Hip Pain Trigger Points
Trigger Point Therapy for Hip Pain
Hip pain disorders are rapidly becoming as commonplace as low back disorders. No longer is hip replacement surgery being employed in just the elderly, as more and more people in middle adulthood are having this procedure done.
Unfortunately, many of these procedures could be eliminated or postponed if the modern medical establishment recognized the role that trigger points play in hip pain and dysfunction syndromes. Many hip pain disorders occur as unnecessary secondary conditions to mismanaged low back pain disorders.
Damage to the hip joint itself is a condition that frequently develops from chronic trigger point-induced muscle tension in the muscle groups that function to move the hip joint.
There are three muscle groups that can contain trigger points that refer pain to the hip joint, though trigger points in a few other muscles groups may also impair the proper functioning of the hip joint, but not refer pain directly. The three muscles typically involved are:
• The Quadratus Lumborum
• The Tensor Fascia Latae
• The Piriformis
The Quadratus Lumborum Trigger Points that Cause Hip 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.
The trigger point that is located right above the rim of the pelvic bone is responsible for directly referring pain to the hip joint.
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 pain 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, my patients will present with hip pain, gluteal pain, and groin pain. They usually 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 Tensor Fascia Latae Trigger Point that Causes Hip Pain
The Tensor Fascia Latae (TFL) is a small muscle located above and slightly in front of the hip joint. It attaches to the front outside rim of the pelvis, and travels downward to join into a long, flat tendon sheet called the iliotibial tract.
The iliotibial tract runs down the outside of the thigh and attaches above and below the knee joint. This muscle contracts to help stabilize the pelvis and knee during walking.
The trigger point in this muscle refers pain and soreness (tenderness to the touch) to the hip joint and sometimes down the thigh to the knee.
Tensor Fascia Latae Trigger Point Symptoms
A person that comes to see me with an active TFL trigger point will have pain and extreme soreness over the hip joint (greater trochanter) , which may extend down the outside thigh at times. Their pain will prevent them from being able to walk fast.
Sleeping on the side of their affected hip makes the soreness over the hip unbearable. Sleeping on the other hip may cause pain in the affected hip if that leg is not supported by a pillow between the knees.
Basically any body position that forces them to lean their trunk backwards on their hips causing them pain. Bending (at the waist) really far forward causes them pain as well, such as when sitting in a deep, low chair. Most people with an active TFL trigger point will stand and walk slightly bend forward to alleviate the pain. They will also use crutches to help them walk with less hip pain.
Runners may often develop TFL trigger point activity that produces hip pain and outside thigh pain during running or just after. Trigger point-induced tension in this muscle can stress the iliotibial tract that runs down the side of the thigh and attaches at the knee, causing IT Band Syndrome.
The Piriformis Trigger Points that Cause Hip 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.
Additionally, 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: