The obturator internus muscle can be a source of chronic pelvic pain and dysfunction. When this muscle becomes tight or develops trigger points, it can cause deep, persistent discomfort that is often misdiagnosed. An internal myofascial release technique targets this deep muscle to alleviate tension and restore function, offering relief from symptoms that traditional treatments may not address. Addressing this muscle is often necessary in a comprehensive pelvic pain management strategy.
Anatomy and Function of the Obturator Internus
The obturator internus muscle is situated deep within the pelvic cavity, covering the internal surface of the obturator foramen in the hip bone. It originates from the inner wall of the pelvis and attaches to the greater trochanter on the femur. This positioning allows the muscle to act as both a deep hip rotator and a functional component of the pelvic floor.
Its primary role is to laterally rotate the hip and assist in hip abduction when the hip is flexed. It works with other deep hip rotators to stabilize the hip joint and control the position of the femoral head during movement. Because of its close fascial connection to the pelvic floor muscles, tension in the obturator internus can directly influence the function and tone of the entire pelvic floor. The muscle can become tight due to factors like chronic sitting, trauma, or compensatory movement patterns resulting from hip or back issues.
Symptoms of Obturator Internus Tightness
Tightness or dysfunction in the obturator internus causes deep, aching pain in the pelvis or buttock area. This discomfort is often localized around the ischial tuberosity, or “sit bone,” making it painful to sit for extended periods. The muscle’s relationship with nearby nerves can lead to referred pain patterns that mimic other conditions.
The obturator internus fascia forms Alcock’s Canal, which encases the pudendal nerve. When the muscle is tight (hypertonic), it can compress this nerve, causing pudendal neuralgia symptoms like shooting, burning, or stabbing pain in the genitals, perineum, or anus. This tightness can also cause pain during sexual activity (dyspareunia). Because the obturator internus tendon is near the sciatic nerve, its contracture can cause pain that radiates down the back of the leg, often misdiagnosed as sciatica.
Step-by-Step Guide to Internal Release
Professional Release
Internal release of the obturator internus is a targeted myofascial technique that relieves tension and trigger points deep within the muscle belly. This procedure is most safely and effectively performed by a licensed Pelvic Floor Physical Therapist (PFPT) who accesses the muscle through the vaginal or rectal wall. The therapist applies slow, sustained pressure, often asking the patient to perform gentle movements or breathing exercises to facilitate the release. This professional approach ensures correct anatomical targeting and appropriate pressure modulation for safety.
Self-Release Using a Pelvic Wand
For those advised to perform self-treatment, internal release may be possible using a specialized pelvic wand. The wand should be cleaned and lubricated before careful insertion into the vagina or rectum, based on the therapist’s instruction. The user guides the tip toward the side of the pelvic wall, angling it slightly outward to locate the obturator internus, which feels like a taut, tender band of tissue.
Once the tender point is located, gentle, sustained pressure is applied, aiming for a discomfort level no higher than three out of ten on a pain scale. The pressure should be held for five to ten seconds while maintaining deep, relaxed breathing to encourage the muscle to lengthen and release. Prioritize hygiene by cleaning the wand before and after each use to prevent infection. This self-administered technique should only be attempted after assessment and training with a PFPT.
Supportive Care and Safety Considerations
Internal release is typically one component of a broader treatment plan for obturator internus dysfunction, not a standalone solution. Complementary external techniques support the internal work and maintain muscle flexibility. External hip stretches, such as the figure-four stretch or the 90/90 stretch, target the deep hip rotators and help lengthen the obturator internus indirectly. These stretches should be performed gently, focusing on a deep stretch in the hip or gluteal region, and held for at least 30 seconds to promote tissue change.
Safety is paramount, and internal release is not appropriate for everyone. Contraindications include:
- Active vaginal or rectal infection.
- Acute pelvic injury.
- Certain stages of pregnancy.
Anyone with recent pelvic surgery or acute, unexplained pelvic pain should consult a physician before attempting internal work. Supportive care involves strengthening supporting muscles and improving postural habits. A physical therapist can also guide the incorporation of breathing techniques and core stabilization exercises, which help the entire pelvic girdle function more efficiently. Long-term relief relies on integrating the release work with a home exercise program designed to improve muscle coordination and prevent the obturator internus from becoming overactive again.