Article Adapted from RiverStoneChiropractic.com
However, there are 5 more deep external hip rotators. They are the piriformis, superior gemellus, inferior gemellus, obturator internus, obturator externus, and quadratus femoris. See the image. They all allow you to move your leg back and out, and to rotate your leg outward. They attach to the hip bone on one end, and somewhere on the pelvis or sacrum on the medial end.
When they are functioning properly, they don’t make the headlines. But when they become aggravated through overuse or injury, they can press on the sciatic nerve, or worse, become “glued” to the sciatic nerve thanks to adhesions.
You may be wondering how they get overused or injured in the first place, right? Because they are so deep, it’s not like these muscles get “pulled” in the same way you might pull a calf muscle. And you rarely fall on your butt. So what is going on?
The truth: It’s the end result of a long chain of compensations!
Generally, it all starts with tight hip-flexors (either from chronic shortness, not enough stretching, sitting at a desk for eight hours a day, or too much/too soon marathon training). Once the hip flexors become injured, they inhibit the muscles on the other side of the joint - the Glutes. This basically means that the hip flexors “turn off” the Glutes. What do you think happens when big muscles like the Glutes stop working?
Our body, being amazingly adaptable, has a different muscle or set of muscles try to take over the work. It’s like one employee with specialized knowledge of a work project becomes ill, so two others on his team take over one of his projects. They may complete it by the deadline, but it may be riddled with errors.
In the body, we now have a case where one (or more) of the deep rotator muscles (employees trying to be good team players), are trying to bear the load that the gluteus maximus (sick employee) usually bears. The two muscles have completely different axis of rotation, their force ability is different, and they were overall designed to perform different actions. But if they don’t step in, who else will?
Once we enter this situation, it’s easy to extrapolate that those small muscles are about to get overworked and aggravated. An aggravated muscle is constantly contracting (spasm), which results in decreased circulation (thus decreased oxygen). This hypoxia (lack of O2) causes further adhesions to form in the muscle.
These adhesions and the chronically contracted muscle tissue are now your immediate source of butt pain, even though tight hip flexors may have been the initial cause.
Neuromuscular therapy, trigger point therapy, and myofascial techniques can all help both restore the integrity of the hip flexors as well as reduce adhesions in the specific deep external rotator muscle or muscles that are causing you the pain.