Are you experiencing hip pain that seems sometimes constant and excruciating, which causes a limp while walking, or problems while lying on your side at night, or perhaps difficulty rising from a chair and/or the inability to stand up straight?
Are you struggling with finding a stretching movement or change of position that succeeds in relieving the pain, or having trouble lying down comfortably and walking normally?
Have the outside edge/s of your feet (or has one individual foot) been feeling tingly, weak or painful, but you haven’t yet been able to pinpoint or name one particular activity or incident that you can attribute the bizarre pattern to?
Then this article may be for you!
Before this discussion gets underway, please allow me to brief you on the definition and general nature of trigger points,
those hyper-irritable spots in muscles, that when pressed on often refer a sensation distant to the area of contact.
Osteopath Richard Bachrach of the Center for Sports and Osteopathic Medicine explains..
Trigger points (TrP) are foci of hyperirritability in muscle, fascia or ligaments (connecting bone to bone as in joints). They are characterized by taut fibrous bands, a twitch response when stimulated, and constant areas of referred pain. The pain patterns thus produced are called myofascial pain syndromes.
Active TrPs are always tender. They prevent full lengthening of the muscle and weaken it. Direct compression, stretching, or other sources of irritation such as accumulation of the toxic chemical byproducts of muscle metabolism, or lack of oxygen, will ignite the TrP. From it, localized pain is produced in a specific area with associated autonomic changes. These may include increased or reduced skin temperature, sweating or dryness. The area of referred pain is often distant from the TrP.
Let’s first explore the possible symptoms arising from gluteus minimus (outer hip muscle) trigger points..
The gluteus minimus can be easily overlooked, says David, since the referred pain from this muscle is felt so deep and remotely from the location of the trigger points. An analysis of the gluteus minimus muscle’s anatomy and trigger point pain referral patterns clarifies how the function of this thigh abductor helps keep the pelvis level during single limb weight bearing and hints at the potential for a spillover connection (or the satellite nature of gluteus minimus trigger points) by way of the peroneal muscle tendons that attach into the foot. Trigger points harbored in the anterior fibers of the gluteus minimus can refer into the lower buttock, down the lateral aspect of the thigh, and then further into the fibular region of the leg where the peroneal muscles are found.
Activation of Trigger Points (in the gluteus minimus muscle)
Myofascial trigger points in the gluteus minimus muscle may be activated or perpetuated by sudden acute or repetitive
chronic overload, SI joint dysfunction, injection of medications into the muscle, and nerve root irritation. Perpetuating factors may include prolonged immobility, tilting the pelvis by sitting on a wallet, postural distortions and unstable equilibrium when standing. Gluteus minimus TrPs may be activated by an acute overload imposed by a fall; by walking too far or too fast, especially on rough ground or over uneven terrain; or by overuse in running and sports activities, such as swimming, tennis and handball.
This fan-shaped hip muscle has the potential to refer pain into the lateral calf, AND, according to Travell and Simons’ Myofascial Pain and Dysfunction Trigger Point Manual (scroll down to Ch. 9 once on this page. It will be approximately 13 pages beyond the Gluteus Medius referral pattern chart on p. 151 of Ch. 8), this muscle can also refer pain into the lateral ankle, and even to the foot, because of the anterior gluteus minimus muscle’s potential to activate lateral leg trigger points, which can then spill over and induce satellite trigger points in the peroneal muscles located on the outside of the calf.
Note referral zone of Gluteus Minimus in Image 1B (scroll about 1/3 of way down screen to view).
Trigger points in the gluteus minimus and the gluteus medius will restrict adduction* of the thigh. *Remember adduction is the movement of bringing the thigh towards and/or across the midline of the body.
So, how does one correct a gluteus minimus trigger point pain pattern? Activities that impose unusual stress on the muscle, such as vigorous sports and hiking, need to be avoided for a time. Athletic training through incremental conditioning should be integrated and routinely implemented into one’s recreational or sports program. A person can try using their body weight to achieve deep ischemic compression right on top of the gluteus minimus trigger points located under the tender area at the top of the femur by using a tennis ball to slowly apply a stripping massage. Leaning against a smooth wall while slowly rolling the tennis ball at a rate of about 1 inch every 10 seconds, moving towards either the iliac crest or the sacrum and following the natural layout of the gluteus minimus muscle fibers, can often be quite effective, especially when followed by application of moist heat.
Associated Trigger Points
Referred pain that shoots down the leg from gluteus minimus trigger points (side sciatica) may activate trigger points in the peroneal muscles. Additionally, the presence of gastrocnemius trigger points, soleus trigger points, and the tibialis anterior trigger point may weaken their respective muscles and in turn overload the peroneal muscles, causing trigger points to form in them. Unaddressed trigger points of the quadratus lumborum can act as perpetuators of satellite gluteus minimus trigger points as well.
Corrective actions to restore proper function and flexibility of the peroneal muscles include wearing shoes that provide a good arch and foot support; eliminating under thigh compression when seated, avoiding walking on a slanted sidewalk and/or running on a track or road surface that’s slanted, and avoiding wearing high or spiked heals. Other hugely therapeutic approaches involve: doing a peroneal stretch while in a warm bath or hot tub, practicing postisometric relaxation techniques, and doing gentle passive stretching of the peroneus longus and peroneus brevis muscles while grasping the forefoot, fully inverting and adducting it, then pulling it upward into dorsiflexion.