Quadratus Femoris Trigger Points

Introduction

The quadratus femoris is a deep hip muscle responsible for hip external rotation and stabilization. When trigger points develop in this muscle, they can cause deep buttock pain, hip tightness, and sciatic-like symptoms, often mimicking piriformis syndrome, hip bursitis, or SI joint dysfunction.

Name and Area

  • Name: Quadratus Femoris

  • Area: Located deep in the posterior hip, running from the ischial tuberosity (sit bone) to the intertrochanteric crest of the femur.

Indications

Quadratus femoris trigger points may contribute to:

  • Deep Buttock Pain That Feels Like a Constant Ache or Tightness (Mistaken for Sciatica or Hip Bursitis)

  • Pain That Extends to the Outer Hip and Upper Thigh (Can Mimic SI Joint Dysfunction or Gluteal Pain)

  • Hip Tightness and Reduced External Rotation (Difficulty Crossing the Legs or Sitting Comfortably)

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

  • Instability or Weakness in the Hip When Walking or Standing on One Leg

  • Pain That Worsens with Hip Flexion or External Rotation (Common in Athletes, Dancers, and Martial Artists)

Pain from this muscle is often mistaken for SI joint dysfunction, piriformis syndrome, or hip joint disorders.

Muscle Action

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

  • Stabilizes the Hip Joint: Helps control hip alignment and prevents excessive femoral movement.

The quadratus femoris is crucial for hip control, pelvic stability, and lower body coordination.

Signs and Symptoms

Individuals with quadratus femoris trigger points often report:

  • Deep Hip or Buttock Pain That Increases with Sitting or Standing for Long Periods

  • Pain That Extends to the Outer Hip or Upper Thigh (Can Feel Like a Deep, Aching Sensation)

  • Restricted Hip Mobility (Difficulty Turning the Leg Outward or Crossing the Legs)

  • Pain That Worsens with Hip Flexion, Running, or Pivoting Movements

  • Tightness in the Hip That Feels Like a "Pinching" or "Compressed" Sensation

  • Difficulty Maintaining Balance or Stability When Standing on One Leg

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

Perpetuating Factors

Common causes of quadratus femoris trigger points include:

  • Prolonged Sitting (Can Cause Chronic Hip Tightness and Compression in the Posterior Hip)

  • Repetitive Hip External Rotation Movements (Common in Golf, Tennis, Martial Arts, and Ballet)

  • Running or Sprinting with Poor Hip Mechanics (Leads to Overuse and Tightness in the Deep Hip Rotators)

  • Pelvic Imbalances or Leg Length Discrepancy (Can Cause Asymmetrical Hip Loading and Overuse of the Quadratus Femoris)

  • Weak Glute Muscles (Forces the Quadratus Femoris to Overcompensate for Hip Stability)

Trigger Point Referral Pattern

Trigger points in the quadratus femoris refer pain to:

  • The deep buttock and lateral hip (Can Mimic SI Joint Dysfunction or Gluteal Pain)

  • The upper thigh and outer hip (Mistaken for Hip Joint Dysfunction or Bursitis)

  • The ischial tuberosity (Can Resemble Sit Bone Pain or Hamstring Origin Tendinopathy)

Pain from this muscle is often confused with hip impingement, piriformis syndrome, or gluteal dysfunction.

Differential Diagnosis

Quadratus femoris trigger points may be mistaken for:

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

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

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

  • Hip Bursitis (Outer Hip Pain, Can Be Tender to Touch and Worsens with Sleeping on the Affected Side)

  • Gluteus Medius or Minimus Dysfunction (Weakness and Pain in the Hip, Affects Walking Mechanics and Balance)

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

Associated Trigger Points

Quadratus femoris 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)

  • Obturator Internus (Inner Hip and Groin Pain, Can Contribute to Pelvic Floor Dysfunction)

  • Hamstrings (Posterior Thigh Pain, Can Resemble Sciatic Nerve Irritation or Tightness)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Quadratus Femoris Ischial tuberosity (sit bone) Intertrochanteric crest of the femur Nerve to quadratus femoris (L4–S1)

The quadratus femoris is innervated by the nerve to the quadratus femoris (L4–S1), which also controls hip rotation and stability.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules deep in the posterior hip and near the ischial tuberosity.

  • 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 maintaining balance on one leg.

  • SI Joint and Hip Flexion Testing: Rule out joint dysfunction or impingement issues.

Corrective Actions

Dry Needling

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

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots in the deep hip and sit bone area.

  • Massage Therapy: Helps improve circulation and reduce muscle tension in the hip and pelvis.

Stretching

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

  • Supine Hip External Rotation Stretch: Lying on the back, pull the affected leg toward the opposite shoulder to stretch the quadratus femoris.

Strengthening Exercises

  • Clamshells: Strengthens the hip external rotators and stabilizers.

  • Single-Leg Balance Exercises: 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 Overuse of the Quadratus Femoris)

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

Conclusion

The quadratus femoris plays a crucial role in hip external rotation, pelvic stability, and lower limb control, but trigger points in this muscle can cause significant deep hip, buttock, 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.