Hip & Thigh Trigger Points

August 4th, 2014 by Laura

I made this image to show all hip and thigh trigger points/referred pain on one image. It saves me from frantically flipping through a book or scrolling web pages as I am releasing, trying to figure out which tender points are causing which sensations.

RELEASE NOTES
This is a list of notes on my own problematic points and methods to release.

Psoas and Iliacus (Iliopsoas)
Psoas and Iliacus are clearly separate in them abdomen but seem to come together in the thigh, and are grouped together as ‘Iliopsoas’.

I haven’t manually released here due to surgical materials in my abdomen, and the only other option to get at it would be to swallow the beastie ball. A search for other psoas release options turned into many nights reading about the complexity of this muscle.

Its usually not recommended to just go straight for the psoas as it is not the root of the problem. Areas such as quads, piriformis, the back and just about anywhere else influence the psoas, causing it to function more like a ligament. Those areas should be worked on first and it can become a real guessing game as to which muscles are causing what. Professional testing is very helpful. I spent years trying to sort this out on my own with fleeting successes here and there. My psoas seems to resolve itself (without direct intervention) when other quirks in my body are fixed.

TFL
IT Band pain is due to tightness in the TFL and glutes. Releasing these areas will relieve IT band pain whereas direct massage of the IT band will not relieve symptoms. Pain in the side of the thigh is most likely coming from the underlying vastus lateralis. Be mindful of sleeping and sitting positions, avoid pulling knees up to chest while sitting and refrain from lying in fetal position while sleeping.

Vastus Medialis
I was certain that I had another meniscus tear when there were trigger points here. They can cause a buckling knee and are often mistaken for ligament damage or arthritis.

All Quad Points
I wish all points released as easily as the quads. Any method works. I can take one out with my thumb while waiting at a traffic light. The quads are capable of a strong pull on the pelvis as well as knee and hip pain. Sometimes I forget to even bother with them because they are so quick to release but my posture always feels improved when they are clear of congestion.

Adductor Longus, Adductor Brevis, Pectineus and Gracilis
Adductor and groin trigger points can be tricky to close in and one of the most painful to release. I’ve had them completely alter my squat pattern by pulling me to the side. They have also caused inflammation similar to an actual cartilage tear or injury on my knee. The adductor group is actually bigger than the hamstrings and only a little smaller than the quads so their ability to tilt the pelvis is significant. They are also capable of inhibiting the glutes.

I’ve noticed that building strength as well as improving tissue quality in the adductors is a fairly quick process and found plenty of sources that agree – however I have personally found that the inverse is also true. They are quick to regress and bind up.

Due to the awkward angle, I can release these points best by using my hands. There are tutorials online on how to manually release muscles without exhausting your hands, and technique really does get remarkably better with practice. The Adductors go up pretty high so don’t be afraid to get right into the origin. I use a deep, alternating stroke massage, angling down over the point, digging in with the thumb once I find the tender spot. My masseuse noticed a large improvement in my inner thighs after just a month of using primarily hands on this area.

I can also reach these trigger points while lying on a lacrosse ball and passively turn my leg (foot turned in). My dog’s Kong ball is good for this – the larger diameter makes it easier to reach the adductors.

When things are really bad and I am desperate to get through a session, there is the bar. This method is harsh and I should probably forget that it exists. I heat the area first, then hang myself over the barbell by one leg. From there, roll around a bit to find the tender spot(s) and sink in. 99% of the time my full weight on the bar is more than enough but if I want more, hold a weight on top of that. Sometimes violent releases like that can shut things down more than help; just have to know when to stop.

Also just want to note that I get a spot that is so bad that it requires metal, it usually means something is wrong and I have some real work to do aside from releasing. Figuring out and fixing what is actually wrong (aka why the trigger point exists in the first place) resolves the points better than overly aggressive releases.

 
Femoral Triangle

Probably should be mindful of the Femoral Triangle when releasing in the adductor region, especially when using aggressive methods.

Adductor Magnus TrP2
This is easy to reach sitting on a chair with a lacrosse or beastie ball under me. It provides some instant relief to get through a session, but this is another one that resolves itself for me without intervention when other areas are addressed.

Gluteus Minimus and Medius
Can be excruciating and can cause some of the worst dysfunction of all points to have. Some sources say that almost everyone has a trigger point in one or both. Can feel like disc herniations and radiate down the legs. Lateral thigh and calf can light up, too.

If you find something here, also check the opposite shoulder, most likely there will be something in there, too. And check adductors – the adductor points are usuallly the primary points that keep the glutes from fully engaging in the first place.

I had devastating effects when I began working on my medial glutes, I was very unstable the first few times I released it. My glute med and min trigger points would not resolve unless adductors were dealt with at the same time. I haven’t had a lot of trouble with my glute max.

