Muscles That Cause Hip Pain
How Trigger Points in the Gluteus Medius, Gluteus Minimus, Piriformis, and Iliopsoas Produce Deep Hip, Buttock, and Groin Pain
Hip pain is among the most diagnostically complex complaints in musculoskeletal medicine, in part because the muscles surrounding the hip joint refer pain in patterns that closely mimic structural pathology. This post explains which muscles are most often responsible, where their trigger points send pain, and why they are so frequently missed.
- The gluteal muscles represent the highest-prevalence trigger point region in patients with radiating leg pain; active trigger points were found in the gluteus medius in 83% of cases and in the gluteus minimus in 74% of cases, with overall gluteal trigger point prevalence of 82.7% (Holm-Jensen et al., 2021).
- The gluteus minimus refers pain down the entire length of the outer or posterior leg in a pattern that is clinically indistinguishable from true sciatic nerve compression, leading to a diagnostic category researchers have called gluteal syndrome, a form of nociplastic pain mimicking sciatica (Skorupska et al., 2021).
- Ultrasound-guided dry needling of the piriformis has been shown in a randomized controlled trial to produce clinically meaningful reductions in pain compared with a waitlist control, providing the strongest available evidence for a direct myofascial contribution to piriformis-related hip and buttock pain (Tabatabaiee et al., 2019).
- Both dry needling and ischemic compression of the gluteus medius reduce pain and improve quality of life in patients with non-specific low back pain and latent trigger points, with dry needling demonstrating stronger effects at one-week follow-up (รlvarez et al., 2022).
- The iliopsoas refers pain to the anterior hip and groin in a pattern that closely resembles hip joint pathology, making it one of the most commonly missed myofascial sources of anterior hip symptoms, particularly in patients with a negative hip joint examination.
- Hip trigger point activity is frequently perpetuated by the same postural and mechanical factors that load the lumbar spine, which is why addressing the gluteal and hip flexor muscles is often essential for resolving low back pain that has not responded to spinal-focused treatment alone.
Could Muscles in Your Hip and Buttock Be the Source of Your Pain?
At Morningside Acupuncture, we evaluate the full myofascial picture of hip and buttock pain, including the gluteal muscles, piriformis, and iliopsoas, which are rarely assessed in standard hip workups. Many patients who come in after months of inconclusive imaging and unsuccessful physical therapy have active trigger points in the gluteal muscles that are directly driving their symptoms. Dry needling can reach these deep muscles precisely, often producing results that surface treatments cannot.
Schedule NowWhy Hip Pain Is So Difficult to Localize
The hip region is anatomically dense. The actual hip joint sits deep behind multiple layers of muscle and fat, and pathology at the joint itself, including labral tears, femoroacetabular impingement, and early osteoarthritis, produces pain that is often felt in the groin, the lateral hip, the buttock, or the anterior thigh. Trigger points in the surrounding muscles refer pain into exactly the same locations. The result is that a patient with lateral hip pain, for example, could be experiencing gluteus medius trigger point referral, greater trochanteric bursitis, gluteus minimus trigger point referral, IT band irritation, or a combination of several of these, and no single imaging study will reliably distinguish between them.
The practical consequence is that many patients cycle through treatments targeting structural diagnoses while the myofascial component continues untreated. Trigger points in the gluteal muscles, piriformis, and iliopsoas do not appear on MRI, do not cause swelling or warmth, and are not tested by standard orthopedic maneuvers. They are identifiable only through skilled palpation and a working knowledge of referred pain patterns.
Tool Trigger Point Pain Finder โ Locate the Muscle Behind Your Hip Pain| Muscle | Referred Pain Location | Commonly Confused With | Key Clinical Note |
|---|---|---|---|
| Gluteus Medius | Lateral hip, iliac crest, SI joint, lower lumbar | Greater trochanteric bursitis, SI joint dysfunction, lumbar radiculopathy | Most prevalent hip/buttock trigger point in both low back pain and radiating leg pain populations; refers in three distinct patterns depending on trigger point location within the muscle |
| Gluteus Minimus | Outer hip, entire lateral or posterior leg, ankle | L5/S1 radiculopathy, sciatica, peripheral neuropathy | Produces the most sciatica-like referral of any muscle; pain can travel to the ankle and is indistinguishable from disc herniation symptoms without neurological testing |
| Piriformis | Deep buttock, posterior hip, posterior thigh | Sciatica, deep gluteal syndrome, SI joint dysfunction | Can refer pain into the posterior hip and thigh; in some individuals the sciatic nerve passes through the piriformis, creating an additional nerve entrapment component |
| Psoas Major / Iliacus | Anterior hip, groin, anterior thigh, lumbar spine | Hip joint pathology, hip flexor tendinopathy, inguinal hernia, femoral nerve irritation | Anterior hip and groin pain with negative joint examination should raise immediate suspicion for iliopsoas trigger points; symptoms worsen with prolonged sitting and hip extension |
| Tensor Fasciae Latae (TFL) | Lateral hip, outer thigh, lateral knee | Greater trochanteric bursitis, IT band syndrome, gluteus medius tendinopathy | Trigger points at the anterior iliac crest refer into the lateral hip and thigh; loading the IT band from above, producing a chain of lateral symptoms from hip to knee |
| Gluteus Maximus | Deep buttock, coccyx, posterior hip | Coccydynia, sacral stress fracture, hamstring origin tendinopathy | Three distinct trigger point sites produce different buttock and posterior hip patterns; the lowest site refers pain to the coccyx and is sometimes the source of "tailbone pain" without any coccyx pathology |
The Gluteus Medius: The Most Common Hip Pain Muscle
The gluteus medius is a fan-shaped muscle that covers much of the lateral pelvis, running from the outer iliac crest to the greater trochanter. It is the primary hip abductor and plays a central stabilizing role during walking, running, and single-leg stance. When the gluteus medius develops trigger points, and they form readily in response to sustained sitting, hip instability, or direct trauma to the lateral hip, they produce pain in a lateral hip-to-lower back distribution that varies depending on which part of the muscle is affected.
