Low Back Pain - Sciatica Trigger Points
Trigger Point Therapy for Low Back Pain
Low back pain is the most common pain disorder of modern times. But despite the fact that millions of people suffer through it every year, there exists very few effective treatments for it. Pain killers can help in the short term, but in the long term than can do more harm than good. Chiropractic treatments can hit or miss, and are rarely an effective long term solution. Surgery is an invasive, and not consistently effective treatment option.
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So why are all these treatment options not really effective? The "big mystery" to understanding low back pain is understanding the source of the pain. The modern medical establishment is trained to examine the nerves and joints for sources of low back pain. While these structures may be involved occasionally, it is the muscular system that takes much of "wear and tear" of daily life and therefore is much more likely to be the source of the pain.
Video: The Low Back Pain Trigger Points
Acute (one week in duration or less) low back pain disorders respond very well to Clinical Trigger Point Therapy. Long term low back disorders can become complicated, involving many muscle groups and multiple trigger point interactions. It can take some time to effectively address the complexity of chronic back pain conditions, but the comprehensive treatment protocol that we designed specifically for this complaint can get the job done.
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There can be as many as twelve muscle groups involved in a low back disorder. A simple case of low back pain may only involve two or three muscle groups, but if left untreated, up to ten additional muscle groups may become involved.
The trigger points in these additional muscle groups can produce Sciatica symptoms like radiating pain or numbness that travels down the leg (see below). The following four muscle groups are primary factors in nearly all low back disorders:
Trigger Point Therapy for Sciatica
"Sciatica" is a non-specific term that describes pain (and/or numbness or tingling sensations) that travel from the buttocks down the back (or side) of the leg. Sciatica symptoms can have various causes. Typically, this type of pain is generally associated with the compression of the sciatic nerve by a damaged or prolapsed spinal disc. This situation is very serious and produces a pain that is nearly constant and unbearable. Surgery is the only viable option in this situation.
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Radiating pain or numbness that "comes and goes" with your activities and body position, suggests that a muscular source is the cause, and not a disc herniation. Trigger points in the Gluteus Minimus and Piriformis muscles can easily produce sciatica symptoms. Typically, trigger point produced sciatica symptoms occur secondarily to a previous (or concurrent) low back or hip pain disorder.
The Quadratus Lumborum Trigger Points that Cause Low Back Pain
The Quadratus Lumborum muscle group is composed of several small muscles that are located deep within the lower back muscle mass. It attaches to the lowest rib, at several spots along the lower (lumbar) spine, and along the pelvic rim.The Quadratus Lumborum contracts to help stabilize the spine, and to flex the trunk to either side.
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This muscle group can contain up to four trigger points that produce low back pain, groin pain, hip pain, and gluteal pain. It is primarily the upper two trigger points under the rib cage that produce the low back pain symptoms.
A person with active Quadratus Lumborum trigger points will typically experience severe pain when their trunk is in an upright position. Often they will instinctively brace and support their upper body with their arms to avoid this severe pain.
Referred pain from Quadratus Lumborum trigger points may also activate other trigger points in muscle groups that function to move the hip joint, causing hip joint dysfunction.
Quadratus Lumborum Trigger Point Symptoms
A patient that comes to me with active quadratus lumborum trigger points will have a very deep aching low back pain on one side of their belt-line that they can't get relief from. It hurts when they move and when they sit or lie down. It sometimes has a sharp, lighting bolt-type of pain that can drop them to their knees if they are standing.
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In acute pain situations, most of these patients cannot stand and may have to crawl to move around. If they are standing or sitting upright, they have to support the weight of their upper body with their hands, like with crutches or holding on to a low wall or person. Sneezing or coughing brings pure agony.
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In chronic pain situations, these trigger points will often cause hip pain, gluteal pain, and groin pain. The patient may have a history of low back pain, but they currently only have the hip or gluteal pain complaints.The hip pain at this stage may resemble trochanteric bursitis.
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The pain may also extend into the groin and genitals, though I only see this in very chronic cases. Sciatica symptoms can also develop from related (satellite) trigger point activity in the gluteus minimus muscle group.​
The Gluteus Medius Trigger Points that Cause Low Back Pain
The Gluteus Medius muscle group is a small fan shaped muscle that lies partially underneath the larger Gluteus Maximus muscle group. It attaches just under the rip of the pelvic bone, and runs diagonally downward to attach on the leg bone at the hip joint.
This muscle functions to raise the leg to the side, and to stabilize the pelvis during walking. Trigger points in this muscle refer pain to the buttocks and along the belt-line.
It is primarily the medial and lateral trigger points that refer pain to the low back (belt-line and lumbar spine) region.
Gluteus Medius Trigger Point Symptoms
Patients with active gluteus medius trigger points typically complain of low back and gluteal pain while walking or laying on the painful side.
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In clinical practice, the medial trigger point in this muscle is the most active, producing low back pain along the belt-line, Sacroiliac joint pain, and buttock pain. The middle and lateral trigger points become active in more chronic cases, causing buttock pain and low back pain, respectively.
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Trigger points in the gluteus medius and quadratus lumborum muscles go hand-in-hand, as it is extremely common to see simultaneous trigger point activity in both of these muscle groups.
