Trigger Point Therapy

There is nothing great about greater trochanteric pain syndrome. Nothing at all.

~ Dr. Robert Speirs DC ~ Leave a comment

Your hip typically has about six small fluid-filled sacs called “bursa” that act as cushions between tendons and bone. One of the most common causes of hip pain is a condition called, “hip bursitis” which means that one or more of your bursas have become painfully inflamed. The broader (more accurate) diagnosis of “Greater trochanteric pain syndrome” (GTPS) describes an uncomfortable collection of problems affecting the outermost portion of your hip. GTPS can include swelling of one or more of the fibrous tendons that attach your muscles onto your hip – a condition called, “tendinitis.” In addition to bursitis & tendonitis, GTPS may originate from tightness in the muscle that travels over your hip en route to your knee- resulting in compression and irritation to your hip.


Greater trochanteric pain syndrome is most common in middle age to elderly adults and is 2-4 times more common in females. Sometimes the problem affects both hips at the same time. Approximately 1/3 of patients with GTPS have lower back pain. Patients who have arthritis in their hips and knees are more likely to suffer from ongoing complaints.

Your symptoms probably include a persistent pain on the outside of your hip, buttock, and upper thigh. Your discomfort may be aggravated by sitting with your leg crossed, arising from a seated position, prolonged standing, climbing stairs, and high-impact activities, like running. Sometimes patients find it difficult to sleep, since lying on the painful hip usually increases symptoms.

For adults, x-rays may or may not be needed to confirm the diagnosis, but children and adolescents usually require films to rule out more serious childhood diseases. Be sure to tell your doctor if you notice that you have a fever, leg numbness, pain radiating significantly beyond your knee, or pain in the front of your groin crease (the area where you leg meets your pelvis.)

Conservative treatment, like the type provided in this office, is successful in about 90% of cases. If you have acute pain, you may need to temporarily limit or discontinue activities that increase your discomfort. Using ice or ice massage at home may help. Some patients find temporarily relief by applying sports creams. Very commonly, patients with pain on the outside of their hip suffer from weakness in one of their buttock muscles, called the “gluteus medius.” When this muscle lacks strength, it is unable to protect your hip during normal activities, like walking. Research has shown that strengthening your hip has a dramatic effect on your progress.

Athletes should avoid running on a banked surface, like the crown of a road or indoor track. Be sure to reverse directions each mile if you run on a circular track. Avoid running on wet or icy surfaces, as this can cause increased tension in your hip. Runners with a “lazy” narrow-based running gait will benefit by increasing their step width to minimize stress on their hip. Cyclists need to make sure that their seat is not positioned too high. Overweight patients should consider weight reduction programs.

Trigger points in the iliopsoas muscle

~ bryancobb ~ Leave a comment

This muscle originates on the bodies and disks of T12-L5 and the inner ilium. It inserts on the lesser trochanter of the femur. The psoas flexes the hip when the spine is fixed. When the leg is fixed it extends the lumbar spine increasing lumbar lordosis. This Muscle is often chronically shortened due to inactivity and sitting posture. When trigger points are present they will refer pain primarily to the lower lumbar area and the sacrum as well as into the anterior thigh. Trigger points in the iliopsoas muscle can mimic appendicitis.

Pulled Hammie! Man Down!

~ Dr. Robert Speirs DC ~ Leave a comment

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Your hamstring is the group of muscles in the back of your thigh that flex your knee, i.e., moving your heel toward your buttock. The term “strain” means that a muscle or its tendon has been stressed beyond its limit and has frayed, much like a rope that has been pulled too hard. Your hamstring may be “pulled” or “strained” when it is forced to contract beyond its capacity, like during running or from excessive stretch. This tearing leads to bleeding, bruising, swelling, pain and loss of function.

