Detailed, evidence-based help for common painful problems

Massage Therapy for Back Pain, Hip Pain, and Sciatica

Perfect Spot No. 6, an area of common trigger points in the gluteus medius and minimus muscles of the hip

PAGE INFO updated  by Paul Ingraham
Word count: 2,100
Reading time: 9 minutes
Published: 2005
Updates: 3
Footnotes: 7
Citations: ~8

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.

Anatomical diagram, a superfical dissection of a man, with a spot circled at the top of his left hip, with red colouring representing trigger point referral spreading down the side and back of his thigh to the knee.

A pain in the butt

And hip. And hamstrings. The deep glutes are a common unsuspected source of pain.

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!

Jan Campbell, retired French language teacher, Palm Springs, recovered easily from several months of hip pain

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.

Anatomical diagram showing gluteus minimus and gluteus medius, and their similarity in shape to a slice of pizza. The location of a common gluteal trigger point is shown.

The deltoid of the butt

The gluteus minimus & medius muscles are shaped like slices of pizza. (The minimus is hidden here: it is the same shape as the medius, but smaller & lying directly under it.) Perfect Spot No. 6 is usually found halfway down the lateral edge, right on the side of the hip, in the meaty area between the ridge of the pelvis & the big bone on the side of the hip (greater trochanter). But rather than being “soft,” the edge of the gluteus medius is usually quite rigid — almost as hard as the bones above & below!

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 special interest is on the side of the hip and 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.

Photogrpah of a KONG dog toy, which is hard cone of red rubber with a hole through the centre of it. It’s a surprisingly good massage tool.

The KONG® dog toy is an amazingly good self-massage tool!

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.

Photograph of a woman using a foam roller on the side of her hip, a popular method of self-massage.

Foam rollers work well on the side of the hip.

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.

Photograph of a spine roller, also useful for massage of the hip.

Spinal rollers by Allan Saltzman

Allan Saltzman’s simple but sturdy “spinal rollers,” built for the spine but recommended here for the side of the hip. Available at YogaTools.com.

Last but not least, for the best in a pokier self-massage, I recommend The Knobble, a massage tool classic from Pressure Positive.

Photograph of a mushroom-shaped massage tool.

The Knobble

The Knobble is the best possible tool for applying a focused pressure to a specific spot on the side of the hip. This is the best tool for the long term, once you know where to aim it & have worked your way up to tolerating stronger pressures.

About Paul Ingraham

Headshot of Paul Ingraham, short hair, neat beard, suit jacket.

I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter.

What’s new in this article?

2017 — Science update — Cited evidence of poor correlation between hip pain and radiographic signs of arthritis (Kim et al).

2016 — Added footnote explaining contralateral gluteus medius and minimus action. Added footnote about the poor safety record of hip replacement surgery. Miscellaneous minor edits.

2016 — Miscellaneous editing and improvements. Fixed a few minor errors, moved some details into footnotes.

2005 — Publication.

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

Picture of the cover of my ebook, Save Yourself from Trigger Points and Myofascial Pain Syndrome.

Not too good to be true.

Just ordinary good. Trigger point therapy isn’t a miracle cure, but it is a valuable life skill. Practically anyone can benefit at least a little & many will experience significant relief from stubborn aches & pains. The first few sections are free.

Appendix B: All the perfect spots

There’s also a more detailed index of the spots and other trigger point resources.

  1. Massage Therapy for Tension Headaches — Perfect Spot No. 1, in the suboccipital muscles of the neck, under the back of the skull.
  2. Massage Therapy for Low Back Pain — Perfect Spot No. 2, in the erector spinae and quadratus lumborum muscles in the thoracolumbar corner
  3. Massage Therapy for Shin Splints — Perfect Spot No. 3, in the tibialis anterior muscle of the shin
  4. Massage Therapy for Neck Pain, Chest Pain, Arm Pain, and Upper Back Pain — Perfect Spot No. 4, an area of common trigger points in the odd scalene muscle group in the neck
  5. Massage Therapy for Tennis Elbow and Wrist Pain — Perfect Spot No. 5, in the common extensor tendon of the forearm
  6. Spot No. 6 is this page.
  7. Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome — Perfect Spot No. 7, the masseter muscle of the jaw
  8. Massage Therapy for Your Quads — Perfect Spot No. 8, another one for runners, the distal vastus lateralis of the quadriceps group
  9. Massage Therapy for Your Pectorals — Perfect Spot No. 9, in the pectoralis major muscle of the chest
  10. Massage Therapy for Tired Feet (and Plantar Fasciitis!) — Perfect Spot No. 10, in the arch muscles of the foot
  11. Massage Therapy for Upper Back Pain — Perfect Area No. 11, the erector spinae muscle group of the upper back
  12. Massage Therapy for Low Back Pain (So Low That It’s Not In the Back) — Perfect Spot No. 12, a common (almost universal) trigger point in the superolateral origin of the gluteus maximus muscle
  13. Massage Therapy for Low Back Pain (Again) — Perfect Spot No. 13, The Most Classic Low Back Pain Trigger Point
  14. Massage Therapy for Shoulder Pain — Perfect Spot No. 14, The Most Predictable Unsuspected Cause of Shoulder Pain

Notes

  1. 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.

  2. 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.
  3. 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 of 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.

  4. 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.
  5. 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.
  6. 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?.
  7. 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 one of 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!