Obturator Externus Trigger Points

Introduction

The obturator externus is a deep hip muscle responsible for hip external rotation and pelvic stability. When trigger points develop in this muscle, they can cause deep hip pain, groin discomfort, and limited hip mobility, often mimicking hip bursitis, SI joint dysfunction, or sciatica.

Name and Area

  • Name: Obturator Externus

  • Area: Located deep in the hip, running from the external surface of the obturator foramen to the greater trochanter of the femur.

Indications

Obturator externus trigger points may contribute to:

  • Deep Hip and Groin Pain (Mistaken for Hip Flexor Strain or SI Joint Dysfunction)

  • Pain That Extends to the Inner Thigh or Buttocks (Can Mimic Sciatica or Adductor Strain)

  • Hip Stiffness and Limited Rotation (Difficulty Crossing Legs or Turning the Hip Outward)

  • Pain That Increases with Walking, Running, or Lifting the Knee Toward the Chest

  • Discomfort or Instability When Standing on One Leg

  • Pain That Worsens with Prolonged Sitting or Sleeping on the Affected Side

Pain from this muscle is often mistaken for hip bursitis, adductor strain, or lower back issues.

Muscle Action

  • Externally Rotates the Hip: Turns the thigh outward, essential for walking, running, and balance.

  • Stabilizes the Hip Joint: Works with other deep hip rotators to control leg movement and prevent instability.

  • Assists in Hip Adduction: Helps bring the thigh toward the midline during certain movements.

The obturator externus is essential for proper hip alignment, gait mechanics, and lower body coordination.

Signs and Symptoms

Individuals with obturator externus trigger points often report:

  • Pain Deep in the Hip or Groin That Feels Like a Dull Ache or Pinching Sensation

  • Pain That Extends to the Buttocks or Inner Thigh (Can Resemble Sciatic Nerve Pain or Adductor Tightness)

  • Hip Tightness That Restricts Rotation and Leg Mobility (Feels Like the Hip Is "Stuck")

  • Pain When Moving the Leg Outward or Crossing the Legs (Common in Dancers, Runners, and Martial Artists)

  • Discomfort When Sitting with Legs Crossed or Sleeping on the Affected Side

  • Pain That Increases with Hip Flexion or External Rotation (Common in Athletes and Active Individuals)

Pain worsens with excessive hip rotation, prolonged sitting, or sudden twisting movements.

Perpetuating Factors

Common causes of obturator externus trigger points include:

  • Prolonged Sitting with Crossed Legs (Can Shorten and Overload the Hip External Rotators)

  • Repetitive Twisting or Rotational Movements (Common in Tennis, Golf, and Martial Arts)

  • Tight Hip Flexors or Weak Glutes (Can Lead to Overuse of the Obturator Externus for Stability)

  • Pelvic Imbalances or Leg Length Discrepancy (Causes Uneven Weight Distribution on the Hips)

  • Running or Sprinting Without Proper Hip Activation (Leads to Hip Tightness and Compensation Patterns)

Trigger Point Referral Pattern

Trigger points in the obturator externus refer pain to:

  • The deep hip and groin area (Can Mimic Hip Flexor or Adductor Strain)

  • The upper inner thigh (Mistaken for Groin Strain or Obturator Nerve Irritation)

  • The lower buttocks and ischial tuberosity (Can Resemble SI Joint Dysfunction or Sciatic Pain)

Pain from this muscle is often confused with hip joint dysfunction, nerve entrapment, or adductor tightness.

Differential Diagnosis

Obturator externus trigger points may be mistaken for:

  • Hip Bursitis (Lateral Hip Pain That Worsens with Activity or Sleeping on the Affected Side)

  • Adductor Strain (Pain in the Groin or Inner Thigh, Often from Sports Injuries)

  • SI Joint Dysfunction (Pain in the Lower Back and Buttocks, Worsens with Sitting or Walking)

  • Sciatica (Pain Radiating Down the Leg Due to Nerve Compression, Can Mimic Deep Hip Pain)

  • Obturator Nerve Entrapment (Pain and Weakness in the Inner Thigh, Often Associated with Pelvic Issues)

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

Associated Trigger Points

Obturator externus trigger points often co-exist with:

  • Piriformis (Deep Buttock and Hip Pain, Can Contribute to Sciatic-Like Symptoms)

  • Gluteus Medius (Outer Hip and Buttock Pain, Common in Runners and Walkers)

  • Quadratus Lumborum (Lower Back and Hip Pain, Contributes to Postural Imbalances)

  • Adductor Longus and Brevis (Groin Pain and Hip Adduction Weakness, Can Affect Leg Stability)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Obturator Externus External surface of the obturator membrane and surrounding bones Trochanteric fossa of the femur Obturator nerve (L3–L4)

The obturator externus is innervated by the obturator nerve, which also controls hip adduction and stability.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules deep in the groin and outer hip.

  • Resisted Hip External Rotation Testing: Assess pain and weakness when rotating the thigh outward against resistance.

  • Gait Analysis: Look for hip instability, pelvic drop, or difficulty balancing on one leg.

  • Pelvic and SI Joint Testing: Rule out joint dysfunction or lumbar spine involvement.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the obturator externus, reducing hip tightness and improving mobility.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots in the groin and outer hip.

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

Stretching

  • Seated Figure-Four Stretch: Helps lengthen the hip rotators and reduce tension.

  • Hip External Rotation Stretch: Improves mobility and reduces hip stiffness.

Strengthening Exercises

  • Clamshells: Strengthens the hip external rotators and stabilizers.

  • Single-Leg Balance Exercises: Improves pelvic alignment and core activation.

  • Glute Bridges: Helps engage the posterior chain to counterbalance tight hip muscles.

Postural and Movement Adjustments

  • Avoid Prolonged Sitting with Crossed Legs (Encourages Proper Hip Alignment and Reduces Tension)

  • Ensure Proper Walking Mechanics (Engage the Glutes to Prevent Overuse of the Obturator Externus)

Incorporate Dynamic Hip Mobility Drills (Prevents Hip Tightness and Improves Range of Motion)

Conclusion

The obturator externus plays a crucial role in hip external rotation, pelvic stabilization, and lower body coordination, but trigger points in this muscle can cause significant hip, groin, and thigh pain. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent chronic hip dysfunction.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

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.