Pectineus Trigger Points

Introduction

The pectineus is a key inner thigh muscle responsible for hip flexion, adduction, and stabilization. When trigger points develop in this muscle, they can cause groin pain, inner thigh tightness, and hip mobility restrictions, often mimicking adductor strain, hip impingement, or nerve entrapment.

Name and Area

  • Name: Pectineus

  • Area: Located in the anterior inner thigh, running from the pubic bone to the femur (pectineal line).

Indications

Pectineus trigger points may contribute to:

  • Pain in the Groin and Inner Thigh (Mistaken for Adductor Strain or Hip Flexor Issues)

  • Pain That Radiates to the Upper Inner Thigh and Knee (Can Mimic Obturator Nerve Entrapment)

  • Hip Stiffness and Limited Flexion (Difficulty Lifting the Leg or Crossing the Legs)

  • Pain When Walking, Running, or Performing Side-to-Side Movements (Common in Runners, Cyclists, and Athletes)

  • Discomfort or Weakness When Bringing the Legs Together (Affects Hip Stability and Gait Mechanics)

  • Pain That Worsens with Sitting for Long Periods or After Hip Flexion Exercises

Pain from this muscle is often mistaken for hip flexor strain, SI joint dysfunction, or nerve compression.

Muscle Action

  • Flexes the Hip: Assists in bringing the thigh toward the torso.

  • Adducts the Hip: Moves the thigh inward, important for stabilizing movement and balance.

  • Supports Pelvic Stability: Helps maintain proper hip and core alignment.

The pectineus is essential for hip function, leg control, and postural stability.

Signs and Symptoms

Individuals with pectineus trigger points often report:

  • Deep Groin Pain or Inner Thigh Discomfort That Feels Like a Pulling Sensation

  • Pain That Radiates to the Inner Knee (Can Be Mistaken for Nerve Compression or Adductor Tightness)

  • Stiffness in the Hip That Makes It Difficult to Cross the Legs or Lift the Knee

  • Pain When Performing Lateral Movements, Side Lunges, or Sprinting

  • Discomfort When Sitting for Long Periods (Common in Office Workers, Cyclists, and Long-Distance Drivers)

  • Pain That Worsens with Hip Flexion, Abduction, or Sudden Twisting Movements

Pain worsens with prolonged sitting, hip flexion activities, or rapid lateral movements.

Perpetuating Factors

Common causes of pectineus trigger points include:

  • Prolonged Sitting (Causes the Pectineus to Remain in a Shortened, Overactive State)

  • Overuse From Running, Cycling, or Side-to-Side Sports (Soccer, Tennis, Hockey, Martial Arts)

  • Weak Gluteal or Core Muscles (Leads to Overuse of the Inner Thigh for Stability)

  • Tight Hip Flexors (Can Cause Overcompensation by the Pectineus and Other Adductors)

  • Pelvic Imbalances or Leg Length Discrepancy (Leads to Asymmetrical Hip Loading and Overuse)

Trigger Point Referral Pattern

Trigger points in the pectineus refer pain to:

  • The groin and inner thigh (Can Mimic Hip Flexor Strain or Adductor Dysfunction)

  • The inner knee (Mistaken for Knee Ligament or Obturator Nerve Pain)

  • The upper pubic area (Can Resemble Hernia or Pelvic Floor Pain)

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

Differential Diagnosis

Pectineus trigger points may be mistaken for:

  • Hip Flexor Strain (Pain in the Front of the Hip, Worsens with Running or Sprinting)

  • Adductor Strain (Groin Pain, Common in Soccer, Hockey, and High-Impact Sports)

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

  • Obturator Nerve Entrapment (Pain and Numbness in the Inner Thigh, Affects Walking and Running Mechanics)

  • Femoroacetabular Impingement (FAI) (Hip Pain That Worsens with Deep Squats or Flexion Movements)

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

Associated Trigger Points

Pectineus trigger points often co-exist with:

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

  • Iliopsoas (Deep Hip and Lower Back Pain, Can Contribute to Anterior Pelvic Tilt and Hip Flexor Tightness)

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

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

Anatomy and Innervation

Muscle Origin Insertion Innervation
Pectineus Superior pubic ramus Pectineal line of the femur Femoral nerve (L2–L4), Obturator nerve (L2–L3)

The pectineus is innervated by both the femoral and obturator nerves, allowing it to assist in hip flexion, adduction, and stabilization.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the inner thigh and pubic region.

  • Resisted Hip Flexion and Adduction Testing: Assess pain and weakness when bringing the thigh toward the torso or squeezing the legs together.

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

  • SI Joint and Obturator Nerve Testing: Rule out joint dysfunction or nerve entrapment.

Corrective Actions

Dry Needling

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

Manual Therapy

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

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

Stretching

  • Butterfly Stretch: Helps lengthen the inner thigh and relieve tension.

  • Lunge Stretch: Opens up the hip flexors and reduces tightness in the pectineus.

Strengthening Exercises

  • Hip Adduction with Resistance Bands: Strengthens the pectineus and other adductor muscles.

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

  • Glute and Core Strengthening: Prevents overcompensation by the pectineus and inner thigh muscles.

Postural and Movement Adjustments

  • Avoid Prolonged Sitting Without Breaks (Encourages Proper Hip Alignment and Reduces Tension)

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

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

Conclusion

The pectineus plays a crucial role in hip flexion, adduction, and pelvic stability, but trigger points in this muscle can cause significant groin, thigh, and hip 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.