.
Again, compensation isn't really inherently dangerous. But if your lower back has to contribute more and more over time because your hip isn't contributing enough, then the demand might exceed what that individual can tolerate, and it can become relevant to the symptoms they're having.
However, this capacity can also be rebuilt when you gradually expose the body to that range again.
As a physio I wouldn't say that having a particular amount of hip internal rotation is damaging to your back. What matters clinically is whether someone has the hip mobility, strength, and control required for their day-to-day activities and what they're asking their body to perform.

(Side Note: Understanding rotations

Many people notice movement patterns such as knees moving inward (“knock-kneed” appearance) or outward (“bow-legged” appearance). While these patterns can have many different contributing factors, hip mobility, strength, and movement control can influence how the lower limb moves as a connected system. This is why physiotherapists often look beyond the knee itself and assess how the hip, pelvis, and ankle are working together.

A 2015 literature review found that limitations or asymmetries in hip rotation were commonly observed in individuals with low back pain and discussed how restricted hip movement may contribute to compensatory movement patterns through the lumbar spine. Importantly, this does not mean that limited hip rotation directly causes low back pain, but it highlights why hip movement can be relevant when assessing symptoms that appear elsewhere in the body. (Sadeghisani et al., 2015)https://pubmed.ncbi.nlm.nih.gov/26751745/ .)

 Q8: I’ve noticed that when I sit at my desk, I tend to rotate slightly to my right, probably because I often hold my phone in my right hand. Over time, I imagine this could create some asymmetry in my body. You’ve mentioned core anti-rotation exercises before. Could you explain how they help, and what we can do to address this during everyday work?

Sophie: Yes. A few of the exercises I've mentioned before are Pallof presses, which are really good for core anti-rotation.
I don't think there's necessarily an issue with sitting with your phone in one hand, or having one hand on the mouse while your torso faces a second screen. The issue is more when we're sitting like that for eight hours a day, without moving very much.
You're giving yourself a very limited range of movement. If your body can't tolerate that, that's when you might start getting aches on one side.
For example, if your right hand is always reaching for a mouse or phone, you might find that the right side of your trunk, including your lower back muscles and glutes, is working harder than the left. That can lead to compensations in your movement.
Core anti-rotation exercises are great for training the core and lower back muscles to work together on both sides, rather than allowing one side to relax while the other works harder.
But for everyday work, I'd recommend changing your sitting position regularly. You can't have a perfect desk setup, and no one can maintain a perfect posture all day. An ergonomic chair or a sit-stand desk can help you change positions throughout the day, perhaps every 20 minutes or half an hour.
Exercise in the gym is great, but you also need movement throughout those eight hours of work.

Follow-up: That's interesting because I tend to rotate to my right, but it's actually my left shoulder blade that hurts. Could the problem be coming from somewhere other than where I feel the pain?

Sophie: Exactly. Where you feel pain isn't always where the problem is coming from.
From what you've described, your left hand is on the laptop while your right hand rests on the armrest holding your phone. Your left shoulder stays elevated, so that side is constantly working to hold its position, while your right side does more of the rotational movement.
For you, it would be about moving your left arm more and allowing your whole torso to rotate together, rather than keeping one side stationary while the other does all the reaching and moving.

Q9: That’s interesting because I also experience pain that seems to travel from my hip all the way down my leg, sometimes reaching my shin or ankle. I've tried using a foam roller to loosen what I think is a tight piriformis muscle, but it doesn't really resolve the pain. Why might that be?

Sophie: Some people think that if it's their piriformis, they can just use a foam roller or one of those trigger point balls to resolve it. In some cases, that can help. But quite often, it's more than just one muscle group that's contributing to the issue.
If your piriformis is already irritated, stretching or deep tissue work might actually have the opposite effect and aggravate your symptoms further.
So it's important to understand whether the pain in your glutes, hamstrings, calves, or ankles is coming from the piriformis itself, or whether something else, like your lower back or your movement tolerance, is contributing to it.
Where you're feeling the pain isn't necessarily where the issue originates. It could involve other surrounding structures as well. That's why it's important to be mindful of that and, if needed, have it properly assessed.

Q10: So how do we know when it's enough to just work on a specific muscle, and when we should be looking at other areas that might be contributing to the pain?

Sophie: If you've tried foam rolling, trigger point release, or stretching without any improvement, it might be time to consider strengthening exercises or seek advice from a physiotherapist or healthcare professional.

