Relieve Low Back Pain and Pseudo Sciatica – Gluteus Minimus

selhelpbannerGluteus Minimus
Relieve Back Pain and “Pseudo Sciatica”   with this Everyday Object
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Is it really Sciatica or just a trigger point in your buttocks muscle?  In this issue we focus on the Gluteus Minimus, a muscle in your buttocks with a surprising referred pain pattern that mimics the pain of sciatica!  A quick assessment of this muscle can prevent misdiagnosis for low back and leg pain sufferers.

True Sciatic Pain is caused by compression or irritation of the Sciatic Nerve or one of its nerve roots.  The nerve runs along the back of the leg starting from the center of the buttocks down to the heel.  When the nerve is compressed or irritated, the whole back of the lower limb can suffer severe pain (sciatica).

The drawing on the left shows the two common referred pain patterns resulting from trigger points in the Gluteus Minimus.  Notice how the pain (indicated by the red areas) extends from the buttocks region down the back and side of the entire lower limb into the ankle.  The referred pain caused by these trigger points (indicated by “x“) affects almost the identical areas as Sciatica.  For this reason, President Kennedy’s physician, Dr. Janet Travell, called this pain “Pseudo Sciatica”.

Along with pain in these areas, if you have trigger points in the Gluteus Minimus, you might also experience: 

  • Difficulty rising from a chair after sitting for long periods
  • Pain when walking that ironically isn’t relieved by lying down
  • Inability to sit comfortably with legs crossed

Perform the following quick tests and learn how an everyday tennis ball can help you assess and resolve trigger points and myofascial dysfunction in this important buttocks muscle.

  

*The information in this article is not intended to diagnose or treat any medical condition and does not substitute for a thorough evaluation by a medical professional.  Please consult your physician to determine whether these self-care tips are appropriate for you.

(2) Quick Self-Tests to Tell if You have Trigger Points in Your Gluteus Minimus: Follow the instructions below to get a good idea of whether myofascial trigger points might be causing you “pseudo sciatica” pains.

TEST 1:  Knee Cross Over Test

      

 PASS                                 FAIL

Start by sitting upright.  Then, without using your hands, raise one knee and attempt to cross it completely over the opposite knee.  A Passing result is when the top knee crosses completely over and rests flush on top of the bottom knee (as shown above).  There should be no space in between the knees.  A Failing result occurs when knee is unable to cross completely over and space is left between the the two knees.  The picture above depicts significant dysfunction in the patient’s left Knee Cross Over test.

TEST 2:  Gluteus Minimus Palpation

As always, palpation (the medical term for pressing, feeling and squeezing to evaluate body tissue) is often the most effective test to identify myofascial trigger points in your Gluteus Minimus muscle.

There are 3 overlapping layers of gluteal muscle:  the Gluteus Maximus, Gluteus Medius, and the Gluteus Minimus.   The Gluteus Minimis is the deepest of the three, so there are a couple of tricks to feeling for these deeper trigger points:

Lying on your side (gentle):  Lie on the opposite side you wish to palpate.  Press your finger tips deep into the muscle tissue above the hip bone (the area shaded in green).  Feel for tender spots and taut bands of muscle tissue.

Standing with a tennis ball against the wall (deeper):

 In order to get deep enough to feel for trigger points, you may require the assistance of a tennis ball placed between you and a wall (as shown).  Position the ball in different spots to cover the area above the hip bone (shown in green) and lean into the ball, feeling for tender spots and taut bands.  Only push to gentle tolerance.Also, take note of any Referred Pain, especially pain that refers into the pain pattern down in the back of the lower limb.


3-Step Simple Self-Care Remedies

As always, treating myofascial trigger points in your Gluteus Minimus with gentle self-care techniques can be effective at eliminating pain and improving the health and flexibility of your body.  A simple tennis ball and a few minutes a day is a great place to start.

Step 1:  Warming Up with Moist Heat

Click here to view larger imageTo get deep into the taut bands of muscle (trigger points) in your Gluteus Minimus, moist heat is a useful first step.  A warm bath works, or lying on a hot pack for 10-15 minutes is great.

Step 2:  Compression

One of the best tools for treating the Gluteus Minimus is again the common tennis ball.

You can lean against the wall, just as you did for palpation.  When you find a tender spot, press into the ball to pain tolerance (“good pain” – not pain that is sharp or makes you want to withdraw).  Hold for 10 seconds while completing at least two full breaths in and out.  Then continue searching for more tender spots until the entire muscle is covered.

Lying on your side on top of the tennis ball is also very effective (as shown) and may provide a deeper compression for trigger points in the Gluteus Minimus.  You can comfortably perform this self-care technique while reading or watching television, as long a you don’t lose focus on the muscle you are treating.  Varying the softness of the surface (floor, pillow on top of floor, etc.) may be needed if the pressure of the ball is too much.

Step 3:  Stretching the Gluteus Minimus

Below is an excellent intermediate stretch that you can perform seated1.

Sit in a chair and cross one leg over the other, placing your ankle on the opposite thigh as shown.  Let the elevated knee drop toward the floor and hold for 20 seconds.  Now, clasp the elevated knee with both hands as shown.  Simultaneously pull the knee gently up toward the opposite shoulder and resist with your knee, pushing back against your hands with 30% of your strength.  Hold this contraction for 15 seconds.  Then relax, exhale and gently press your knee back down toward the floor (only to comfort).  Repeat 3 times and watch to see if your knee gradually stretches further toward the floor.

1 Sharon Sauer, CMTPT, LMT and Mary Biancalana, CMTPT, LMT  Trigger Point Therapy for Low Back Pain. New Harbinger Publications: Oakland, CA 2010.

 

 

 

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