Perfect Spot No. 6, an area of common trigger points in the gluteus medius and minimus muscles of the hip Trigger points (TrPs), or muscle “knots,” are a common cause of stubborn & strange aches & pains, and yet they are under-diagnosed. The 14 Perfect Spots (jump to list below) are trigger points that are common & yet fairly easy to self-treat with massage — the most satisfying & useful places to apply pressure to muscle. For tough cases, see the advanced trigger point therapy guide. Pain Location Problems Related Muscles in the low back, hip, buttocks (especially immediately under the buttocks), side of the thigh, hamstrings sciatica, trochanteric bursitis, low back pain gluteus medius and minimus When you have low back pain, buttock pain, hip pain, or leg pain, your trouble might be caused by trigger points in the obscure gluteus medius and minimus muscles. They are a pair of overlapping pizza-slice shaped muscles on the side of the hip. Other muscles in the region are usually involved as well, such as the gluteus maximus, piriformis, and the lumbar paraspinal muscles. However, the gluteus medius and minimus are a bit special: their contribution to pain in this area is often significant, and yet people who have buttock and leg pain rarely suspect that it might be radiating from muscle knots so high and lateral. The leg pain that the lateral glutes produce can be so nasty that many health professionals mistake it for sciatica1 (irritation of the large sciatic nerve that passes through the buttocks and into the leg). But beware: sciatica is often an incorrect diagnosis for pain in this area.2 Arthritis is another common scapegoat, but this diagnosis is rarely correct, even in many aging people: most signs of arthritis (on X-ray) are not associated with any pain, and most people who have hip pain definitely do not have arthritis — only 9–15% according to one large study.3 Most hip pain is something else, and muscle pain is a strong candidate, especially when there is no other clear diagnosis. One trigger point therapy treatment completely relieved a nasty stubborn hip pain that I'd had for five months! What does Perfect Spot No. 6 feel like? Sciatica, among other things Even without nasty symptoms, pressure on these muscles may still feel important. They usually harbour trigger points that aren’t obvious until they are poked (“latent” trigger points), but which cause symptoms like stiffness, “heavy”-ness, muscle fatigue, vague discomfort and diffuse aching throughout the hip and buttocks and descending into the leg. Their importance is often unsuspected because the key gluteus medius and minimus trigger points are not found where the symptoms are… but they produce symptoms that spread backwards to the sacrum and down the leg.4 Given their stealthy nature, massaging these muscles can feel like a surprising and satisfying discovery of the true source of stiffness you did (or didn’t) know that you had — that’s what makes it a “perfect spot.” The deltoid of the butt: anatomy and function of the lateral gluteal muscles The gluteus medius and minimus together are “the deltoid of the butt.” Just as the deltoid muscle lifts the arm out to the side, these lateral glutes lift the leg out to the side: they are “abductors.” They are small cousins of the more famous gluteus maximus, the big muscle that gives shape to the buttocks (and the home of nearby Perfect Spot No. 12). Medius and minimus are very much a pair, almost one muscle in two parts: they have nearly identical shape, location, and function, both acting as lateral stabilizers, preventing the hips from swinging too far from side to side as you walk and balance. You can activate them easily just by standing on one leg and lifting the other out to the side several times. When you start to feel a burn on the sides of your hips, both of them,5 you are feeling your lateral glutes. These muscles evolved for all-terrain activity, which may be why they cause trouble for many people in the modern world.6 Both the medius and minimus are shaped just like a wide slice of pizza; the points converge downwards on the bony projection on the side of your hip, the greater trochanter at the top of the femur. Their “crust” follows the iliac crest, a bony ridge at the top of the pelvis that defines the waist. The medius completely covers the minimus, and the maximus covers most of the medius — but you can still easily reach these muscles simply by pressing into the soft tissue just below the waist at the side and back. Where exactly is this perfect spot in the lateral glutes? As with several of the spots, Perfect Spot No. 6 is actually a small area where you are likely to find a significant trigger point, or several of them. This region of is on the side of the hip behind it. Or, to use the pizza as a guide, it is roughly the