Quadratus Femoris and Gemelli: Pain Pattern and Treatment
The quadratus femoris and the two gemelli are the short rotators of the hip that lie below the piriformis, running from the sit bone and the pelvis to the back of the femur. They turn the hip outward and steady it in the socket. Their documented pattern is the pattern of the group: deep pain in the low buttock beside the sit bone, at the back of the hip, and down the back of the thigh, worst sitting and with the hip turned. When piriformis treatment has helped and a lower, deeper ache remains, these are the muscles to check. They are sub-pages of the piriformis page.
Attachments and action
Origin: Quadratus femoris: the outer edge of the ischial tuberosity. Superior gemellus: the ischial spine. Inferior gemellus: the upper part of the ischial tuberosity.
Insertion: Quadratus femoris: the quadrate tubercle on the intertrochanteric crest of the femur. Gemelli: the tendon of the obturator internus, and through it the greater trochanter.
Action: External rotation of the hip; the quadratus femoris also adducts; all three steady the head of the femur in the socket.
Where the pain is felt: Deep in the low buttock beside the sit bone. At the back of the hip. Down the back of the thigh on the same side. Worst sitting, and turning the hip. Sometimes sciatic-like symptoms, from irritation of the nerve nearby.
Common causes: Long sitting, especially on a wallet or a hard seat; driving; cycling; a fall onto the buttock; running and kicking sports; a hip held turned out to protect a sore joint; the months after hip surgery.
Patients say: "Lower than the piriformis, right beside my sit bone." "Sitting is the worst." Pain down the back of my thigh that the hamstring work did not touch. "Turning my leg in the car sets it off."
When to get evaluated: Buttock or hip pain with a fall, an inability to bear weight, or a leg that looks shortened or turned needs an X-ray first. New numbness in the groin or inner thighs, loss of bladder or bowel control, or leg weakness that is getting worse needs urgent medical care. Deep hip pain with catching or locking, or in a young athlete, needs imaging before this muscle is treated.
How this muscle is examined and treated
Examination tests outward rotation against resistance with the hip bent and straight, then presses deep in the low buttock between the sit bone and the greater trochanter for the point that reproduces the familiar deep ache and the thigh pain, and checks for sciatic signs. Needling here addresses the muscles deep in the low buttock, below the piriformis, with the sciatic nerve's course respected. Assessment and treatment happen in the same visit.
Related conditions
Hip & Glute PainSciaticaChronic Pain Patterns
This page is educational. It describes muscle referral patterns commonly associated with pain; it does not diagnose your condition. Individual patterns vary. For evaluation of your specific pain, see a licensed clinician. Seek immediate medical care for emergencies. Eugene Baek, L.Ac. · New Jersey License 25MZ00080600