Trigger points in the posterior portion refer primarily into the low back and SI joint, mimicking sacroiliac dysfunction so closely that patients are frequently treated for SI joint problems for months without resolution. Trigger points in the middle and anterior portions refer into the lateral hip and iliac crest, a location that is also consistent with greater trochanteric bursitis. Because both diagnoses are common and both are treated differently from a myofascial trigger point, the muscle is persistently under-diagnosed as a source.
A randomized controlled trial found that a single session of dry needling of the gluteus medius produced greater reductions in pain intensity and improvements in pressure pain threshold than ischemic compression in patients with non-specific low back pain, with effects measurable at 48 hours and at one-week follow-up (รlvarez et al., 2022). This is a clinically relevant timeframe and outcome, and it supports direct treatment of the muscle rather than relying on the surrounding joint or lumbar structures as the primary target.
Related Gluteus Medius Trigger Points โ Lateral Hip, SI Joint, and Low Back PainThe Gluteus Minimus: The Pseudo-Sciatica Muscle
The gluteus minimus is the deepest of the three gluteal muscles and lies almost entirely beneath the gluteus medius. Its trigger points produce the most dramatic and far-traveling referred pain of any hip muscle, sending pain down the entire length of the outer or posterior leg, sometimes as far as the ankle. This pattern, running from the lateral hip through the lateral thigh to the calf and ankle, is virtually identical to the distribution of L5 or S1 radicular pain from disc herniation, which is why patients with gluteus minimus trigger points are regularly investigated for lumbar disc pathology before the muscle is ever assessed.
Research examining this phenomenon has characterized it as "gluteal syndrome," a distinct pain subtype that meets the clinical presentation of sciatica while arising entirely from myofascial tissue. One study using thermographic and vasomotor assessments found that trigger point zones in the gluteal muscles produce amplified vasodilatation within the referred pain area, a neurophysiological signature different from true nerve compression, which may eventually serve as an objective test to differentiate the two conditions (Skorupska et al., 2021).
From a practical standpoint, the absence of positive straight-leg-raise results, normal nerve conduction studies, and failure to respond to lumbar epidural injections should all raise the suspicion that the reported leg pain is of gluteus minimus trigger point origin. Dry needling of the gluteus minimus is one of the few treatments capable of deactivating these deep-seated trigger points directly (Skorupska et al., 2015).
Related Gluteus Minimus Trigger Points โ Pseudo-Sciatica and Lateral Leg PainHip or Leg Pain That Hasn't Improved With Lumbar Treatment?
When leg pain has been attributed to the lumbar spine but epidural injections, lumbar physical therapy, and imaging findings have not translated into relief, the gluteal muscles deserve direct evaluation. Morningside Acupuncture specializes in identifying and treating the myofascial layer of hip and buttock pain, including trigger points in the gluteus minimus, piriformis, and iliopsoas that standard evaluations routinely miss. Dry needling provides precise access to these deep muscles.
Schedule NowThe Piriformis: Deep Buttock Pain and the Sciatic Nerve
The piriformis muscle lies deep in the posterior hip, running from the anterior sacrum to the superior greater trochanter. It externally rotates and abducts the hip, and in a proportion of the population, the sciatic nerve passes through or between the divided heads of the muscle rather than beneath it, creating the anatomical basis for piriformis syndrome. Trigger points in the piriformis refer pain into the deep posterior buttock, the SI joint area, and the posterior thigh, and in individuals with the variable sciatic nerve course, they may also produce true neurogenic symptoms including tingling and numbness.