front half of the slice, and especially closer to the tip of the slice. Start at the big lump of the greater trochanter on the side of the hip — the lower tip of the muscles — and explore up and back from there: all over the side of the hip, right where the seam of your pants would be. Self-massage tools that are particularly useful on the side of the hip Trigger points in this area are easy enough to find, but less easy to self-massage. It is a spot that cries out for a massage tool, more so than many other areas: something to trap between your hip and the floor. Tennis ball massage is always a great option for this, of course — and most people already have one around — but there are some other excellent choices as well. For instance, a KONG® dog toy is a surprisingly useful (and quirky) self-treatment tool for this location; its unusual wedge shape allows you to roll the side of your hip onto it, the pressure increasing as you roll further. This is a difficult (and slightly absurd) procedure to describe, so all I can do is encourage you to take my word for it and experiment. Your dog may get jealous. Balls and other “pointy” tools are often too intense for the sensitive trigger points in the gluteus medius and minimus muscles. Tubes and rollers fit more naturally into the space between the bones on the side of the hip: you can settle your weight onto them and roll back and forth quite cozily. There are countless foam rollers available — but don’t spend too much, because there are plenty of cheaper and even free improvised options (e.g. pool noodles!). With a foam roller, it’s easier to just settle your weight onto the roller. For a super firm roller, I particularly like the spinal rollers handmade by Allan Saltzman, creator of YogaTools.com — Relieve Tension, Stiffness, and Physical Distortions with Yoga Tools. His spinal rollers are just extremely hard tubes padded with a dense, rubbery foam: simple but very handy, and very sturdy. Last but not least, for the best in a pokier self-massage, I recommend The Knobble, a massage tool classic from Pressure Positive. Appendix A: Is trigger point therapy too good to be true? Trigger point therapy isn’t too good to be true: it’s just ordinary good. It can probably relieve some pain cheaply and safely in many cases. Good bang for buck, and little risk. In the world of pain treatments, that’s a good mix. But pain is difficult and complex, no treatment is perfect, and there is legitimate controversy about the science of trigger points. Their nature remains somewhat puzzling, and the classic image of a tightly “contracted patch” of muscle tissue may well be wrong. What we do know is that people hurt, and it can often be helped. The Perfect Spots are based on a decade of my own clinical experience as a massage therapist, and years of extensive science journalism on the topic. Want to know more? This is the tip of the iceberg. I’ve written a whole book about it … Appendix B: Quick Reference Guide to the Perfect Spots for pain: almost anywhere in the head, face and neck, but especially the side of the head, behind the ear, the temples and forehead related to: headache, neck pain, migraine muscle(s): suboccipital muscles (recti capitis posteriores major and minor, obliqui inferior and superior) for pain: anywhere in the low back, tailbone, lower buttock, abdomen, groin, side of the hip related to: low back pain, herniated disc muscle(s): quadratus lumborum, erector spinae for pain: in the shin, top of the foot, and the big toe related to: shin splints, drop foot, anterior compartment syndrome, medial tibial stress syndrome muscle(s): tibialis anterior for pain: in the upper back (especially inner edge of the shoulder blade), neck, side of the face, upper chest, shoulder, arm, hand related to: thoracic outlet syndrome, lump in the throat, hoarseness, TMJ syndrome muscle(s): the scalenes (anterior, middle, posterior) for pain: in the elbow, arm, wrist, and hand related to: carpal tunnel syndrome, tennis elbow (lateral epicondylitis), golfer’s elbow (medial epicondylitis), thoracic outlet syndrome, and several more muscle(s): extensor muscles of the forearm, mobile wad (brachioradialis, extensor carpi radialis longus and brevis), extensor digitorum, extensor carpi ulnaris for pain: in the low back, hip, buttocks (especially immediately under the buttocks), side of the thigh, hamstrings related to: sciatica, trochanteric bursitis, low back pain muscle(s): gluteus medius and minimus for pain: in the side of the face, jaw, teeth (rarely) related to: bruxism, headache, jaw clenching, TMJ syndrome, toothache, tinnitus muscle(s): masseter for pain: in the lower half of the thigh, knee related to: iliotibial band syndrome, patellofemoral pain syndrome muscle(s): quadriceps (vastus lateralis, vastus intermedius, vastus medialis, rectus