Trigger Points – Stiff Low Back with Pain in the Lower Hip

This is one of several posts about a stiff, fragile low back. A stiff low back is usually a combination of a binding intervertebral joint with more than one muscle involved. If you have a stiff low back, you should compare these posts.

Client Description

These people complain of stiffness at the base of the spine with pain that is low in the hip. These people press into the fleshy part of the lower buttock and say that it hurts there.

Usually, they also have stiffness in the base of the spine, and often, have noticed some tenderness there when they press into their back just above the dimple in their hip. Sometimes, this area is sharp and debilitatingly painful.

The pain in the hip can be sudden and sharp or dull and achy. These people are fidgety and adjust their seating to try to get relief.  The pain in the hip can be sharp when they twist unexpectedly.  Older people are concerned about their hip joint and may have recently had an orthopedist check their hip for the pain only to have the doctor say that their hip is just fine.

This condition, like other QL problems, is usually activated by a teetering activity like sweeping, mowing the grass, moving boxes or washing dishes. It is also activated by leaning forward and reaching out as when stacking things in the back of a low cabinet.

Self Care

variation of the supine twist by Yoga Journal

The supine twist helps problems like this by mobilizing the binding in lumbar facet joints. This variation, with the legs crossed and twisted away from the top leg, is particularly effective. Twist slowly to one side and back while holding your abdomen in. Hold for about 2 seconds and return to upright. Repeat this 10-12 times. Cross your legs and do the other side, as well. The tender vertebra will often click with a feeling of relief. You’ll find that you can target the spot by moving the foot of the lower leg closer or farther away from your hip.

Icing helps to reduce pain and inflammation. Heat feels good when it is applied but makes the condition worse when inflammation occurs a few hours later. Many clients have come to me over the years who use a heating pad at night. It makes rising easier, but the condition continues to worsen as the days go on. They consistently improve when they stop using heat on their low back. Vapocoolants like Icy-Hot offer temporary relief.

Avoid the offending exercises mentioned above until this your back has strengthened and stabilized.

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Therapy Notes


This is a combination of two muscles that are affected by a binding lumbar vertebra; multifidus and quadratus lumborum. The sharp pains around the affected vertebrae, L4, are attributed to the multifidi. Other vertebrae may be binding and need treatment.

The QL creates the fragile low back with referral into the SI joint. The trigger point is in the deep, iliolumbar section of the QL at the L4 vertebra. Direct trigger point work here is difficult and less effective.

The lumbar vertebra has to be freed. It can be done in many ways; osseous adjustment, static pressure on the vertebra, METs, craniosacral work, etc.  Treatment is more likely to stabilize and have lasting relief when the pelvis, spine, and cranium are treated for distortions and restrictions as well.

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Tony Preston has a practice in Atlanta, Georgia where he sees clients.

He has written and taught about anatomy, trigger points and cranial therapies since the mid-90s.

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The Body

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