The clinical challenge of piriformis trigger points is that they are inaccessible to most manual therapy techniques. The muscle sits beneath the gluteus maximus and cannot be reliably palpated or manually compressed from the surface in most body types. This is why dry needling, guided by either anatomical landmarks or ultrasound, is the most effective method for directly treating the piriformis. A randomized controlled trial found that three sessions of ultrasound-guided dry needling of the piriformis produced clinically significant reductions in pain intensity compared with a waitlist control group in patients with confirmed piriformis syndrome (Tabatabaiee et al., 2019).
Piriformis trigger points are commonly activated by sustained hip rotation in seated positions, direct compression from hard seating surfaces, running on banked surfaces, and sudden loading from falls or sports impacts. Patients who describe deep buttock pain that worsens with prolonged sitting but is not clearly reproduced by lumbar flexion or extension testing often have a significant piriformis component.
Related Piriformis Trigger Points โ Deep Buttock Pain and Sciatica-Like Symptoms Related Sciatica Treatment NYC โ When Leg Pain Comes From the Muscles, Not the Spine| Muscle | Primary Activating Factors | Why This Muscle Is Vulnerable |
|---|---|---|
| Gluteus Medius | Sustained sitting, altered gait from any lower limb injury, leg length discrepancy, hip abductor weakness | Primary hip abductor and pelvic stabilizer; under continuous demand during standing and walking; first muscle to compensate for hip joint instability |
| Gluteus Minimus | Same as gluteus medius; often co-activated; direct trauma to lateral hip; prolonged hip abductor fatigue | Deepest gluteal muscle; rarely treated directly; trigger points persist even when gluteus medius is addressed if minimus is not separately evaluated |
| Piriformis | Sustained hip external rotation (cross-legged sitting), prolonged sitting on hard surfaces, running on banked or uneven terrain, direct falls to the buttock | Deep location beneath gluteus maximus; inaccessible to surface massage; sits in close proximity to the sciatic nerve and can irritate it when hypertonic |
| Psoas Major / Iliacus | Prolonged sitting, hip flexion-dominant exercise, lumbar fusion or hip replacement postures, abdominal surgery | Only muscle connecting the lumbar spine to the femur; in a shortened state from desk work, it loads both the lumbar spine and the anterior hip capsule simultaneously |
| TFL | Running, cycling, prolonged standing, hip abductor compensation, leg length discrepancy | Overactivated when gluteus medius is weak or inhibited; takes on additional stabilizing load and develops trigger points rapidly in compensatory patterns |
| Gluteus Maximus | Direct falls onto the buttock, sustained sitting on hard surfaces, post-surgical immobilization | Largest muscle in the body; rarely addressed in rehabilitation; direct compressive trigger point activation from seating is common and under-recognized |
The Iliopsoas: Anterior Hip and Groin Pain
The psoas major originates from the lateral bodies of the lumbar vertebrae and, along with the iliacus, converges into a single tendon that attaches to the lesser trochanter of the femur. As the primary hip flexor and the only muscle that directly connects the lumbar spine to the lower extremity, the iliopsoas is under enormous mechanical demand in modern sedentary lifestyles. Prolonged sitting shortens the muscle, increases lumbar lordosis, and concentrates compressive load on the lumbar facets, which is one reason that iliopsoas dysfunction is so commonly associated with both low back pain and anterior hip pain simultaneously.
Trigger points in the psoas major refer pain vertically along the lumbar spine and into the anterior hip, while the iliacus trigger points tend to produce a more focal anterior hip and groin ache. Patients describe this as a deep, hard-to-locate pain at the front of the hip that worsens with rising from a chair, climbing stairs, or walking uphill, and temporarily eases with forward trunk flexion. Because this pattern overlaps with hip joint pathology, including femoroacetabular impingement and labral tears, patients are frequently investigated with hip MRI and arthroscopy before the muscle is considered.
A useful clinical test is to have the patient lie supine and perform resisted hip flexion. If this reproduces the anterior hip pain, and the pain is accompanied by tenderness on deep palpation of the iliac fossa where the iliacus lies, the diagnosis of myofascial trigger points becomes considerably more likely than structural hip joint pathology. Treatment requires reaching the muscle at depth, which dry needling achieves more reliably than manual techniques given the anatomical location.
Related Psoas Major Trigger Points โ Anterior Hip, Groin, and Low Back Pain Tool Pain Finder: Hip, Thigh, and Knee โ Map Your Symptoms to Their Muscle SourceHip Pain That Hasn't Responded to Injections, Surgery, or PT?
At Morningside Acupuncture, we are the highest-rated acupuncture and dry needling clinic in New York City with over 500 five-star Google reviews. We specialize in identifying myofascial sources of hip pain that standard evaluations miss, including deep trigger points in the gluteus medius, gluteus minimus, piriformis, and iliopsoas. Whether your diagnosis is greater trochanteric bursitis, piriformis syndrome, hip impingement, or simply "hip pain of unclear origin," a thorough myofascial evaluation may reveal what imaging alone cannot. We would be glad to help you find answers.
