PT Classroom - The Role of Myofascial Trigger Points of the Gluteus Medius   ׀ by Mallory Washington, SPT


The study of and science behind myofascial trigger points (TrPs) has grown exponentially in recent years, but the importance of understanding TrPs in physical therapy treatment may still be underappreciated. TrPs are one of the leading causes of musculoskeletally driven pain, especially chronic pain, with an incidence rate of TrP as high as 85% (Fischer et al., 2018). This statistic is especially important seeing that chronic pain impacts quality of life, emotional response, socioeconomic status and gross domestic product in the global economy (Iaroshevskyi, Morozova, Logvinenko & Lypnyska, 2019).

TrPs are often of insidious origin and can be a major factor in many limitations treated in physical therapy, such a pain and functional limitations (Fischer et al., 2018). They are known as taut bands found in muscle tissue that are palpable and are considered latent or active (Fischer et al., 2018). Active TrPs cause pain spontaneously or continuously, while latent TrPs cause pain when compressed and do not consistently present with symptoms (Fischer et al., 2018). Common symptoms include referral pain, paresthesia, mobility limitations, deficits in proprioception and coordination, and autonomic nervous system irregularities such as nausea and dizziness (Fischer et al., 2018). This tissue dysfunction originates for multiple reasons, including trauma, chronic overload or chronic overstretching of a muscle (Fischer et al., 2018). Regardless of mechanism, it is theorized that TrPs are due to extended release of calcium from the sarcolemma from a malfunction of the motor endplate (Fischer et al., 2018). The body attempts to increase calcium reuptake through increase ATP use, but the body cannot keep up and an energy crisis ensues within the muscle (Fischer et al., 2018). Some common treatments of these taut bands are biomechanical correction, dry needling, therapeutic exercise and manual therapy, with the most improvement shown when all treatments are used in conjunction (Iaroshevskyi et al., 2019). Eliminating the presence of TrPs result in increased motor function due to ability for the motor units involved to be recruited during muscle activation (Roach, Sorenson, Headley & San Juan, 2013).

The gluteus medius (glute med) is a commonly worked muscle that is especially prone to the development of TrPs.This muscle acts as a dynamic stabilizer of the hip, working to keep the pelvis level during single limb stance of gait in closed chain and acts to abduct the leg in open chain. Weakness or inability to recruit motor units in this muscle can have multiple negative effects, such as genu valgum or trendelenburg gait where an individual sways from side to side. Not only is this muscle’s strength critical to daily ambulation, but TrPs in this muscle can be a source of symptoms in a variety of other conditions.

Patellofemoral pain syndrome (PFPS) is a common diagnosis that physical therapists treat, and accounts for anywhere to 21-40% of knee issue seen in sports medicine centers. This condition has been associated with weak hip musculature, which includes the glute med, in terms of decreased force production and stabilization. When this muscle is weak, the eccentric control of hip adduction during single limb stance causes increased frontal plane motion of the pelvis that leads to increased knee valgum moments and resulting PFPS. Individuals with this condition are proven to high a higher prevalence of TrPs in bilateral glute meds (87%) when compared to controls (13%) and have less hip abductor strength. However, TrP pressure release therapy alone does not increase hip abduction strength in this condition. Thus, PT treatment to alleviate this condition must be multimodal, and should address TrPs to improve overall motor function of the glute med to reduce stress placed on the patellofemoral joint (Roach et al., 2013).

Another condition in which many clinicians might not associate with TrPs is nonspecific low back pain (LBP). The definition of LBP is pain between the costal margins and gluteal folds that includes limitation of movement due to pain but can also be associated with referred pain. This condition is a common health problem that reduces quality of life through a decrease in sleep quality, an increase in disability ratings, and an increase in pain. Relating to LBP, studies have shown that the glute med has an increased number of active TrPs in those with LBP than controls. Additionally, the higher the number of TrPs present, the higher the pain intensity experienced by the individual with LBP. These TrPs may cause an unfortunate positive feedback system by increasing sensory and motor symptoms in individuals with LBP and further contribute to sensitizing mechanisms that cause the condition itself. Thus, analyzing glute med TrPs may be a helpful tool to battling a stubborn and chronic condition (Iglesias-Gonazalez, Munoz-Garcia, Rodriques-de-Souza, Alburquerque-Sendin, Fenandez-de-las-Penas, 2013).

