Dry Needling Treatment of Gluteus Maximus for Hip/Pelvis Referred Lower Back Pain

Do you have contracted hamstring muscles and suffer from referred lower back pain?

One of the common complaints of referred lower back pain is due to dysfunction of the hip/pelvis, also known as the sacroiliac joint (SIJ). The common source of the problem is the neuromuscular inhibition of the gluteus maximus muscle (buttock region) due to being stretched and compressed in a seated position over long periods of time, whilst the hamstring and erector spinae muscles are “over-facilitated” or “hypertonic”.

A muscle is “over-facilitated” or “hypertonic” if the muscle is wanting to fire, even though it should be releasing or at rest.

An example of a form of activity that exacerbates the condition is cycling.

The condition typically presents tight, over-facilitated hamstrings as well as overworked erector spinae muscles. A further consideration/assessment is that a cycling posture typically places the rectus abdominis muscles in flexion, whilst the athletic load works the hip flexors (along the functional line of soft tissues called anterior kinetic chain) of the body.

I would check for restricted range of motion in the Single Leg Raise (SLR) test as an indication of over-facilitated hamstring myofascial tissue. Palpation of the muscles of the thigh will help to validate the assessment and localise and target affected tissue.

Most of my treatment would involve soft tissue techniques, finding and locating particular “myofascial trigger points” (sore points), firm pressure on the target tissue, as well as static stretching techniques.

The emphasis of treatment is to increase the range of motion, as well as to reduce the degree of pain at the sore points.

A more advanced treatment involves the application of myofascial dry needling to the gluteus maximus muscle (buttock region), which plays a functional role in hip extension and lumbo-pelvic stabilisation. Terms such as “deep longitudinal sling” or “posterior kinetic chain” describe the functional line of soft tissues that support the back of the body. Neuromuscular inhibition (where motor units are not responding to contract) compromises the tension integrity (“tensegrity”) of the functional line of soft tissues, and causes the symptoms of pain, stiffness, and restriction. This represents a holding pattern.

The application of myofascial dry needling is intended to affect the neuromuscular holding pattern, so that isometric contraction (or functional) exercises can be prescribed to encourage a correct neuromuscular firing pattern.

I recommend taking a long-term strategy to correct the neuromuscular holding pattern that is the cause of the dysfunction.

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