Table 2.

Referred Pain Patterns: Trunk and Thigh Muscles

Muscle	Referral Pattern	Patient Complaint
Rectus abdominis	Bilateral symptoms across upper or lower back, precordial pain/ fullness, nausea/vomiting	Urinary urgency/ frequency, bladder pain, perineum pain, buttock pain, iliosacral, back pain
External abdominal oblique	“Heartburn” symptoms, Groin, genital pain	Belly pain
Internal abdominal oblique	Groin, genital pain, lower quadrant abdominal pain	Pelvic pain
Transversus abdominis	Groin, genital pain, lower quadrant abdominal pain	Belly pain, pelvic pain
Pyramidalis	Pain bladder, urethra, pubic bone, SIJ, buttock, hip	SIJ, buttock, hip pain especially with sitting and standing
Iliopsoas	Ipsilateral spine from thoracic region to sacroiliac/upper buttock; anterior thigh/groin	Inguinal pain
Quadratus lumborum	SIJ, lower buttock, iliac crestanteriorly; lower abdomen, groin, greater trochanter	Belly pain, back pain, buttock pain
Gluteus maximus	Local to buttock, superior to sacrum, inferior to uppermost ipsi posterior thigh	Sitting bone pain, perineum pain, iliosacral pain
Gluteus medius	Posterior crest ipsi ilium, sacrum, post/lat ipsi buttock and upper thigh	Pain with walking or supine lying, ipsilateral sidelying, slumped sitting, SIJ/back pain
Gluteus minimus	Lower lateral buttock, lateral aspect thigh, knee into ankle or see similar pattern more posteriorly	Sit to stand
Hip adductors: adductor longus, adductor brevis, adductor magnus, gracilis	Deep pelvic pain, groin, medial thigh, knee, & shin pain	Tenderness in any of the referred pain zones, pelvic pain
Hamstrings: biceps femoris, semitendinosus, semimembranosus	Lower buttock, ischial tuberosity, posterior/medial or posterior/lateral thigh to posterior knee to calf	Pain after prolonged sitting or walking, possible sleep disruption, “pseudo” sciatica

Note. For more information about referred pain patterns in the thigh and trunk muscles see Itza et al., 2010; Simons & Travell, 1999b; Wise & Anderson, 2010.