Often associated and concurrent with LBP is the presence of pain in the leg. In a study that compared TrPs in those with LBP only, leg pain only and LBP with leg pain, TrPs in all cases were the highest in the glute med. This same study proved that manual therapy with soft tissue release and a TrP block are useful in reducing symptoms in individuals with these conditions. Thus, incorporating glute med TrP release in a variety of low back and leg pain is clinically relevant to help manage patient pain and symptoms (Kameda & Tanimae, 2019).

Moving forward, chronic pelvic pain (CPP) has been associated with an increase in TrPs in the glute med, but is much less common in the general population with a prevalence between 5.7-26.6%. CPP is described as noncyclic pain last a minimum of six months within the pelvis, anterior abdominal wall, region inferior to the umbilicus, lower back or gluteal region that is not caused by sexual intercourse or menstruation. Pain in CPP can be continuous or intermittent and can reduce quality of life. While there are many causes for this condition, the musculoskeletal system is often not considered a factor by clinicians. However, TrPs present in this condition can cause hyperalgesia and contribute to the altered pain sensation, reinforcing central sensitization and CPP. It has been shown through research that those with CPP have significantly more active TrPs in the glute med and surrounding areas, and it is likely that central sensitization, depression and anxiety play a role in their development. These TrPs have been shown to reproduce symptoms of CPP, showing that TrP evaluation and treatment in the glute med and surrounding musculature should be a part of clinical practice in treating a patient with this condition (Fuentes-Marques, Carmen Valenza, Cabrera-Martos, Rios-Sanchez & Ocon-Hernandez, 2019).

While it is not logical to state that TrPs located within the glute med cause all of the conditions aforementioned, it is important to note that the role of TrPs in this important muscle are a factor that should be considered in patients who possess these diagnoses. A trained professional is reliable at finding and diagnosing TrPs, even within a muscle as deep as the glute med (Rozenfelf, Finestone, Moran, Damri & Kalichman, 2017). Additionally, there are a variety of interventions that physical therapists can use to treat TrPs in myofascial tissue to help alleviate pain and other symptoms associated with many diagnoses. All in all, while TrP science has gained popularity, they may have a more critical role in patient pain and symptom intensity than many physical therapists realize.


Last revised: 12/17/19
by Mallory Washington, SPT

Fischer, M. J., Horvath, G., Krismer, M., Gnaiger, E., Goebel, G., & Pesta, D. H. (2018). Evaluation of mitochondrial function in chronic myofascial trigger points - A prospective cohort pilot study using high-resolution respirometry. BMC Musculoskeletal Disorders, 19(1), 388. doi:10.1186/s12891-018-2307-0
Fuentes-Marquez, P., Carmen Valenza, M., Cabrera-Martos, I., Rios-Sanchez, A. & Ocon-Hernandez, O. (2019). Trigger points, pressure pain hyperalgesia, and mechanosensitivity of neural tissue in women with chronic pelvic pain. Pain Medicine, 20(1), 5-13.
Iaroshevkyi, O. A., Morozova, O. G., Logvinenko, A. V. & Lypynska, Y. V. (2019). Non-pharmacological treatment of chronic neck-shoulder myofascial pain in patients with forward head posture. Wiadomosci Lekarskie, 72(1), 84-88. Retrieved from
Iglesias-Gonzalez, J. J., Munoz-Garcia, M. T., Rodrigues-de-Souza, D. P., Alburquerque-Sendin, F. & Fernandez-de-las-Penas, C. (2013). Myofascial trigger points, pain, disability, and sleep quality in patients with chronic nonspecific low back pain. Pain Medicine, 14(12), 1964-1970.
Kameda, M., & Tanimae, H. (2019). Effectiveness of active soft tissue release and trigger point block for the diagnosis and treatment of low back and leg pain of predominantly gluteus medius origin: A report of 115 cases. Journal of Physical Therapy Science, 31(2), 141–148. doi:10.1589/jpts.31.141
Roach, S., Sorenson, E., Headley, B. & San Juan, J G. (2013) Prevalence of myofascial trigger points in the hip in patellofemoral pain. Archives of Physical Medicine and Rehabilitation, 94(3), 522-526.
Rozenfeld, E., Finestone, A. S., Moran, U., Damri, E. & Kalichman, L. (2017). Test-retest reliability of myofascial trigger point detection in hip and thigh areas. Journal of Bodywork and Movement Therapies, 21(4), 914-919.

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