Muscle and Joint Pain of the Groin and Pelvis

Usual Suspects

  1. Muscles of the upper thigh
  2. Muscles of the abdomen
  3. The piriformis muscle
  4. The hip joint
  5. Muscles of the interior of the pelvis

The Imbue Pain Relief Patch temporarily relieves minor aches and pains of muscles and joints. In the diagrams below, the X’s show the locations of common trigger points (localized muscle strain), and the colored shading shows the pain pattern each trigger point produces. This pain is often several inches (or more) away from the trigger point at which it originates. If application of the Imbue Patch directly to the knee does not significantly improve your pain, applying the Imbue Pain Relief Patch at the site of strain in nearby muscles sometimes yields better results.

Pain of the groin and pelvis can be caused by a wide range of problems, including disorders of the reproductive organs, the urinary tract, the intestines, the lymphatic system, the joints, muscles, and ligaments in the area, and more. It is important to see a doctor right away for any prolonged or intense pain, especially if it is accompanied by changes in bowels or urination, nausea or vomiting, a rigid belly, swelling, bleeding, or fever. However, muscle strain and arthritis can also cause pain in this region. If a medical examination reveals no internal problems, it may be worthwhile to consider the possibility of a structural reason for your pain. Let’s look at the muscles and joints that may be involved.

Groin and Pelvic Pain Due to the Muscles of the Upper Thigh

The muscles of the inner thigh are probably the most common cause of groin pain. There are five muscles involved. Let’s look at them:

Adductor Longus and Brevis:

These muscles run from the bottom of the pelvis to the upper, rear surface of the thigh bone. Contracting these muscles brings the thigh toward the midline of the body (adduction). The X’s in this diagram show the general location of trigger points that form when this muscle is irritated. The red shading shows the pain pattern it is capable of producing. Pain is primarily felt at the groin and front of the hip, but it may also travel down the inner/front thigh to the inner/top of the knee. It may also run down the inside of the shin. If you sit with your ankle crossed over your knee, and imagine a line that divides the inside surface of your thigh in half lengthwise (see dotted line in diagram), you will feel adductor longus and brevis near the upper end of this line. If you raise your knee slightly toward your face while feeling your inner thigh, these muscles (adductor longus, in particular) should stand out. Feel thoroughly in this region. If you find any points that are significantly tender, do some gentle massage here. If these points are at least several inches away from the groin and your skin in this area is not too sensitive, you can use the Imbue Pain Relief Patch here. If you are concerned about removal, you can try applying a thin layer of lotion or oil to the skin before putting the patch on. If irritation occurs, remove the patch promptly by soaking it in warm water.

Adductor Magnus:

Similar to adductor longus and adductor brevis, this very large muscle runs from the base of the pelvis to the back of the thigh bone (femur). We use this muscle to “adduct” the thigh, meaning, to bring it inward toward the other thigh. If you try to squeeze a ball between your knees, adductor magnus is one of the main muscles that makes this possible.

There are two general locations where trigger points form in this muscle when it is irritated. First, X’s at the middle of the inside thigh show trigger points that can produce a broad region of pain along the inner thigh and into the groin (see red shaded area). Second, the X in the rightmost diagram shows the location of upper trigger points, near where adductor magnus attaches to the bottom of the pelvis. Trigger points here are capable of producing pain deep inside the pelvis (see red shading). This pain can be easily mistaken for a bowel, bladder, prostate, or vaginal issue. (If you do experience inner pelvic pain, always see a doctor to get an accurate diagnosis.) If this trigger point is active, certain sexual positions may antagonize it, potentially leading to the perception that intercourse is painful, when the upper thigh is actually to blame.

The trigger points of the mid inside thigh can be found just slightly behind the midline of the inner thigh. While seated on a bed or chair, you can open the inner thigh by resting one ankle on the opposite knee (see diagram in the adductor longus/brevis section above) or you can sit on the edge of a bed with the bent leg on the bed and the other leg hanging down with the foot on the floor. Adductor longus (above) is located roughly along the midline of the inner thigh (see dotted line in diagram above), while adductor magnus is a bit more toward the back of the leg. You can feel the whole length of it, keeping in mind that the most common trigger point locations are near or just above the halfway point between the groin and the knee.