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The Ilio-Psoas Trigger Point that Cause Low Back Pain
The IlioPsoas muscle group is composed of two distinct, but functionally related muscles, the Iliacus and the Psoas muscles. The muscle group is located very deep in the abdominal cavity, on either side of the spine. It attaches at various points along the spine, to the pelvis, and on the large leg bone (femur). It contracts to stabilize the trunk on the hips, and to flex the trunk forward and/or lift the thigh.
Though this muscle is in the front of the body, its trigger points refer pain to the low back, in a vertical pattern that runs parallel with the spine. People with active IlioPsoas trigger points will typically have more pain when standing, and have a difficult time performing a sit-up.
Ilio-Psoas Trigger Point Symptoms
Patients with active ilio-psoas trigger points will present with low back pain has a vertical distribution, and may or may not have simultaneous groin pain. If both Ilio-psoas muscle groups have active trigger points then the patient may feel that the pain runs horizontally across the lumbar spine region.
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The patient typically reports that standing makes the pain worse and that leaning slightly forward at the waist helps reduce the pain while standing. The pain may also be worse during a bowel movement.
The Rectus Abdominis Trigger Points that Cause Low Back Pain
The Rectus Abdominis muscle is the "six-pack" muscle group in the stomach region. It attaches to the breast bone and adjacent ribs, and runs downward to attach to the pelvis. This muscle contracts to flex or curl the trunk on the pelvis, and helps stabilize the trunk during upright activities.
Trigger Points in this muscle group can refer pain to the belt-line, across the mid back, and at very places in the stomach region. Additionally, the trigger points may produce such diverse symptoms such as, abdominal bloating, heartburn, nausea, and may even resemble the pain associated with appendicitis.
Rectus Abdominis Trigger Point Symptoms
Patients with active lower rectus abdominis trigger points will present with low back pain across the belt-line and in both sacroiliac joints. If the upper trigger point in this muscle is active then they will complain of mid-back pain across the base of the rib cage.
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I've had some patients come to me with active rectus abdominis trigger points that have no back pain component of their symptoms. These patients complain of various types of abdominal and pelvic pain. Some patients have both abdominal and back pain symptoms. The symptoms depend on which trigger points (or all) are active.
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The lateral trigger point in this muscle can produce lateral abdominal pain that mimics appendicitis if it's on the patient's right side. The mid trigger point(s) produce pelvic pain and testicular or vaginal pain.
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Other symptoms include abdominal pressure or bloating, nausea, gall bladder attack, heartburn, and painful menstruation.​
The Gluteus Minimus Trigger Points that Cause Sciatica
The Gluteus Minimus is a small, fan-shaped muscle group that lies deep in the buttock region, just above and behind the hip joint. It attaches to the pelvic bone and runs downward to attach to the thigh bone (the femur) near the hip joint. Like the larger Gluteus Medius muscle group that lies over it, the Gluteus Minimus functions to stabilize the pelvis during walking and other upright activities.
Gluteus Minimus trigger points can refer pain to the hip joint, buttocks, down the back of the leg to the calf, and down the outside of the leg to the ankle.
These trigger points can be activated by trigger points in the Quadratus Lumborum muscle group, by long periods of immobilization, or by the abnormal body mechanics that are created when a person must limp for any reason. Additionally, men may activate these trigger points by sitting on a large wallet that is kept in the back pocket.
Gluteus Minimus Trigger Point Symptoms
Patients with trigger point activity in the gluteus minimus muscle group may report buttock pain, hip pain and pain down the back of the leg to the calf. The buttock pain and the pain down the leg together can make a convincing case of sciatica.
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The hip pain is produced by the lateral trigger points in this muscle. These trigger points may also refer pain down the outside of the thigh and lower leg and is termed "side-sciatica". This hip pain will cause the patient to limp while walking. and have difficulty getting out of a chair.
The Piriformis Trigger Points that Cause Sciatica
The Piriformis muscle is a short, thick muscle that is located deep in the buttock region. It functions to rotate the thigh, and helps to stabilize the hip joint during walking.
This muscle lies next to a major nerve (the Sciatic Nerve) and blood vessels. Trigger points in this muscle can cause it to become tense enough for it to entrap or compress the nerve and blood vessel, producing systems such as pain, numbness, and swelling that travel down the leg from the gluteal region. When this entrapment occurs, it is termed Piriformis Syndrome.
Piriformis Trigger Point Symptoms
Most of my patients that have active piriformis trigger points don't have symptoms of Piriformis Syndrome, though if any patients present with sciatica symptoms I always treat the piriformis, along with any gluteus minimus trigger points.
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If there is compression of the Sciatic nerve (Piriformis Syndrome), symptoms may include pain and numbness in the buttocks and down the back of the leg, swelling in the leg, sexual dysfunction, and groin pain.
Related Instructional Videos from Dr. Perry
While the videos below were created to teach therapists how to locate and release these trigger points, many non-professionals have used them to learn these techniques successfully.
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If you have a partner, a little time, you can use these videos to learn how to treat your own trigger points.
Related Articles from Dr. Perry
More extensive articles on these muscles and trigger points are available from Dr. Perry on our sister website TriggerPointTherapist.com. Click on the titles below to read them:
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Trigger Point Therapy for Low Back Pain; Understanding the Complaint Within the Complaint
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The Quadratus Lumborum Trigger Points: Masters of Low Back Pain
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Iliopsoas Trigger Points: Hidden Pranksters of Low Back Pain
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Gluteus Minimus Trigger Points: A Small Muscle With A Big Mouth
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