Gluteal or Buttock Pain Trigger Points
The Quadratus Lumborum Trigger Points that Cause Gluteal Pain
Trigger Point Therapy for Buttock or Gluteal Pain
It can be difficult sometimes to clinically distinguish pain in the buttocks from low back pain. Generally we say that pain experienced along the belt-line or above is low back pain, and anything below the belt-line in the buttock, sacroiliac joint, or sacral regions is termed gluteal pain.
The gluteus maximus trigger points are the only to refer pain exclusively to the gluteal region.
Trigger points in the quadratus lumborum and gluteus medius muscles refer pain to gluteal region, but also to the low back region. While trigger points in the gluteus minimus, quadrates lumborum, and piriformis muscles refer pain to gluteal and hip regions.
Because of this overlap in pain patterns, I typically treat low back pain and gluteal pain as one disorder in my practice, especially in chronic pain situations. I've found this comprehensive treatment approach to be the most effective as trigger point activity will spread to different muscle groups over time. Often I see a patient that initially experienced a low back pain complaint come to me with a gluteal pain complaint.
Video: The Gluteal Pain Trigger Points
The Quadratus Lumborum Trigger Points that Cause Gluteal Pain
The Quadratus Lumborum muscle group is composed of several small muscles that are located deep within the lower back muscle mass. It attaches to the lowest rib, at several spots along the lower (lumbar) spine, and along the pelvic rim.
The Quadratus Lumborum contracts to help stabilize the spine, and to flex the trunk to either side. This muscle group can contain up to four trigger points that refer pain to the low back, groin, hip, and gluteal regions.
Trigger points in the middle of this muscle group seem the most responsible for the gluteal pain projection.
A person with active Quadratus Lumborum trigger points will typically experience severe pain when their trunk is in an upright position. Often they will instinctively brace and support their upper body with their arms to avoid this severe pain.
Referred pain from Quadratus Lumborum trigger points may also activate other trigger points in muscle groups that function to move the hip joint, causing hip joint dysfunction.
Quadratus Lumborum Trigger Point Symptoms
A patient that comes to me with active quadratus lumborum trigger points will have a very deep aching low back pain on one side of their belt-line that they can't get relief from. It hurts when they move and when they sit or lie down. It sometimes has a sharp, lighting bolt-type of pain that can drop them to their knees if they are standing.
In acute pain situations, most of these patients cannot stand and may have to crawl to move around. If they are standing or sitting upright, they have to support the weight of their upper body with their hands, like with crutches or holding on to a low wall or person. Sneezing or coughing brings pure agony.
In chronic pain situations, these trigger points will often cause hip pain, gluteal pain, and groin pain. The patient may have a history of low back pain, but they currently only have the hip or gluteal pain complaints.The hip pain at this stage may resemble trochanteric bursitis.
The pain may also extend into the groin and genitals, though I only see this in very chronic cases. Sciatica symptoms can also develop from related (satellite) trigger point activity in the gluteus minimus muscle group.
The Gluteus Maximus Trigger Points that Cause Gluteal Pain
The Gluteus Maximus is the large muscle group that forms most of the buttock muscle mass. The primary job of this powerful muscle is to hold the trunk in the upright posture. It is also active during jumping, running and squatting movements.
The gluteus maximus can harbor up to three trigger points that refer pain to the buttocks, sacrum (tailbone) and and to the ischial tuberosity (sits bone).
Gluteus Maximus Trigger Point Symptoms
Patients with active gluteus maximus trigger points typically complain of gluteal pain while they are sitting. Sometimes this pain can be very sharp in nature, especially if they are sitting in a slouched posture.
Occasionally the gluteal pain will be focused around the tailbone, creating a pressure-type sensation there.
Strenuous activities such as swimming, martial arts, and weight lifting can overload this muscle and cause trigger points to form.
The Gluteus Medius Trigger Points that Cause Gluteal Pain
The Gluteus Medius muscle group is a small fan shaped muscle that lies partially underneath the larger Gluteus Maximus muscle group. It attaches just under the rip of the pelvic bone, and runs diagonally downward to attach on the leg bone at the hip joint.
This muscle functions to raise the leg to the side, and to stabilize the pelvis during walking. Trigger points in this muscle refer pain to the buttocks and along the belt-line.
All the trigger points in this muscle produce gluteal pain.
Gluteus Medius Trigger Point Symptoms
Patients with active gluteus medius trigger points typically complain of low back and gluteal pain while walking or laying on the painful side.
In clinical practice, the medial trigger point in this muscle is the most active, producing low back pain along the belt-line, Sacroiliac joint pain, and buttock pain. The middle and lateral trigger points become active in more chronic cases, causing buttock pain and low back pain, respectively.
Trigger points in the gluteus medius and quadratus lumborum muscles go hand-in-hand, as it is extremely common to see simultaneous trigger point activity in both of these muscle groups.
The Piriformis Trigger Points that Cause Gluteal Pain
The Piriformis muscle is a short, thick muscle that is located deep in the buttock region. It functions to rotate the thigh, and helps to stabilize the hip joint during walking.
This muscle lies next to a major nerve (the Sciatic Nerve) and blood vessels. Trigger points in this muscle can cause it to become tense enough for it to entrap or compress the nerve and blood vessel, producing systems such as pain, numbness, and swelling that travel down the leg from the gluteal region. When this entrapment occurs, it is termed Piriformis Syndrome.
The Piriformis trigger points may refer pain to the buttock and hip joint regions. The outside trigger point is primarily responsible for referring pain and tenderness to the hip joint.
Piriformis Trigger Point Symptoms
A patient that presents to me with pain and tenderness at the Sacroiliac (SI) joint is usually a good sign that have active piriformis trigger points. Most of these patients will also have pain in the hip region too.
If both trigger points are active in this muscle the patient will typically describe their pain as in the buttock. As trigger points in other muscles may also refer pain to the SI joint, buttock, and hip regions, I like to have all three regions indicated to confirm the piriformis trigger points as the responsible party.
Most of my patients that have active piriformis trigger points don't have symptoms of Piriformis Syndrome, though if any patients present with sciatica symptoms I always treat the piriformis, along with any gluteus minimus trigger points.
If there is compression of the Sciatic nerve (Piriformis Syndrome), symptoms may include pain and numbness in the buttocks and down the back of the leg, swelling in the leg, sexual dysfunction, and groin pain.
Related Instructional Videos from Dr. Perry
While the videos below were created to teach therapists how to locate and release these trigger points, many non-professionals have used them to learn these techniques successfully.
If you have a partner, a little time, you can use these videos to learn how to treat your own trigger points.
Related Articles from Dr. Perry
More extensive articles on these muscles and trigger points are available from Dr. Perry on our sister website TriggerPointTherapist.com. Click on the titles below to read them:
The Quadratus Lumborum Trigger Points: Masters of Low Back Pain
The Gluteus Maximus Trigger Points: A Real Pain in the Rear End