The symptoms of a hamstring strain may vary from mild discomfort to severe pain, depending upon the amount of tissue that has been torn. Over 90% of hamstring strains occur abruptly with a tearing, burning or popping feeling accompanied by immediate pain below your buttock. Your symptoms will likely increase when straightening your leg, walking or flexing forward. You may notice some bruising that starts near the site of injury. Be sure to tell your doctor if you have notable pain in your lower back, if your pain extends into your calf, if your pain worsens with coughing or sneezing, or if you have a rash on the back of your thigh.

Hamstring injuries are more common when your muscles are tired from activity and happen more frequently as we age. Having excessive tightness or weakness in your hamstring, having quadriceps that are significantly stronger than your hamstring, having too little core strength or poor running form also predispose you to injury.

Nearly all hamstring strains can be successfully managed with conservative care, like the type provided in our office. Your healing period will vary based on several factors, including the specific region of your hamstring that has been injured. Tears that involve the part of the muscle closest to your ischial tuberosity (the bones you sit on) take longer to heal than those that occur further down the muscle.

Initially, you should use ice or ice massage over the injured area for 15 minutes at a time, up to once per hour. Our office may advise you to use an ACE wrap or compression bandage to help limit swelling. The use of NSAIDs for hamstring strains is controversial, as some research suggests this may delay healing. Patients who have more severe injuries may need to use crutches. While you are recovering, you may need to limit some activities, like running and jumping and instead, cross train by stationary cycling or swimming. You are more likely to strain your hamstring in the future and recurrent injuries may take twice as long to heal as the initial injury, so be sure to allow yourself adequate healing time, consistently perform your exercises and warm-up properly prior to activity.

What is Fibromyalgia?

~ Dr. Robert Speirs DC ~ Leave a comment

Fibromyalgia, although often misdiagnosed and misunderstood, is the second most common musculoskeletal disorder behind osteoarthritis. The condition affects nearly 12 million Americans and is ten times more common in women.

The diagnosis of fibromyalgia is made when a certain set of symptoms has been present for at least three months. The most common symptoms include wide-spread muscle and joint pain, achiness or soreness- especially in the neck, shoulders, back, and hips. Your muscles may constantly feel overworked and tired. Fibromyalgia patients often exhibit a set of predictable “tender points” spread throughout the body. Some patients have trouble sleeping and feel as though they are in a “brain fog” most of the day. This can lead to fatigue or mood changes, like anxiety and depression.


Stress is a known contributor to fibromyalgia, and patients should seek ways to de-stress, including yoga or meditation. Fibromyalgia patients should minimize their caffeine intake, as this is a known stimulant for nervousness, anxiety, and insomnia. Breathing exercises are sometimes helpful.

Although your sleep may be restless, you should try to establish a bedtime routine that gives your body the best chance for recovery. Try to avoid late night electronics, like the television or computer. Keep your bedroom dark, quiet, cool, and distraction-free. Be sure to take time for yourself each day for relaxation or to do something you enjoy. Combat “brain fog” by carrying a notebook or a phone to make notes for important things. Some patients report decreased muscle tightness by applying moist heat or a taking warm bath. The American Pain Society recommends conservative treatment, including chiropractic, along with moderate aerobic exercise.

Trigger points in the piriformis muscle

~ bryancobb ~ Leave a comment

The piriformis muscle is a small muscle deep to glute max and lies over top of the sciatic nerve. It originates on the anterior sacrum, and inserts on the greater trochanter of the femur. It’s main action is to laterally rotate the femur. When trigger points developed in this muscle they will refer pain into the sacro-iliac region, across the posterior hip and down the leg. This muscle can also be a cause of sciatic nerve irritation if it gets tight, causing “sciatica” symptoms.

Piriformis Syndrome; a real bummer.

~ Dr. Robert Speirs DC ~ Leave a comment

Piriformis syndrome results from compression of the sciatic nerve as it passes underneath a muscle in your buttock called the piriformis. Your piriformis muscle attaches from the lowest part of your spine (sacrum) and travels across to your hip. The muscle helps to rotate your leg outward when it contracts. In most people, the sciatic nerve travels deep to the piriformis muscle.