Q11: We've talked a lot about hip mobility and how different movements affect the body. What are your thoughts on floor sitting and its potential benefits for hip mobility and overall movement?

Sophie: I think it's a brilliant idea. My favorite thing about a floor-sitting desk is that every time you get up, you have to use your glutes, hamstrings, and quads. Standing up from a chair requires a much smaller range of movement, whereas getting up from the floor is almost like getting a mini workout throughout your day.
Floor sitting also naturally gives you access to a much wider variety of movements and sitting positions than a standard chair. You can sit cross-legged, side-sit, or move into a comfortable squat, putting your ankles, knees, and hips into different positions and angles.
The real benefit isn't that sitting on the floor is magically going to fix everything, but that it introduces more movement variety into your day. I think there's something really practical about that, especially when it comes to maintaining mobility as we get older.
Of course, it won't suit every individual. If you're not used to sitting on the floor, I wouldn't recommend jumping straight into an eight-hour day. Start with 15 minutes, go back to your normal position, and gradually integrate floor sitting into your routine.
You might find that floor sitting is more comfortable for you, or that alternating between a normal-height desk and a low desk works better. It's really about having more movement options and taking your time to get used to them.

Q12: Lastly, what are some of your favorite exercises to help desk workers break out of their sedentary routines? And are there any exercises you'd particularly recommend for people working from a floor-sitting desk?

Sophie: I'd personally choose a couple of simple exercises rather than giving people 15 or 20 different corrective exercises for posture. Realistically, the most important thing is movement.
I do not think people need to turn their working day into a series of complicated corrective exercises. I would much rather give someone a few simple movements that they can actually integrate into their day.

1. Sit-to-stand, which are very similar to squats. They're practical, train your posterior chain, and help keep your hips and knees moving through their full range of motion. I often ask my patients to do 10 sit-to-stands every time they get up from their desks, setting a reminder every half hour. They can then grab a glass of water or make a cup of tea. It's a nice way to integrate movement into your routine without setting aside another half hour for exercise.
2. Single-leg movements, such as a single-leg Romanian deadlift or a Bulgarian split squat. These exercises challenge the lateral hip and gluteal muscles, including the gluteus medius, while also requiring stability and control as you load one leg.
3. Anti-rotation work, such as the Pallof press. This challenges the core in a different way from traditional exercises such as crunches and asks the body to control rotation while keeping the left and right sides working together.
4. Floor-based movement. Floor sitting provides another opportunity to introduce movement into the working day.
   a)    90/90 hip switches， which are a good way to work on hip internal rotation while introducing movement from side to side.
   b)    Knee rocks, performed while lying on your back. This allows movement through the pelvis and mid-back, while also encouraging spinal extension and rotation. If you've been working at a computer for several hours in a slightly hunched position, these movements can help you move your spine and pelvis in directions that may not have been used much during the day.

But exercise is only one part of it. I also encourage people to change their position regularly throughout the workday. A simple approach is to change position or move every 20–30 minutes, giving your body a different demand to respond to throughout the day. Going to the gym and exercising is great, but it is also important to incorporate movement into those eight hours of work rather than remaining in the same position for long periods.

Conclusion：

Our conversation with Sophie offers a different way to think about pain, showing that it is rarely an isolated problem, but rather something connected to the way the body moves as a whole.

When one muscle or area isn't contributing enough, the body doesn't simply stop. It adapts. Other muscles can step in and help get the movement done. Over time, that compensation can travel through the kinetic chain, which means the place where we feel pain isn't always where the problem began.

That perspective changes how we think about movement. Instead of only focusing on the area that hurts, we can start asking what the rest of the body is doing — and whether there are muscles, movements, or ranges that aren't getting enough opportunity to contribute.

Ultimately, the takeaway from Sophie’s approach is clear: movement isn’t just about treating where it hurts, but about giving every part of the body the opportunity to contribute.

References

1. Karandikar, N., & Ortiz Vargas, R. (2011). Kinetic chains: A review of the concept and its clinical applications.PM&R, 3(8), 739–745.
https://onlinelibrary.wiley.com/doi/10.1016/j.pmrj.2011.02.021 

2. Sadeghisani, M., Manshadi, F. D., Kalantari, K. K., Rahimi, A., Namnik, N., Karimi, M. T., & Oskouei, A. E. (2015). Correlation between Hip Rotation Range-of-Motion Impairment and Low Back Pain: A Literature Review. Ortopedia, Traumatologia, Rehabilitacja, 17(5), 455–462.
https://pubmed.ncbi.nlm.nih.gov/26751745/