Gluteus Maximus Trigger Points

Introduction

The gluteus maximus is the largest and most powerful muscle in the body, responsible for hip extension, external rotation, and pelvic stability. When trigger points develop in this muscle, they can cause buttock pain, lower back discomfort, and difficulty with walking or standing, often mimicking sciatica, sacroiliac joint dysfunction, or hip bursitis.

Name and Area

  • Name: Gluteus Maximus

  • Area: Located in the buttocks, spanning from the sacrum and ilium to the femur and iliotibial band (IT band).

Indications

Gluteus maximus trigger points may contribute to:

  • Deep, aching pain in the buttocks (mistaken for sciatica or piriformis syndrome)

  • Pain that extends to the lower back and back of the thigh (can mimic nerve compression or SI joint dysfunction)

  • Weakness in hip extension (difficulty rising from a chair or climbing stairs)

  • Pain when sitting for long periods (common in office workers, drivers, and cyclists)

  • Tightness in the buttocks or hips (feels like stiffness or restricted movement)

  • Pain that worsens with walking, running, or standing for extended periods

Pain from this muscle is often mistaken for sciatica, SI joint dysfunction, or hip bursitis.

Muscle Action

  • Extends the Hip: Moves the leg backward (essential for walking, running, and jumping).

  • Externally Rotates the Hip: Turns the thigh outward.

  • Stabilizes the Pelvis: Works with the core and hip muscles to support posture and movement.

The gluteus maximus is essential for upright posture, propulsion during movement, and shock absorption.

Signs and Symptoms

Individuals with gluteus maximus trigger points often report:

  • Pain in the buttocks that feels like a deep ache or soreness

  • Pain that extends to the lower back or upper hamstrings (can resemble sciatica or SI joint pain)

  • Weakness in hip extension (difficulty walking uphill or standing up from a seated position)

  • Pain when sitting for long periods (common in desk workers and cyclists)

  • Tightness in the buttocks or hips, leading to limited mobility

  • Pain or discomfort when engaging the glutes (squats, lunges, running, or jumping)

Pain worsens with prolonged sitting, standing, or engaging in high-impact activities.

Perpetuating Factors

Common causes of gluteus maximus trigger points include:

  • Prolonged sitting or sedentary lifestyle (causes glute inhibition and weakness)

  • Overuse from running, sprinting, or jumping movements

  • Tight hip flexors (can lead to overcompensation and increased gluteal tension)

  • Heavy lifting without proper glute activation (e.g., deadlifts, squats, or carrying heavy objects)

  • Pelvic imbalance or poor posture (leads to uneven loading of the gluteus maximus)

Trigger Point Referral Pattern

Trigger points in the gluteus maximus refer pain to:

  • The buttocks (can mimic piriformis syndrome or SI joint dysfunction)

  • The lower back and sacrum (often mistaken for lumbar spine issues or herniated discs)

  • The back of the thigh (can resemble sciatic nerve pain or hamstring strain)

Pain from this muscle is often confused with sciatica, SI joint dysfunction, or lumbar radiculopathy.

Differential Diagnosis

Gluteus maximus trigger points may be mistaken for:

  • Sciatica (sharp, radiating pain down the back of the leg due to nerve compression)

  • SI joint dysfunction (pain in the lower back and buttocks, worsens with movement or sitting)

  • Hip bursitis (lateral hip pain that worsens with activity or sleeping on the affected side)

  • Hamstring strain (pain in the back of the thigh, worsens with stretching or running)

  • Lumbar radiculopathy (lower back pain with leg symptoms, related to disc herniation or nerve compression)

A thorough lower back, pelvis, and hip examination is necessary to rule out these conditions.

Associated Trigger Points

Gluteus maximus trigger points often co-exist with:

  • Piriformis (Deep buttock pain and sciatica-like symptoms)

  • Gluteus medius (Lateral hip and buttock pain, often confused with hip bursitis)

  • Quadratus lumborum (Lower back and pelvic pain, contributes to postural instability)

  • Hamstrings (Pain in the back of the thigh and weak hip extension)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Gluteus Maximus Ilium, sacrum, coccyx Iliotibial band, gluteal tuberosity of the femur Inferior gluteal nerve (L5–S2)

The gluteus maximus is innervated by the inferior gluteal nerve, which also controls hip extension and stabilization.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the buttocks and sacrum.

  • Hip Extension Strength Testing: Assess pain and weakness when lifting the leg backward against resistance.

  • Gait Analysis: Look for gluteal weakness, abnormal hip movement patterns, or pelvic instability.

  • SI Joint and Lumbar Spine Testing: Rule out joint dysfunction or lower back issues.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the gluteus maximus, reducing muscle tightness and improving mobility.

Manual Therapy

  • Trigger Point Release: Apply direct pressure to tight spots in the buttocks and sacral area.

  • Massage Therapy: Helps improve circulation and reduce muscle tension.

Stretching

  • Glute Stretch: Cross one ankle over the opposite knee and lean forward to stretch the gluteus maximus.

  • Hip Flexor Stretch: Helps reduce tightness in the front of the hip, which can contribute to glute tightness.

Strengthening Exercises

  • Glute Bridges: Strengthens the gluteus maximus and improves hip stability.

  • Hip Thrusts: Builds power in the glutes for improved function and reduced pain.

  • Step-Ups: Enhances single-leg strength and stability.

Postural and Movement Adjustments

  • Avoid prolonged sitting without breaks (take standing breaks every 30–60 minutes)

  • Ensure proper form during strength training (engage the glutes when lifting or squatting)

  • Incorporate more walking and hip activation exercises (prevents gluteal amnesia from sedentary lifestyles)

Conclusion

The gluteus maximus plays a crucial role in hip extension, pelvic stability, and lower body movement, but trigger points in this muscle can cause significant buttock, lower back, and thigh pain. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent future dysfunction.

➡️ Learn more about Trigger Points

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.