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Trigger Points And Pain In The Rear

Charlottesville, Virginia

April 22, 2021

If I walk a lot, which I tend to do, I get what feels like a knot just behind my right hip joint. It is not (pun) only painful (5 out of 10), but it hinders my stride. If I sit for a few minutes, sometimes the knot will subside, sometimes it doesn't. In the case where it doesn't, I search out something hard I can put my hip against and lean hard into it, trying to "pop" the knot. And if that doesn't work, I head home to hit the floor and do some stretches that target that area.

I found this helpful description of my issue:

When you have low back pain, buttock pain, hip pain, or leg pain, your trouble might be caused by trigger points in the obscure gluteus medius and minimus muscles. They are a pair of overlapping pizza-slice shaped muscles on the side of the hip. Other muscles in the region are usually involved as well, such as the gluteus maximus, piriformis, and the lumbar paraspinal muscles. However, the gluteus medius and minimus are a bit special: their contribution to pain in this area is often significant, and yet people who have buttock and leg pain rarely suspect that it might be radiating from muscle knots so high and lateral.

The leg pain that the lateral glutes produce can be so nasty that many health professionals mistake it for sciatica (irritation of the large sciatic nerve that passes through the buttocks and into the leg). But beware: sciatica is often an incorrect diagnosis for pain in this area.

Arthritis is another common scapegoat, but this diagnosis is rarely correct, even in many aging people: most signs of arthritis (on X-ray) are not associated with any pain, and most people who have hip pain definitely do not have arthritis — only 9–15% according to one large study.3 Most hip pain is something else, and muscle pain is a strong candidate, especially when there is no other clear diagnosis.

I also found this discussion helpful:

What are trigger points (MTrPs) and where are they found?

1. A taut band or muscle fibers which are in constant state of contracture.

• MTrP formation occurs in order to protect or stabilize around site of potential or actual muscle damage or too much mobility at a joint.

• This could be due to tendonitis, whiplash, inflammation or injury to joint or nerve.

• May occur more often as a result of overload in eccentric muscle contractions.

• Can occur as result of inefficient, sustained postures that put abnormal stress on the soft tissues.

2. Common around arthritic joints.

3. Source of local pain and pain at a remote location.

• MTrPs elicit spontaneous and referred pain and pain is familiar when pressure is applied.

• Constant input into the nervous system which can alter motor control strategies, overload muscle or lead to disuse and weakness.

• This will perpetuate pain and cause what may be a mild irritation to be significantly painful.

Why are Myofascial Trigger Points detrimental?

1. Sustained contracture of muscle fibers causes local restriction in oxygen flow.

• This lack of oxygen may trigger an increased concentration of a key substance that potentiates the cycle of sustained muscle contraction.

• Low oxygen will also lower the pH at the site of the trigger point. This leads to release of several substances that trigger sensation of pain.

2. Lead to weakness without muscle atrophy

3. Source of chronic pain

• Muscle pain associated with MTrPs can create joint dysfunction creating potential for increased muscle pain as muscles have to meet higher work demand.

• Muscle pain can cause modified movement patterns and stiffness in order to protect the structure from further pain or injury. This leads to overall range of motion loss.

How are Myofascial Trigger Points and Myofascial Pain related?

1. Widespread pain is common in many syndromes such as low back pain and other chronic musculoskeletal conditions, whiplash, migraines, irritable bowel syndrome, temporomandibular joint (TMJ) disorders, and fibromyalgia.

2. While signaling to drive this pain occurs in the central nervous system, MTrPs are often involved in these conditions.

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