When your piriformis muscle is irritated or goes into spasm, it may cause a painful compression of your sciatic nerve. Approximately ¼ of the population is more likely to suffer from piriformis syndrome because their sciatic nerve passes through the muscle.

Piriformis syndrome may begin suddenly as a result of an injury or may develop slowly from repeated irritation. Common causes include: a fall onto the buttocks, catching oneself from a “near fall,” strains, long distance walking, stair climbing or sitting on the edge of a hard surface or wallet. In many cases, a specific triggering event cannot be pinpointed. The condition is most common in 40-60 year olds and affects women more often than men.

Symptoms of piriformis syndrome include pain, numbness or tingling that begins in your buttock and radiates along the course of your sciatic nerve toward your foot. Symptoms often increase when you are sitting or standing in one position for longer than 15-20 minutes. Changing positions may help. You may notice that your symptoms increase when you walk, run, climb stairs, ride in a car, sit cross-legged or get up from a chair.

Sciatic arising from piriformis syndrome is one of the most treatable varieties and generally is relieved by the type of treatment provided in this office. You may need to temporarily limit activities that aggravate the piriformis muscle, including hill and stair climbing, walking on uneven surfaces, intense downhill running or twisting and throwing objects backwards, i.e., firewood. Be sure to avoid sitting on one foot and take frequent breaks from prolonged standing, sitting and car rides. You may find relief by applying an ice pack to your buttock for 15-20 minutes at a time, several times throughout the day.

Trigger points in the gluteus minimus

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The gluteus minimus is a small but important muscle that lies deep to the gluteus medius. It originates on the gluteal surface of the ilium, and attaches on the greater trochanter of the femur. It’s main actions are to abduct and medically rotate the hip. Trigger points in this muscle refer pain into the buttock and down the lateral and posterior leg, mimicking sciatica. This muscle should be the first to be examined if a straight leg test turns out negative.

Trigger points in the gluteus medius muscle

~ bryancobb ~ Leave a comment

The gluteus medius muscle plays an important role in hip and pelvic stability. It originates on the gluteal surface of the ilium, deep to the gluteus Maximus. It inserts on the greater trochanter of the femur. It’s main actions are to abduct the hip and to assist in internal rotation of the hip. It also maintains pelvic stability during walking and running. Trigger points in this muscle will refer pain into the sacrum, the iliac crest, and down the lateral hip and into the thigh. This muscle is often a cause of lower pack pain.

Trigger points in the gluteus Maximus

~ bryancobb ~ Leave a comment

The gluteus Maximus is the buttock muscle. It originates on the gluteal surface of the ilium, lumbar fascia, sacrum and sacrotuberous ligament. It inserts on the gluteal tuberosity of the femur and the iliotibial tract. Extension and lateral rotation of the hip are it’s main actions. This muscle is heavily involved in activities like ice skating and is a common area to develops trigger points. When trigger points do develop they can refer pain in a crescent pattern from the gluteal fold to the sacrum. Trigger points can also refer pain deep into the buttock itself making it feel like other deeper muscles are involved. These symptoms can sometimes be mistaken for s.i. Joint problems.

Trigger points in the supraspinatus

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The supraspinatus is a muscle of the rotator cuff. Is sits above the infraspinatus and originates on the supraspinous fossa of the scapula. It’s insertion point is the superior facet of the greater tubercle of the humerus. It’s main function is to abduct the arm at the glenohumeral joint working with the deltoid. All rotator cuff muscles act to secure and support the head of the humerus in the glenoid fossa during arm movements acting as a sling. This muscle often gets impinged during overhead movements such as painting a ceiling. When trigger points form in this muscle they primarily refer a deep achy pain into the mid deltoid area with spillover pain radiating down the arm into the elbow.