Deep hip rotator overload – a cause of hip muscle pain

Deep hip muscle pain

Deep hip rotator overload causes a diffuse deep hip muscle pain, felt centrally in the buttock.

Pain in the buttocks and hip often peaks the day after exercise. It causes pain on stretching (eg. sitting) and activation (eg. squats, walking upstairs).

It is caused by excessive fatigue of one or more of the six small hip muscles that sit underneath the gluteal group (larger hip abductor muscles).

Deep hip muscle anatomy

These small muscles rotate the hip laterally (outwards, referred to as “external rotation”) and assist with hip joint stability.

Why do deep hip rotators cause so much hip muscle pain?

The answer is what makes them vulnerable and so very effective.

These muscles are short, which means they aren’t able to stretch very far.

They’re also small. That doesn’t matter when they work together but leaves them prone to overload if one is working harder than the rest.

So if one of the group is overloaded relative to the others, it spells trouble.

Piriformis is the most prone to overload and pain. It’s also implicated in some forms of Sciatica.

As the individual muscle accrues to much fatigue, a response is initiated that results in pain and some muscle shortening (although the shortening is only temporary).

Remembering that these muscles don’t have a lot of length to begin with, that’s an issue. The shortness causes additional restriction and further overwork, as the muscle activates to try and resist excessive stretch.

This creates a cycle of hip muscle pain and overload that can last for weeks.

So how do you treat it?

Stretching can be effective ONLY if it’s gentle and comfortable!

As the muscles involved are very short, they go from mild stretch to over-stretched very quickly.

A trigger point ball is more effective than a foam roller as the muscles are positioned in a bony recess in the pelvis. That makes them hard to access with the broader surface of a roller.

This is one of those injuries that you can actually “run it out“, kinda. Slow easy running can help restore normal muscle length. But you have to be careful not to add to the overload with further fatigue.

Overloading the muscles or generating fatigue will make it worse but gentle exercise including easy yoga and walking can help gently stretch the muscles and relieve soreness.

Avoid these approaches as they’ll slow your recovery

Trigger point pressures shouldn’t be painful – harder pressure isn’t better.

Firm pressure can be uncomfortable but if you perceive it as pain, the protective response from the brain is to activate and tighten the muscle to avoid damage. So it’ll actually have the opposite effect and worsens the issue.

Strength exercises are not a solution for muscles that are already overloaded.

We can always be stronger but strengthening these muscles while they’re fatigued and sore will only worsen the pain and extend your recovery.

Ice and heat are ineffective. The muscles are too deep to be affected by the thermal effects of ice and heat, so the best they can do is distract you from the deeper pain.

Be wary of these conditions that can mimic hip muscle pain

Bone stress – this can cause deep hip “muscle” pain similar to sacral and hip bone stress injuries, although those injuries behave differently in response to loading.

Low back pain – lumbar pain can refer into the buttock and may worsen after exercise.

Sciatica – Sciatic nerve irritations may be felt in the buttock but commonly progress to pain spreading down the leg.

Muscle tear – a pulled hip muscle can occur with the same overload but it’s often associated with sharp pain on initial loading.


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