Piriformis
If this one loses tone then the glute medius and minimus (and everything else) jumps in to stabilize. This one might also present itself as a twisting spine and hip rotation or stability issues. It is easy to reach by crossing your legs in a figure 4 and sitting on the ball.

Semitendinosus and Semimembranosus
Pain can run down the inside/back of the leg down to the calf and be mistaken for sciatica.
 

Other Points Related to Hip and Thigh Pain
Not shown on the above image are some lower and mid-back points which can refer pain around the hip region and/or pull the pelvis out of alignment.

Quadratus Lumborum

QL trigger points are capable of producing symptoms similar to hip bursitis. The QL points seem to cause a lot of ‘mystery pain’ around the glutes and hips. They aren’t thought of to be very stubborn and I have definitely found that to be true for myself, just a small bit of work makes a difference.

In the case of APT where the lower back is far from the floor, I prefer a larger diameter Kong ball (rubber dog ball) to a lacrosse ball.

Superficial Spinal Muscles (Iliocostalis Lumborum and Longissimus Thoracic)

From the Trigger Point Therapy Workbook : ‘Stiffness or tightness in the lower back is a sign of latent trigger points in the back muscles, even when you are not presently having back pain. Trigger points that keep one side of the back contracted can cause scoliosis curve. Muscle tension maintained by points can also pull the SI joint out of place, keeping the pelvis twisted and cocked.’

Multifidi

Soleus

Soleus trigger points can cause deep pains in the sacroiliac area as well as back spasms. I find it easy to release this point just by digging my thumb into it (TrP3 in this image).

The soleus can also refer pain to the jaw, forming satellite trigger points there. The jaw is a mirror of the hip – more on that below.

Lower Leg Trigger Points.
 

Trigger Points in the Jaw
Jaw trigger points are included in this list because the jaw and hips mirror each other. Releasing tension in the jaw releases tension in the hips and vise versa.

Masseter

There are biting and chewing muscles. Some of us keep these muscles clenched almost all the time. A side benefit of releasing this area is that it can cause sinus drainage and lessen the appearance of undereye bags.

This area can *sort of* be reached from the outside. The most effective method is to put your thumb into your mouth and pinch your fingers against it from the outside. Work from the cheekbone to bottom of jaw.

In addition to trigger point work, a change of habits is absolutely necessary to relieve this area. The trigger points will keep regenerating unless you learn to stop clenching the jaw and grinding teeth when stressed.

For me, not clenching and grinding is much easier said than done. Simply willing myself not to do it doesn’t work. The most promising tips I have come across are on this page. He suggestions include to slur the speech, and to hold the jaw open for extended periods.

 

Lower Leg Trigger Points

July 17th, 2014 by Laura

As a long femured squatter with stance-width restrictions, I need better-than-average dorsiflexion to keep the bar balanced over mid-foot. When my ankles are stiff, I overarch my lumbar, can’t hit depth, get on my toes, bar path goes off and I end up with unfavorable squat angles. I’m lax just about everywhere else – my ankles are the one place where I really had to work on mobility.

It took about 6 months of dedicated work and now I can comfortably drop into a squat with plenty of knee travel at any given time. I haven’t had to revisit anything on this page since. Once the change took place, it was permanent and maintenance-free.

I made the following diagram to have handy during release sessions. It shows all of the lower leg trigger points and referred pain on one image. (Not shown is the pain on the underside of the foot, SI joint and face.)

RELEASE NOTES

This is a list of notes on individual points and methods used to release. ( I’m only logging the points that I work with regularly and have notes that I’d like to remember about them).

Peroneal Trigger Points (Peroneus Longus in particular)
My favorite way to release is to place a lacrosse ball or beastie ball under the lateral calf (under the trigger point area), and place the other leg on top for added weight. Sink into the stab, alternating with gently rocking the hips. I have to be careful to make the movement very tiny. If I keep rolling off of the trigger point, the movement is too large. I tend to tense up against the release for this point. To get around that – draw circles with the big toe, flex and release the foot, alternating with just sinking into the stab. After the release, I give a quick and gentle massage to that area as well as the calves to bring blood and keep from getting too sore.

When this muscle is not being so much of a problem, I can easily stab it with my thumb to release within a minute.

Pain in this area seems to be common among narrow squatters. During times when my hip or SI joint are flaring up, this point becomes active for me.

This point is connected to the gluteus minimus*. The pain referral pattern from that area can activate the peroneal trigger points, causing a chain reaction.

All of my other lower leg trigger points resolved quickly and easily. The peroneal points were the only ones who gave me a hard time (my gluteus minimus was also problematic at the time).

