Gluteus Medius Trigger Points

Introduction

The gluteus medius is a key hip muscle responsible for hip abduction, pelvic stability, and balance during walking. When trigger points develop in this muscle, they can cause hip pain, lower back discomfort, and difficulty with walking or standing, often mimicking sciatica, hip bursitis, or lower back issues.

Name and Area

  • Name: Gluteus Medius

  • Area: Located on the outer surface of the pelvis, running from the ilium to the greater trochanter of the femur.

Indications

Gluteus medius trigger points may contribute to:

  • Pain in the outer hip and buttocks (mistaken for hip bursitis or sciatica)

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

  • Weakness in hip abduction (difficulty walking or standing on one leg)

  • Pain when lying on the affected side (common complaint in sleep discomfort)

  • Tightness in the hip or glutes, leading to restricted movement

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

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

Muscle Action

  • Abducts the Hip: Moves the leg away from the midline (important for walking and maintaining balance).

  • Stabilizes the Pelvis: Prevents pelvic drop during walking and standing on one leg.

  • Assists in Internal and External Rotation of the Hip: Works with other hip muscles to maintain proper leg alignment.

The gluteus medius is essential for single-leg stability, walking mechanics, and lower back health.

Signs and Symptoms

Individuals with gluteus medius trigger points often report:

  • Pain in the outer hip that feels like a deep ache or soreness.

  • Pain that extends to the lower back, SI joint, or side of the thigh (can resemble sciatica or hip bursitis).

  • Weakness in hip abduction (difficulty balancing on one leg or walking up stairs).

  • Pain when sleeping on the affected side (common in side sleepers).

  • Tightness in the hip or buttocks, leading to limited mobility.

  • Pain that worsens with walking, running, or prolonged standing.

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

Perpetuating Factors

Common causes of gluteus medius trigger points include:

  • Prolonged sitting or sedentary lifestyle (weakens the glutes and causes imbalances)

  • Overuse from running, sprinting, or long-distance walking

  • Weak core or hip muscles (forcing the gluteus medius to overcompensate for stability)

  • Pelvic imbalance or leg length discrepancy (leading to uneven loading of the hips)

Sleeping on one side without proper hip support

Trigger Point Referral Pattern

Trigger points in the gluteus medius refer pain to:

  • The outer hip and buttocks (can mimic hip bursitis or SI joint dysfunction)

  • The side of the thigh (mistaken for IT band syndrome or lateral knee pain)

  • The lower back and sacrum (can resemble lumbar spine issues or herniated discs)

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

Differential Diagnosis

Gluteus medius trigger points may be mistaken for:

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

  • 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)

  • IT band syndrome (pain along the outer thigh, often associated with running or cycling)

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

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

Associated Trigger Points

Gluteus medius trigger points often co-exist with:

  • Gluteus minimus (deep hip and buttock pain, can resemble sciatic nerve pain)

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

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

  • Tensor fasciae latae (pain in the outer hip and thigh, contributes to IT band tightness)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Gluteus Medius Ilium (outer surface) Greater trochanter of the femur Superior gluteal nerve (L4–S1)

The gluteus medius is innervated by the superior gluteal nerve, which also controls hip abduction and stability.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the outer hip and iliac crest.

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

  • Gait Analysis: Look for pelvic drop, limping, or hip instability while walking.

  • 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 medius, reducing muscle tightness and improving hip function.

Manual Therapy

  • Trigger Point Release: Apply direct pressure to tight spots in the outer hip and iliac crest.

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

Stretching

  • Glute Stretch: Sit with one ankle crossed over the opposite knee and lean forward to stretch the gluteus medius.

  • Hip Flexor and IT Band Stretch: Helps reduce hip tightness and restore balance between muscle groups.

Strengthening Exercises

  • Clamshells: Strengthens the gluteus medius for better hip stability.

  • Lateral Band Walks: Helps activate the hip abductors and improve balance.

  • Side-Lying Hip Abductions: Builds strength in the glutes to support pelvic alignment.

Postural and Movement Adjustments

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

  • Ensure proper walking mechanics (engage the glutes when walking to prevent hip imbalances).

  • Use a supportive mattress or pillow between the knees while sleeping (reduces strain on the hips and lower back).

Conclusion

The gluteus medius plays a crucial role in hip abduction, pelvic stability, and lower body movement, but trigger points in this muscle can cause significant hip, 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.