femoris) for pain: anywhere in the chest, upper arm related to: “heart attack,” respiratory dysfunction muscle(s): pectoralis major for pain: in the bottom of the foot related to: plantar fasciitis muscle(s): arch muscles for pain: anywhere in the upper back, mainly between the shoulder blades related to: scoliosis muscle(s): erector spinae muscle group for pain: in the lower back, buttocks, hip, hamstrings related to: low back pain, sciatica, sacroiliac joint dysfunction muscle(s): gluteus maximus for pain: in the low back, buttocks, hamstrings related to: low back pain, sciatica, sacroiliac joint dysfunction muscle(s): erector spinae muscle group at L5 for pain: any part of the shoulder, and upper arm related to: frozen shoulder, supraspinatus tendinitis muscle(s): infraspinatus, teres minor Notes Bewyer DC, Bewyer KJ. Rationale for treatment of hip abductor pain syndrome. Iowa Orthop J. 2003;23:57–60. PubMed #14575251. ABSTRACT Patients with lower back or buttock pain that radiates into the posterior or lateral leg are often referred to physical therapy with a diagnosis of sciatica. Often the physical exam does not reveal neurologic findings indicative of radiculopathy. Instead, there is hip abductor muscle pain and weakness. This syndrome involves muscle imbalances that result in overuse strain of the gluteus medius and gluteus minimus muscles, myofascial trigger points, and trochanteric bursitis. This paper describes hip abductor pain syndrome and provides a rationale for the diagnosis and treatment. BACK TO TEXT The reputation of sciatica is overpowering. Nearly any strong pain in the buttocks or back of the leg is likely to be labelled “sciatica,” even though there are several other possible causes of pain in this area. More about sciatica. BACK TO TEXT Kim C, Nevitt MC, Niu J, et al. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study. BMJ. 2015;351:h5983. PubMed #26631296. PainSci #53332. This analysis thousands of patients confirmed a jarring disconnect between signs of arthritis on hip x-rays and hip pain: “Hip pain was not present in many hips with radiographic osteoarthritis, and many hips with pain did not show radiographic hip osteoarthritis.” What they mean by “many” is “practically all”: roughly 80% of patients with signs of arthritis had no pain, and at least 85% of patients with hip pain had no sign of arthritis! These numbers held up even at the extremes — most older patients with a high suspicion of hip arthritis did not in fact have arthritis that could be diagnosed with an x-ray. BACK TO TEXT This is the same phenomenon as the pain of a heart attack spreading into the shoulder and arm (referred pain). In particular, it’s common for referred pain to be strongest right under the butt cheek, which is why it is so often mistaken for sciatica. BACK TO TEXT In fact, you’ll ususally feel it more strongly on the side you’re not lifting: the muscles on the stable side are working even harder to close the leg-trunk angle, or to maintain it. Think of it like this: the leg that is swinging outwards can no longer support you, so why don’t you tip over? Answer: the gluteus medius and minimus on the far side, among others, are holding you upright by pulling down on the top of the pelvis. That’s a hard job, and it feels like it. Do thirty right leg raises while trying to stay upright, and you’ll almost certainly notice that your left hip is the one that kacks out first. BACK TO TEXT A life lived mostly on the flat and stable surfaces of a city offers little challenge to them, so they are weak and easily exhausted by weekend skiing trips, a walk on the soft sand of a beach, or really anything that requires more balancing than usual. The combination of chronic mild weakness with erratic stressful challenges may be the reason they tend to get polluted with trigger points. And this is all just an educated guess. It’s unknown why individual trigger points come and go. I discuss the trouble with running on flat surfaces in Is Running on Pavement Risky?. BACK TO TEXT Harris I. Surgery: The ultimate placebo. NewSouth Publishing; 2016. “Total hip replacement surgery for arthritis is generally considered a very effective operation in achieving pain relief and restoring function, even though it has never been subjected to randomized trial” — literally unproven medicine, despite being on the most popular surgeries in the history of surgery, with a scandalous recent history: the “metal-on-metal” disaster, starting in 2005. MoM “just sounded better” but proved to have serious unintended consequences caused by the release of metal ions. See “How safe are metal-on-metal hip implants?” Extremely unsafe!BACK TO TEXT Original article and pictures take https://www.painscience.com/articles/spot-06-gluteus-medius.php site
Комментариев нет:
Отправить комментарий