Gastrocnemius, soleus and tibialis anterior should also be treated alongside the peroneals. Weaknesses from trigger points in mentioned muscles will cause the peroneal muscles to overload.

Soleus TrP2 and TrP3
These points do not require a lot for me to release, it is easy to dig in with a thumb.

Extensor Digitorum Longus
The referred pain pattern I am currently having is most inline with the Extensor Digitorum Longus, though both extensors could also be involved, as well as the Tibialis Anterior. Much of the pain is on the shin itself. I have been doing a lot of staggered training lately and in that I try to keep my heel planted. This is much more difficult on my right side, and I think that in my efforts to keep my heel planted, I might be doing something odd with my feet. Like most lower leg points, these points usually work in cahoots with something else (hips). Hopefully as my weak hip gains strength, this point will dissolve for good, like my peroneals did when my glutes found their place in this world.

This area seems to want heavy and precise pressure. I have a hard time fully releasing my anterior shin points with my hands alone, my lacrosse and beastie ball do a much better job.
 

STRETCHES

Pistol Stretch
These stretches were only necessary for me when beginning my ankle dorsiflexion project.

When I am feeling stiff, mobilizing one side at a time seems less daunting than trying to force myself into a weightless squat. I don’t find that getting into a full pistol is imperative, but it is helpful to at least shift hips forward and get comfortable in that position pre-squat. Before I was able to get into a full pistol, I’d to start on the ground, keeling. Plant one foot in front, foot flat and lean into it, bringing butt to ankle, letting knee track forward over toe. Rock back and forth a bit to get deeper, if needed. Be careful not to come up on the toe, which will be the tendency if ankles are restricted.

If things are going well, the other leg can extend, or take it a step farther by reaching out and grabbing the foot of the extended leg with opposite hand. I like being able to get into a full pistol pre-squat, I think the balance in that position is useful.

 

Leaning Squat Stretch
Sit down in a squat and shift weight forward. Can place hands on ground or grab something to pull against. Keep heels planted and rock forward as much as possible. Hold for a second or two, then recover back to neutral. Repeat a few times.

I’m cheating here; should really be in flats 🙂

 

Deactivating the trigger point prior to stretching is key. Muscles with trigger points are shortened and can not reach their full length.

Trigger Point Release Protocols

July 16th, 2014 by Laura

Trigger points, also known as trigger sites or muscle knots, are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers.

Trigger points cause pain and they hinder performance. Muscles with trigger points fatigue more easily, stay contracted longer and are weaker than healthy muscles. The decreased range of motion and weakness can also be present in muscles used to maintain body posture.

Unlike mobility work and stretching, working on trigger points won’t encourage your body to lose connection to its normal ranges of motion if you are lax.

 
TECHNIQUES
Deep Stroking Massage
Make stokes with thumbs/fingers across trigger point.
Intermittent pain might allow you to go a little deeper since the pain is off and on.
Deep stroking massage incorporates a bit of muscle lengthening directly on trigger point with each stroke.

Ischemic Compression
Press and hold until the area releases (static pressure).

The method that has been working well for me for most areas is to put heavy pressure on the trigger point and ‘sink in to the stab’, breathing through discomfort and gently rocking intermittently until the pain dissipates.

DURATION
Most sources recommend anywhere between 10 seconds and a minute. 3-5 minutes is the usual recommended limit for working on a trigger point. If it has not released by then, move on to the next.

I’m guilty of assaulting trigger points for way longer than that. It made me very sore and bruised.

FOLLOWING THE RELEASE
When you release a trigger point, it takes some time for the chemistry around the point to change. During this time, all of the unpleasantries relating to the point might come to surface. To minimize this, a gentle massage around the released point and all neighboring muscles is recommended. If you don’t massage afterward, the worst that happens is that you experience lingering inflammation for a few days at most. A good release for me is usually followed by the trigger point area feeling like ‘glass shards’ along with some limpness.

The tenderness during this time *could* affect performance so a big annihilation of trigger points might not be the best idea before a competition or an important training day.

Immediately following a release, it is recommended to briefly lengthen the muscle with a gentle stretch. Many sources also agree that after the release and lengthening, immediately put the muscle to work with a strengthening movement.

MASSAGE THERAPY
I have to remember to try to get in and see my masseuse once per month. By working on my trigger points at home, I am able to get much more out of my massage appointments. She can give more attention to the trigger points that are more difficult to release on my own.

A helpful technique ahe showed me is a pre-workout workout circulation massage for the anterior thigh. You grab the muscle and pull it off the bone in very quick, deep and aggressive alternating strokes, moving up and down the leg (no oil is used).

 

 

Hip & Thigh Trigger Points

Lower Leg Trigger Points