1, 2 & 3: Gluteus Medius
Gluteus medius is one of the three Gluteal muscles (‘glutes’) which form each buttock. They are responsible for extending, abducting and laterally rotating the hip joint.
Gluteus medius is found just below the Iliac crest. There are three common T.P’s in this muscle which can refer pain into the posterior thigh. They are located at the origin of the muscle, all three in a row, just below the iliac crest.
4: Tensor Fascia Latae
TFL (as it is shortened to) is a small muscle found on the outer hip. It attaches to the front of the iliac crest and descends downwards to converge with the IT band on the outer thigh.
A trigger point can often be found in the superior half of the muscle, which radiates pain inferiorly, down the IT band and lateral hamstrings.
The Piriformis muscle is a small muscle found deep within the centre of the buttock. It originates from the Sacrum and crosses horizontally to the head of the Femur (thigh bone).
It is strongly associated with Sciatica as a condition called Piriformis syndrome can also cause sciatic symptoms. However, this is an actual compression of the nerve caused by muscle tension or an anatomical variation where the nerve passes through the Piriformis muscle (rather than behind it). This occurs in around 10% of the population.
This is not the same as a Piriformis trigger point which does not affect the sciatic nerve at all, but radiates the pain into the hamstrings in a similar fashion.
The most common trigger point found within the Piriformis muscle is in the muscle belly, slightly towards the insertional tendon. This trigger point will refer pain into the outer buttock and down the back of the thigh.
Trigger Point Therapy
There has been lots of research undertaken into the best treatment of trigger points. Acupuncture (or dry needling) and ischemic pressure have been shown to be the most effective.
Acupuncture is the insertion of a needle into the trigger point. The small needle is inserted into the trigger point and left in place for a few minutes. During this time, the muscle gradually relaxes and lengthens. 3-4 sessions of dry needling are usually required to eliminate the trigger point.
Ischemic pressure is the application of direct pressure to the trigger point, with enough pressure to temporarily cut off blood flow to the TP (ischemic = no blood!). The aim of this technique is to stimulate receptors in the muscle which regulate its tension, to reduce the muscle tone. This pressure also provides an analgesic (pain relief) effect due to the release of pain mediating substances. Once the pressure is released, a sudden influx of blood to the point helps to flush out any waste products and bring the required nutrients for healing.
Following either technique, it is recommended that the muscles treated are stretched thoroughly to reset the muscle spindle length.