The rear trigger point which causes pain inside the pelvis is found near the inside of the crease at the bottom of the buttock. This is best found and massaged with the help of a sensitive partner, a Thera Cane, or a ball. If using a ball, a lacrosse ball usually works best, but a tennis ball is okay. The diagram on the left shows where to place the ball. In practice, you will put the ball under the crease of the buttock while this leg is resting up on a hard chair or table. The diagram on the right shows one possible arrangement (the ball is shown but it would actually be hidden from view). Rather than keeping the leg you’re working on straight, as in the picture, you may find it more comfortable to half-sit on the table on the buttock that you’re working on, while standing on the other leg. If you find any significantly tender points, particularly if they reproduce or alleviate the pain you have been experiencing, do some gentle massage. As for the use of the Imbue Pain Relief Patch in this area, some people with less sensitive skin and less body hair may have no trouble applying the patch to treat aductor magnus; others with more hair or skin sensitivity should avoid using the patch here. If you are concerned about removing the patch, you can apply a thin layer of oil or lotion to the skin here before putting on the patch.

Pectineus:

This is the uppermost of the inner thigh muscles. It is located just below the crease of the groin. The X in this diagram shows where a trigger point in this muscle will tend to occur when it is irritated. The red shading shows its pain pattern, which is felt as a sharp or dull pain right in the groin area. Feel just below the crease of the groin, roughly halfway between the front and back surfaces of the thigh. If you find significant tenderness in this area, especially if pressing here produces the pain you have been experiencing, do some massage here, but keep it gentle. This area is usually too sensitive for application of the Imbue Pain Relief Patch. If you wish to try using the patch here, do a test first with just a postage stamp sized piece. If no irritation occurs and removal is easy, you may proceed with a larger patch.

Gracilis:

The gracilis muscle is like a long thin strap that runs from the underside of the pelvis at its upper end to the inside of the knee at its lower end. It is not especially likely to be the cause of your groin pain, but it is worth checking anyway. The diagram shows (as X’s) two common locations where trigger points arise when the gracilis is irritated, but trigger points may actually arise anywhere along its length. Unlike most other muscles, the pain of each trigger point occurs in the few surrounding inches, rather than being referred elsewhere. Gracilis pain is often a burning or stinging feeling right under the skin, and possibly a broader achiness. Gracilis lies on top of the other inner thigh muscles, and because it’s so thin may not be able to feel it individually. Just feel thoroughly along the whole inner thigh. If you find any points that are quite tender, especially if they reproduce your groin/pelvic pain, do some gentle massage and apply the Imbue Pain Relief Patch here.

Groin and Pelvic Pain Due to the Muscles of the Abdomen

There are three main muscles in the abdomen that commonly produce pain in the groin and pelvis. These are rectus abdominis, the central “six pack” muscles; the internal and external abdominal obliques, which cover the sides of the abdomen; and the psoas, which runs much deeper, from the spine through to the inside of the hip and thigh.

Rectus Abdominis and the Abdominal Obliques:

In this diagram, rectus abdominis is shown in yellow and the obliques are shown in blue (actually larger than can be seen here). These muscles have similar pain patterns, so we will look at them together.

This diagram shows just two of the many possible sites of trigger points in the abdominal muscles. Lower abdominal trigger points, such as those indicated by the X’s, can cause very broad and unusual pain patterns. The red shading, which shows the range of pain that irritation in these muscles is capable of causing, extends down into the groin and genital area, and also upward and across, to the mid and upper abdomen. This pain may seem to be a hernia, irritable bowel syndrome, appendicitis, or a disorder of the reproductive organs.

Examining your lower abdominal muscles should be a thorough and methodical process. Try to cover the whole region shown in blue in the lower diagram. That is, everything below the navel, including especially along the inside borders of the prominent pelvic bones, and go down as far as the top of the pubic bone. If you find a tender spot that reproduces the pain you have been experiencing, do some massage here and apply the Imbue Pain Relief Patch if the skin is not too sensitive. Remember that finding tenderness does not confirm that the problem is muscular, but there is no harm in address the musculature, even if this is not the source of your pain. Meanwhile, check in with your doctor.

Psoas:

The psoas is a unique muscle. At its upper end, it is attached to the bones of the lower spine. From there it comes forward through the abdomen and connects to the inside of the pelvis and (through its associated muscle, iliacus) to the top of the thigh bone. When it contracts, it brings the thigh toward the torso. It’s also instrumental in helping us sit up from a lying down position. In this diagram, the uppermost X shows the common location of the (right side) upper psoas trigger point. If present, it usually occurs about an inch or two to each side of the navel and sometimes slightly below it. The trigger point at the lower black X is found just inside the most prominent aspect of the hip bone. The yellow X shows an iliacus trigger point which occurs on the inside upper thigh, just below the groin. Tension at any of these three points can produce pain in the groin, genitals, and upper thigh (as well as the lower back).

