Obturator Internus Trigger Points

Introduction

The obturator internus 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, pelvic discomfort, and sciatic-like symptoms, often mimicking piriformis syndrome, SI joint dysfunction, or pelvic floor dysfunction.

Name and Area

  • Name: Obturator Internus

  • Area: Located deep in the pelvis, running from the inner surface of the obturator membrane and pelvis to the greater trochanter of the femur.

Indications

Obturator internus trigger points may contribute to:

  • Deep Hip or Buttock Pain (Mistaken for Sciatica or Piriformis Syndrome)

  • Pain That Radiates to the Groin or Inner Thigh (Can Mimic Adductor Strain or Hernia Pain)

  • Pain or Discomfort While Sitting for Long Periods (Common in Cyclists, Desk Workers, and Runners)

  • Pain That Worsens with Hip External Rotation or Crossing the Legs

  • Pelvic Floor Tension, Leading to Pain During Intercourse or Bowel Movements

  • Tightness or Instability in the Hip That Affects Walking, Running, or Climbing Stairs

Pain from this muscle is often mistaken for SI joint dysfunction, pelvic floor dysfunction, or sciatic nerve compression.

Muscle Action

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

  • Assists in Hip Abduction (When the Hip Is Flexed): Helps stabilize the pelvis during single-leg movements.

  • Supports the Pelvic Floor: Works with deep pelvic muscles to maintain proper pelvic alignment.

The obturator internus is crucial for hip mobility, pelvic function, and proper gait mechanics.

Signs and Symptoms

Individuals with obturator internus trigger points often report:

  • Deep Hip Pain or Discomfort That Feels Like a "Pinching" Sensation

  • Pain That Extends to the Groin, Buttocks, or Upper Thigh (Can Resemble SI Joint Pain or Sciatica)

  • Difficulty Sitting for Long Periods (Pain Worsens with Pressure on the Buttocks or Perineum)

  • Pain or Tightness When Moving the Leg Outward or Crossing the Legs

  • Pelvic Floor Dysfunction Symptoms (Pain During Intercourse, Bowel Movements, or Urination)

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

Pain worsens with prolonged sitting, deep hip flexion, or sudden twisting movements.

Schedule Now

Perpetuating Factors

Common causes of obturator internus trigger points include:

  • Prolonged Sitting with Poor Pelvic Support (Common in Office Workers, Cyclists, and Drivers)

  • Repetitive Hip External Rotation Movements (Common in Ballet, Martial Arts, or Sports That Involve Pivoting Movements)

  • Tight Hip Flexors or Weak Glutes (Can Cause Overuse of the Obturator Internus for Stability)

  • Pelvic Floor Dysfunction or Chronic Stress (Leads to Increased Pelvic Muscle Tension and Discomfort)

  • Leg Length Discrepancy or Hip Imbalance (Causes Uneven Loading of the Hips and Pelvis)

Trigger Point Referral Pattern

Trigger points in the obturator internus refer pain to:

  • The deep hip and buttock area (Can Mimic Piriformis Syndrome or SI Joint Dysfunction)

  • The inner thigh and groin (Mistaken for Hernia Pain or Obturator Nerve Irritation)

  • The perineum and pelvic floor (Can Resemble Pelvic Pain Syndromes or Nerve Compression)

Pain from this muscle is often confused with pelvic floor dysfunction, hip joint issues, or nerve entrapment.

Differential Diagnosis

Obturator internus trigger points may be mistaken for:

  • Piriformis Syndrome (Deep Buttock Pain with Sciatic-Like Symptoms, Worsens with Sitting or Walking)

  • SI Joint Dysfunction (Pain in the Lower Back and Buttocks, Worsens with Sitting or Standing on One Leg)

  • Hip Labral Tear (Deep Hip Pain That Increases with Hip Flexion and Rotation, Common in Athletes)

  • Hernias (Groin or Lower Abdominal Pain, Often Worsens with Straining or Heavy Lifting)

  • Pelvic Floor Dysfunction (Pain in the Perineum, Groin, or Rectal Area, Can Affect Urination and Sexual Function)

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

Associated Trigger Points

Obturator internus trigger points often co-exist with:

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

  • Gluteus Medius and Minimus (Outer Hip and Buttock Pain, Affects Pelvic Stability and Walking Mechanics)

  • Adductor Magnus (Groin and Inner Thigh Pain, Common in Athletes and Runners)

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

Anatomy and Innervation

Muscle Origin Insertion Innervation
Obturator Internus Inner surface of the obturator membrane and surrounding bone Greater trochanter of the femur Nerve to obturator internus (L5–S2)

The obturator internus is innervated by the nerve to the obturator internus, which also controls hip external rotation and pelvic stability.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules deep in the hip and pelvic floor.

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

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

  • Pelvic Floor and SI Joint Testing: Rule out joint dysfunction or pelvic floor imbalances.

Corrective Actions

Dry Needling

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

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots in the inner hip and pelvic floor.

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

Stretching

  • Seated Figure-Four Stretch: Helps lengthen the hip rotators and relieve tightness.

  • Butterfly Stretch: Opens the inner thighs and reduces tension in the pelvic muscles.

Strengthening Exercises

  • Clamshells: Strengthens the hip external rotators and stabilizers.

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

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

Postural and Movement Adjustments

  • Avoid Prolonged Sitting Without Hip Support (Use a Cushion or Change Positions Frequently)

  • Ensure Proper Walking Mechanics (Engage the Glutes to Reduce Hip Overuse)

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

Conclusion

The obturator internus plays a crucial role in hip external rotation, pelvic stability, and lower body coordination, but trigger points in this muscle can cause significant hip, groin, and pelvic 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.

Contact Us to Schedule an Appointment