The obturator internus and its relation to low back and hamstring pain

Written By Allison Gould

The Obturator Internus is a very tiny, very deep muscle of the hip region. It aids in external rotation and abduction of the hip. Additionally, it acts as a stabilizer of the hip joint with its neighbors the superior and inferior gemellus, gluteus minimus and piriformis. Since it is a deep muscle it is often difficult to diagnose and can be even more difficult to effectively treat. (Carro, 2016) Often when this muscle becomes inflamed or problematic, it results in symptoms that can mimic general back pain, sciatica, piriformis syndrome or even a high hamstring strain. (Swezey, 1993) (Murata, 2009) Because of this presentation, it often goes undiagnosed or is misdiagnosed. This leads to pain that will persist and linger even if some improvements are being made.

Some common symptoms we see these patients present with:

  • Difficulty or inability to sit without pain

  • Deep ache in high hamstring region

  • Low back pain 

  • Sciatica like symptoms including shooting pain

Additionally, symptoms can involve the pelvic floor and present as painful sex, bowel and bladder incontinence or constipation, etc. There can be many causes of obturator internus dysfunction and pain can be random, secondary to trauma or injury, caused by poor posture, from faulty body mechanics or simply general muscle imbalances that have built up over time.

There are many barriers to treatment of the obturator internus including knowledge of how to treat and appropriately access the muscle to fully understand its impact and influence on surrounding musculature and structures. Since it is a muscle that is both a deep structure and small in size, it requires a clinician with deep understanding of anatomy and kinesiology and excellent manual therapy skills to effectively treat.

References

  1. Carro LP, Hernando MF, Cerezal L, Navarro IS, Fernandez AA, Castillo AO. Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles Ligaments Tendons J. 2016 Dec 21;6(3):384-396. doi: 10.11138/mltj/2016.6.3.384. PMID: 28066745; PMCID: PMC5193530.

  2. Murata Y, Ogata S, Ikeda Y, Yamagata M. An unusual cause of sciatic pain as a result of the dynamic motion of the obturator internus muscle. Spine J. 2009 Jun;9(6):e16-8. doi: 10.1016/j.spinee.2009.01.004. Epub 2009 Feb 12. PMID: 19213605.

  3. Swezey RL. Obturator internus bursitis: a common factor in low back pain. Orthopedics. 1993 Jul;16(7):783-5; discussion 785-6. PMID: 8361917.

Allison Gould