buttock muscle

The gluteus medius muscle is one of the three gluteal muscles in the buttock. The other two gluteal muscles are gluteus minimus and gluteus maximus. Gluteus medius is located more in the outer part of the buttock and for the most part, it is covered by much larger Gluteus maximus. Gluteus medius is not covered by gluteus maximus at the upper outer portion of the buttock. This is the area where injections are usually administered.

Gluteus medius is not a very big muscle, but it is a thick and strong muscle that plays an important function in allowing us to walk upright. With each step, the gluteus medius muscle on the supporting leg has to contract, to keep the opposite side of the pelvis from dropping down when we lift the opposite leg to make the next step. That translates to generating a force twice the bodyweight every time we take a step. It is not hard to imagine that this muscle tends to get severely overworked when we carry additional weight for prolonged periods of time. This is one of the reasons why many people present with worsening of their back pain after hiking with a heavy backpack or when ruck marching with full gear without proper train up. While it is not intuitive to associate buttock muscles with back pain, this muscle is one of the most important players in the low back pain.

Gluteus Medius and back pain

When gluteal muscles get severely overworked, they become tight and develop trigger points. At this point many people begin to waddle to transfer their body weight fully over the supporting leg when taking a step. This is simply a protective and compensatory mechanism since the gluteus muscles cannot fulfill their function of contracting and relaxing when walking.  The reason why we may feel back pain when gluteus medius is affected, is because the trigger points in the gluteus medius refer pain into the lower back. (please see the images). Certainly, gluteus medius is not the only muscle responsible for back pain. More frequently than not, another muscle called Quadratus Lumborum is affected along with gluteus medius. These two muscles work in tandem and the referral pattern from their respective trigger points overlap. Therefore it is important to always check for presence of trigger points in both of these muscles. Quadratus Lumborum will be discussed in a separate section, but you may remember that one of the hallmarks of involved Quadratus Lumborum is pain when turning in the bed, when coughing or sneezing.

The pain referred from trigger points in the gluteus medius is mostly felt right above the beltline, but strong sensation can be also felt in the sacral area (please see images). In many cases, pain in the outer part of the hip, known as trochanteric bursitis, has a strong component of involved gluteal muscles, and gluteus medius being one of the main muscles involved.

Location of trigger points & Acupressure tips

To locate the trigger points in the gluteus medius, please refer to the detailed description below. In general, however, they can be found along the iliac cress which is the top part of the pelvic bone. The best way to deactivate the trigger points in the gluteus medius is by leaning against the wall and using a baseball or a tennis ball. Alternately, you can place the ball on the floor and lay down on top of the ball to create more pressure. Using a foam roller is not the best method to address these trigger points, because the foam roller cannot deliver the specific pinpoint pressure through the layers of the fat tissue in the buttock muscles.

Pain in the lower back just above and below the beltline

Pain often extends into the buttock and hip

Pan in the hips can make it hard to find a comfortable sleeping position

Pain in both the hips & lower back can make walking almost impossible

Location of trigger points

Find the bony prominence above your groin (ASIS)

The first trigger point is about 2” behind ASIS

Locate the 2nd trigger point about 1 hand breath behind the 1st one

Find the 3rd trigger point next to the sacrum

Pain radiation

To the sacrum

The outer part of the hip

Buttock and lower back above the sacrum

Occasionally along the IT band & back of the thigh

Obesity or pregnancy

Carrying heavy weight while walking

Weight lifting

Sitting on a wallet in the back pocket

Habitual weight bearing on one side

Carrying a child on the same hip

Locate the 1st  trigger point

Place the ball between the wall & the buttock

Move the ball horizontally over the tender spot

Find a new tender spot  behind the 1st spot

Repeat rolling over the tender area

Find the 3rd spot next to the sacrum & repeat

Move ball over the tender area 15-20 times

Find a new spot & repeat the process

Apply this massage at least 2-3 x a day

Several short daily sessions are preferable

Do not apply very strong pressure

The benefits of acupressure can be greatly enhanced with a few additional techniques applied after completion of acupressure. One of the most important modalities in the treatment of myofascial pain is heat. Application of moist heat to the area of trigger point after trigger point massage will dilate local blood vessels and improve blood circulation. Improved blood circulation helps to flush out the inflammatory substances which irritate local nerves and cause pain. Improved blood circulation will also promote healing and loosen up tight muscle tissue.  Apply heating pad for 10-20 min, take a hot shower or bath. After massaging and warming up the muscles, you can gently stretch them. Stretching is another essential aspect for recovery from and prevention of muscle injuries. Lastly, apply topical analgesics such as Bengay or Tiger balm.