A 63 year-old female was referred by her chiropractor to assist with soft-tissue treatment for left buttock pain. The patient described nerve-like sensation that radiated into the posterior thigh. She also felt sensitive “burning skin” on the anterior thigh. To offset her sedentary job, she regularly worked out. She reported that her pain was worse with incline treadmill walking, descending stairs, running, and cross-country skiing.
Evaluation, clinical reasoning & treatment strategizing
Postural assessment showed the pelvis to be fairly balanced and symmetrical. A straight-leg-raise test was within normal limits. Internal hip rotation, as measured by both the prone bent leg fallout and supine passive ROM, however, was reduced on both sides. This indicated short and tight external rotators of the hip. Palpation of the left gluteus maximus muscle mimicked her familiar pain.
Trigger points were easily located and deactivated in the gluteus maximus and the pain subsided dramatically. Treatment on the deep lateral rotators led to further improvement. Thinking that she was better she suffered an exacerbation after XC skiing. We retraced our treatment steps and also addressed functionally related muscles (hip flexors, adductors and quadriceps). To reinforce these gains we recommended self-massage techniques.
Results and follow-up
This case demonstrates that hip and buttock pain sourced from trigger points in the gluteal region, especially the gluteus maximus muscle, can quickly resolve with manual treatment. Within two months the patient was mostly pain-free. We recommended a home care activity for improved external hip rotation and referred her to an athletic trainer for movement retraining and strengthening.