You can access this muscle most easily if you lie on your back with your knees bent and resting together on one side (see picture). This allows you to feel the psoas on the side opposite from where your knees are lying. Use all your fingertips together to press deeply at the uppermost X first (you may want to trim your fingernails for this). Start an inch or two to the outside of your navel, and search a few inches in all directions. If you raise your head, this will contract the more superficial rectus abdominis muscles. Keep in mind that you need to feel outside and underneath these muscles to get to the psoas. If the psoas is overly rigid, it will feel like a firm vertical band, roughly like a hard banana, and it will be tender. If this is the case, do some self massage here (you will likely need to repeatedly work on it to encourage the muscle to really let go) and apply the Imbue Pain Relief Patch where it is most painful. If you are feeling the psoas on the left and notice a strong pulsation in our abdomen, this is probably your descending aorta (a major artery) and you should move just slightly outward (toward your side) to find the psoas.

Next, you can follow the psoas downward and outward to its lower attachment inside the pelvis. From where the pelvic bone sticks up the most (the anterior superior iliac spine or ASIS), you’ll be feeling just slightly closer to the midline. Feel a few inches up and down. If you encounter a very tender point that produces the pain you have been experiencing in your groin or pelvis, do some gentle massage. You may apply a small piece of the Imbue Pain Relief Patch here (being careful to stay away from the genital region). It is less likely that you will need to address the iliacus trigger point (indicated by the yellow X in the diagram above) if you work on these upper points. However, if the pain remains, you can search for this trigger point by lying flat with your legs extended and pressing deeply against the front/inside surface of the thigh bone about an inch below your groin. If you find a significantly tender point that produces the pain you have been experiencing, you can do some massage here. This lower region is usually too sensitive (and hairy) for most people to use the Imbue Pain Relief Patch.

 

Groin and Pelvic Pain Due to the Piriformis Muscle

The piriformis is a muscular band that runs from the side of the sacrum (the bony plate at the base of the spine) outward to the top of the thigh bone (the greater trochanter of the femur). Besides being often responsible for pain in the buttock area (which can potentially radiate into the pelvis), it can cause a lot of problems because of its relationship to the sciatic nerve. The sciatic nerve is a long, thick nerve that runs through this region and then travels down the leg. The piriformis is located on top of it, and in some cases the sciatic nerve runs through the piriformis. This means that when the piriformis is tight, it can clamp down on the sciatic nerve, causing nervy pain down the thigh and lower leg.

The two primary trigger point regions of the piriformis are just to the outside of the edge of the sacrum and just inside the back of the hip joint (see X’s in diagram). Feeling this area is best done with the help of a friend or the use of a Thera Cane or a ball. If using a ball (tennis ball or lacrosse ball), lie on your back on the floor with your knees bent and feet flat. Place the ball under your buttock and roll slowly on it to apply pressure to the region of the X’s. Alternatively, you can place the ball between your buttocks and a wall (see diagram), and then slowly roll it over the target area. It is quite likely that you will find some soreness in this area, which may be worthwhile to massage or utilize the Imbue Pain Relief Patch on, although of primary interest here is pain that radiates to the area where you have been experiencing it.

 

Groin and Pelvic Pain Due to the Hip Jointhiparthritis

Arthritis of the hip joint is somewhat common later in life, and occasionally occurs earlier when there has been considerable stress to the joint or when the socket is especially shallow. These forms of arthritis are due to wear that destroys the smooth cartilage that lines the joint. Hip arthritis may also develop as part of broader inflammatory conditions, such as rheumatoid arthritis, lupus, and ankylosing spondylitis.

The top of the thigh bone, the femur, narrows and angles inward in what is called the femoral “neck” and then is capped with a round femoral “head” that sits in the socket (acetabulum) of the pelvis. Because the joint itself is quite close to the groin, arthritis here tends to produce a deep pain that radiates into the groin. It may also show up at the side of the thigh or buttock, as shown by the red region in this front-view diagram. For hip joint pain that radiates into the groin, apply the Imbue Pain Relief Patch over the front of the joint, which is typically at the upper thigh, a couple inches below the front protrusion of the pelvis at the lower abdomen. Start by applying the patch horizontally, so as to cover the front of the joint and to wrap somewhat around side. If you don’t get adequate relief, try applying the patch over the side of the joint and the back of the joint to determine which location is most helpful.

Groin and Pelvic Pain Due to the Muscles of the Interior and Floor of the Pelvis

The muscles within the pelvis are capable of causing pain and even affecting sexual, urinary, and bowel function, yet they are rarely suspected. (These include bulbospongiosus, levator ani, sphincter ani, and others.) It is not possible to utilize the Imbue Patch for this kind of pain, particularly as some of these trigger points are only accessible through the rectum or vagina. However, when they are the cause of the problem, only by addressing these muscles directly (via massage, acupuncture, or another form of direct manipulation), can the issue be resolved. If no one has been able to diagnose your pelvic pain, urinary dysfunction, or sexual dysfunction, consider seeing a healthcare practitioner who specializes in myofascial pain and trigger points.

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