Glute Maximus Trigger Point Pain Pattern
The gluteus maximus muscle has its origin in the gluteal surface of ilium, lumbar fascia, sacrum, sacrotuberous ligament, and the insertion is located in the gluteal tuberosity of the femur and iliotibial tract. The muscle is innervated by the inferior gluteal nerve (L5, S1 and S2 nerve roots).
The medial trigger point is found adjacent to the lower sacrum, near the muscle’s medial attachment. There are two lower trigger points in this muscle, one that lies near the ischial tuberosity and one that lies on the inside edge of the gluteal fold region, below the tailbone or coccyx. The diagram below shows the areas affected by the trigger points.
Gluteal trigger points are common in people with low back pain. The gluteal muscles compensate for weak core muscles and eventually become overwhelmed and develop trigger points. In patients with chronic low back pain, the gluteal muscles are often hypertonic and tender from constant muscle spasms. Trigger point pain radiates from the low back and down the leg and can be misdiagnosed as sciatica.
Palpation and deep pressure on the trigger point reproduces the referral. Decreasing pressure on the trigger point will decrease the radiating pain.
Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.
When these treatments are incorporated into a treatment plan patients heal faster and are less likely to have long-term pain or soft tissue fibrosis or scar tissue in the injured muscle. These soft tissue treatments are incorporated with therapeutic exercise and flexibility programs.
NSAIDs are often prescribed for the initial acute injury stages. In severe cases that involve multiple joint regions, muscle relaxers or oral steroids can be given. Trigger point injections, botox, or steroid injections can be treatment options. Pain management is not usually required unless stronger medications or joint injections are required for treatment.
MRI and X-rays will not usually be ordered to evaluate mild to moderate muscle, tendon, and ligament injuries. Severe cases may utilize advanced imaging to rule out bone fractures, edema, nerve entrapments, tendon or muscle ruptures. NCV testing may be utilized in cases that also involve muscle, sensory, or reflex loss.
Sciatica is the term for radiating pain down the leg. Most commonly it comes from the back and radiates down the leg. Several back injuries and nerve entrapment injuries can cause sciatic pain in the leg. The pain patterns from a lumbar disc, lumbar joint sprain, sacroiliac sprain, or piriformis syndrome produces different patterns of radiating pain than trigger points. Proper identification of the pain pattern, along with reproduction of pain from palpation of the trigger point allows the provider and patient to feel comfortable with the diagnosis.
Likewise many trigger point injuries are associated with poor joint stabilization in the foot, knee, or hip. This leads to poor alignment and excessive forces being placed onto muscles and tendons. Iliotibial band Syndrome is common in runners who develop the injury because of weakness and poor stabilization of the leg and hip muscles. These runners will also have multiple trigger points in the quadriceps, psoas, gastroc, soleus, and gluteus medius.
Your chiropractor, physical therapist, occupational therapist, or physician will evaluate your condition and make a proper diagnosis and treatment recommendations. Ask them any questions you might have about your injury.
The lower extremity works as a comprehensive unit performing many of the repetitive tasks at home, work, and recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles.
Many therapeutic exercises can help restore proper strength and endurance to the leg muscles muscles. Isometric exercises are often the initial treatment exercises. Followed by single plane rubber band exercises for hip, knee, and ankle; flexion, extension, adduction, abduction, circumduction, inversion, and eversion. Dynamic exercises involving stability foam, rubber discs, exercise ball, and BOSU balls can be performed on the floor. The more unstable of the surface the more effort and stabilization is required of all the lower extremity muscles.
Vibration plates enhance neuromuscular learning throughout the ankle, knee, foot, hip, and back muscles. Additional strength exercises can be found on the hip, knee, and foot strengthening pages. More information for injuries and treatments for knee pain and foot pain.
Our Chandler, AZ Chiropractic & Physical Therapy clinic treats patients with a variety of muscle, tendon, joint, and ligament injuries. The clinic provides treatment for runners, tri-athletes, and weekend warriors in addition to common headache, neck, and back patients traditionally seen in Chiropractic, Physical Therapy, Massage Therapy clinics. We work with all ages and abilities of the residents in Phoenix, Tempe, Gilbert, Mesa, and Chandler AZ.