Schedule NowFrequently Asked Questions
Can trigger points in the hip cause pain all the way down the leg?
Yes, particularly the gluteus minimus. Its trigger points refer pain from the outer hip down the entire length of the lateral or posterior leg, sometimes reaching the ankle. This pattern is so similar to sciatica from disc herniation that it has been given its own name in the research literature: gluteal syndrome. The key difference is that neurological signs such as reflexes, sensation, and straight-leg raise are typically normal, and imaging shows no nerve compression.
How do I know if my hip pain is muscular or from the joint?
There is no reliable way to determine this without a physical evaluation. Some indicators that favor a myofascial source include variable or shifting pain, sensitivity to stress and fatigue, normal or only mildly abnormal imaging, absence of swelling, and pain that can be reproduced by pressing on muscle bellies in the gluteal region or anterior hip. Structural pathology like labral tears or femoroacetabular impingement can coexist with trigger points, and in many patients both contribute to symptoms. A myofascial assessment can clarify which component is dominant.
Why doesn't my hip pain show up on an MRI?
MRI visualizes tissue density and fluid, which means it can detect structural damage like tears, inflammation, and bony changes. Myofascial trigger points involve localized biochemical and neuromuscular changes at a microscopic level that do not produce visible changes on standard imaging. Trigger points are a clinical diagnosis based on palpation, pain reproduction, and referral patterns, not an imaging diagnosis. Many patients with significant trigger point-driven pain have completely normal MRIs, and some patients with abnormal MRIs have trigger points as their dominant pain source.
Is piriformis syndrome actually a real diagnosis?
It is a real clinical entity, though it is debated in terms of definition and prevalence. The term describes pain and sometimes neurological symptoms arising from the piriformis muscle, either from trigger points that refer pain into the buttock and leg, from hypertonic tissue compressing nearby structures, or from direct irritation of the sciatic nerve in individuals where that nerve passes through the muscle. Dry needling of the piriformis has demonstrated effectiveness in a randomized controlled trial, supporting the view that there is a genuine muscular pain generator in this region (Tabatabaiee et al., 2019).
Can Morningside Acupuncture help with hip pain from a labral tear or hip impingement?
We regularly work with patients who have structural hip diagnoses, and we frequently find a significant myofascial component that contributes meaningfully to their pain independent of the structural finding. Treating the gluteal and iliopsoas trigger points reduces the total pain burden and can restore enough function to meaningfully improve daily activity, even when the structural lesion remains. Many patients find that addressing the muscular layer changes their assessment of whether surgical intervention is necessary or urgent.
References
- Holm-Jensen, A., Kjaer, P., Schiรธttz-Christensen, B., Ziegler, D. S., Andersen, S., & Myburgh, C. (2021). The interexaminer reproducibility and prevalence of lumbar and gluteal myofascial trigger points in patients with radiating low back pain. Archives of Rehabilitation Research and Clinical Translation, 3(1), 100044. https://doi.org/10.1016/j.arrct.2020.100044
- รlvarez, S. D., Velรกzquez Saornil, J., Sรกnchez Milรก, Z., Jaรฉn Crespo, G., Campรณn Chekroun, A., Barragรกn Casas, J. M., Frutos Llanes, R., & Rodrรญguez Sanz, D. (2022). Effectiveness of dry needling and ischemic trigger point compression in the gluteus medius in patients with non-specific low back pain: A randomized short-term clinical trial. International Journal of Environmental Research and Public Health, 19(19), 12468. https://doi.org/10.3390/ijerph191912468
- Tabatabaiee, A., Takamjani, I. E., Sarrafzadeh, J., Sanjari, M. A., & Emrani, A. (2019). Ultrasound-guided dry needling decreases pain in patients with piriformis syndrome. Muscle & Nerve, 60(5), 558โ565. https://doi.org/10.1002/mus.26671
- Skorupska, E., Dybek, T., Rychlik, M., Jokiel, M., Zawadziลski, J., & Dobrakowski, P. (2021). Amplified vasodilatation within the referred pain zone of trigger points is characteristic of gluteal syndrome โ a type of nociplastic pain mimicking sciatica. Journal of Clinical Medicine, 10(21), 5146. https://doi.org/10.3390/jcm10215146
- Skorupska, E., Rychlik, M., & Samborski, W. (2015). Validation and test-retest reliability of new thermographic technique called thermovision technique of dry needling for gluteus minimus trigger points in sciatica subjects and TrPs-negative healthy volunteers. BioMed Research International, 2015, 546497. https://doi.org/10.1155/2015/546497
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