Trigger points in the lower back: Why do I have “knots” that cause pain to radiate down my leg?

Many people with lower back pain describe a very specific sensation: “I have a knot in my back that radiates down into my leg.” Sometimes, this pain is not directly related to a herniated disc or classic sciatica, but rather to the presence of muscle trigger points in the lower back and gluteal region.

Myofascial trigger points are a common cause of lower back pain and referred pain, although they often go unnoticed or are mistaken for other spinal problems.

What are trigger points?

Trigger points are small, hyperirritable areas within a muscle, commonly known as “muscle knots.”

They are located in tight muscle bands and can cause:

• Localized pain.
• Muscle stiffness.
• A feeling of tightness.
• Limitation of movement.
• Pain that radiates to other areas.

When pressed, they usually reproduce the pain the patient is feeling.

Why do trigger points appear in the lower back?

The lower back and gluteal muscles bear a heavy load throughout the day. Factors such as sustained tension or poor posture can contribute to the development of trigger points.

The most common causes include:

• Muscle overload.
• Physical or emotional stress.
• Poor posture.
• Sedentary lifestyle.
• Sitting for many hours.
• Repeatedly lifting weights.
• Lack of exercise.
• Previous injuries.
• Biomechanical abnormalities.

In many patients, trigger points develop gradually and eventually lead to persistent pain.

What does trigger point pain feel like?

Myofascial pain can vary greatly from one patient to another, but it is typically described as:

• Deep pain.
• A feeling of pressure or a “lump.”
• Persistent muscle discomfort.
• Lower back stiffness.
• Pain that radiates to the buttock or leg.

In some cases, the pain can be mistaken for sciatica because it radiates to the buttock or the back of the thigh.

Which muscles are usually involved?

In cases of lower back pain with radiation, trigger points are usually located in:

• Lumbar square.
• Gluteus medius.
• Gluteus minimus.
• Pyramidal.
• Spinal erector muscles.

In particular, the piriformis muscle and the gluteus minimus can cause pain that radiates down the leg, much like sciatic pain.

Differences Between Trigger Points and Sciatica

Although they may seem similar, there are important differences.

In some patients, both problems may occur at the same time.

How are trigger points diagnosed?

The diagnosis is usually made by:

• Medical history.
• Physical examination.
• Muscle palpation.

The specialist identifies tight bands and tender areas that replicate the patient’s typical pain.

Sometimes, it is also necessary to rule out other causes of lower back pain through imaging tests.

Treatment of Lumbar Trigger Points

Treatment will depend on the severity of the pain, how long it has lasted, and the triggers.

Conservative Treatments

In many cases, it is recommended that:

• Physiotherapy.
• Therapeutic exercise.
• Stretching.
• Postural correction.
• Muscle strengthening.
• Manual therapy.
• Load control.

Movement and functional recovery are often key to alleviating myofascial pain.

Interventional treatments

When pain is persistent or limits quality of life, specific techniques can be used, such as:

• Dry needling.
• Trigger Point Injection.
• Muscle spasms.
• Radiofrequency.
• Interventional techniques for pain management.

These options are designed to reduce muscle hyperactivity and relieve referred pain.

Can stress make trigger points worse?

Yes. Emotional stress can increase chronic muscle tension and contribute to the development of muscle spasms and trigger points.

For this reason, the management of low back pain often must also include aspects related to:

• Rest.
• Stress Management.
• Sleep quality.
• Postural habits.
• Regular physical activity.

When should you consult with specialists?

It is advisable to seek medical evaluation when:

• Lower back pain persists for weeks.
• The pain radiates down the leg.
• There are limitations on walking or working.
• The pain often returns.
• The usual treatments do not work.

An accurate diagnosis is key to determining whether the source of the pain is muscular, joint-related, neurological, or a combination of several factors.

A Comprehensive Approach to Low Back Pain

We now know that chronic low back pain is rarely caused by a single structure. In many patients, muscles, joints, nerves, and biomechanical factors all play a role at the same time.

Therefore, treatment should be aimed not only at relieving symptoms, but also at restoring function and reducing the risk of relapse.

At MIVI Salud, we have specialists in pain management who take a comprehensive approach to treating lower back and myofascial pain using advanced techniques and personalized treatments.

Dr. Jesús de Santiago

Coordinator of MIVI Canarias