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Tuesday, June 6, 2023

Gluteus Minimus

Brent Brookbush

Brent Brookbush

DPT, PT, MS, CPT, HMS, IMT

Human Movement Science & Functional Anatomy of the:

Gluteus Minimus

by Brent Brookbush MS, PES, CES, CSCS, ACSM H/FS

Gluteus Minimus - Anatomography

By Any Other Name:

  • "TFL's Nasty Cousin" - Despite being associated with the gluteal muscles, the gluteus minimus has more in common with the Tensor Fasciae Latae .

Gluteus Minimus:

  • Origin: External surface of the ilium, between the anterior and inferior gluteal lines and margin of the greater sciatic notch (11).
  • Insertion: Anterior border of the greater trochanter of the femur and hip joint capsule (11).
    • The gluteus minimus is the deepest of the gluteal muscles, lying on the external surface of the ilium and being enveloped by the gluteus medius superficially.
      • Due to the depth of the gluteus minimus it cannot be easily palpated or easily differentiated from the overlying gluteus medius. You may attempt to palpate the overlying gluteus medius and sinking your fingers deeper into this tissue will undoubtedly place your fingers within the fibers of this musculature. If you place your thumb on the PSIS (Posterior Superior Iliac Spine) and your index finger just posterior to the ASIS (Anterior Superior Iliac Spine), and with your other hand, find the bony protuberance that is your greater trochanter (a few inches below the iliac spine) - you will create the shape of a piece of pie between your fingers. This "piece of pie" outlines the gluteus medius. Palpating the area you can feel the density of this muscle and the density of the muscle just below, the gluteus minimus. By cuing abduction, internal rotation and external rotation you can feel various fibers contract under your fingers (12). Regardless of whether you can differentiate between the gluteus medius and minimus under nomral conditions, trigger points in gluteus minimus are common and may develop and be felt in the area just superior to the greater trochanter and inferior the iliac crest (along the mid axllary line).
  • Nerve: Superior gluteal nerve via the sacral plexus and originating from nerve roots L4 - S1 (3).
  • Action: Hip internal rotation (may be the primary internal rotator of the hip), abduction and flexion (2).

Gluteus muscles
https://en.wikipedia.org/wiki/Gluteal_muscles

Integrated Function:

Stabilization:

  • * * The gluteus minimus stabilizes the hip and may play a role in reinforcing the anterior capsule.

Eccentrically Decelerates:

  • * * The gluteus minimus eccentrically decelerates hip adduction, extension and external rotation.

* The gluteus minimus eccentrically decelerates depression of contralateral innominate (a.k.a. positive Trendelenberg Sign).

Synergists:

  • * * The gluteus minimus may play a small role as a synergist of hip flexion, although I doubt that this muscle contributes much to hip flexion torque. This muscle likely plays a larger role as a neutralizer of the adductor moment created by the anterior adductor muscles , specifically the pectineus (the pectineus playing a larger role in hip flexion than other adductor muscles via innervation by the femoral nerve).

* The gluteus minimus is a synergist to the abductor muscles ([Gluteus Medius](https://brentbrookbush.com/online-courses/articles/muscular-anatomy/gluteus-medius/ "Gluteus Medius") and [Tensor Fasciae Latae](https://brentbrookbush.com/online-courses/articles/muscular-anatomy/tensor-fascia-latae-tfl/ "Tensor Fasciae Latae (TFL)")) contributing roughly 20% of the cross-sectional mass of the abductors (3). The primary abductor of the hip is the [gluteus medius](https://brentbrookbush.com/online-courses/articles/muscular-anatomy/gluteus-medius/ "Gluteus Medius") contributing roughly 60% of the total cross-sectional area to the abductors (3); however, this does not consider the altered movement patterns seen in those individuals exhibiting postural dysfunction.  As noted above the gluteus minimus can perform the same actions as the [TFL](https://brentbrookbush.com/online-courses/articles/muscular-anatomy/tensor-fascia-latae-tfl/ "Tensor Fasciae Latae (TFL)") and most often behaves similarly.  The TFL and gluteus minimus often become synergistically dominant for an under-active, weak, or inhibited gluteus medius.  Unfortunately the gluteus minimus is often forgotten in corrective, exercise, and/or treatment programs.

* An interesting relationship may exist between the gluteus minimus and [rectus femoris](https://brentbrookbush.com/online-courses/articles/muscular-anatomy/rectus-femoris/ "Rectus Femoris"). Although I could not find a single picture or reference, both of these muscles have attachments to the anterior capsule.  This may indicate a synergistic relationship for the purposes of reinforcing the anterior capsule, and/or increasing tension in the anterior capsule to prevent impingement during flexion.

Subsystems:

Arthrokinematics:

Hip: The gluteus minimus plays a large role in compression of the hip, only second in contribution of compression force to the gluteus medius  (3). The gluteus minimus may also contribute to an anterior rotary force and superior and anterior migration of the femoral head, along with the TFL .

Facial Integration:

  • * * My Fascial Hypothesis: Large fascial sheaths not only play a role in the transmission of mechanical force, but may also play a role in dictating the function of muscular synergies. This is likely caused by reducing or increasing tone of invested musculature via reflex arcs formed between mechanoreceptors embedded in the connective tissue and the attached musculature. In this way my view of fascia differs slightly from noted expert on the subject Tom Myers. I think of these large fascial sheaths (specifically the thoracolumbar fascia, iliotibial band, and abdominal fascial sheath) as natures "mother board." A place for mechanical information to be communicated to the nervous system for more efficient recruitment of the muscular system. Despite having a slightly different philosophy it does not change the fact that fascia plays an important communicative role in the human body and we have Tom Myers to thank for his work.

Fascial Integration of the Gluteus Minimus:

  • * * Insertion and investment into the anterior capsule - An interesting relationship may exist between the gluteus minimus and rectus femoris. Both the rectus femoris and gluteus minimus invest in the anterior capsule and potentially he ischiofemoral ligament. This may indicate a synergistic relationship for the purposes of reinforcing the anterior capsule and ischiofemoral ligament, and/or increasing tension in the anterior capsule to prevent impingement during flexion. As I could not find a reference to this relationship, further study is needed to determine whether fascial congruity exists between these attachments and whether hip motion results in similar changes in muscle activity. In practice, I have noted that those with hip impingement syndrome often exhibit shortening, over-activity and trigger point development in these two muscles and release and lengthening techniques often results in improvement.

* Origin on the Greater Trochanter - The attachments of the gluteus minimus, [gluteus medius,](https://brentbrookbush.com/online-courses/articles/muscular-anatomy/gluteus-medius/ "Gluteus Medius") [piriformis](https://brentbrookbush.com/online-courses/articles/muscular-anatomy/piriformis/ "Piriformis"), and vastus lateralis have distinct borders on the greater trochanter, but all invest in the periosteum and lay adjacent to one another.  Further consideration into the relationship between these muscles may be worthy of further study.  To view this relationship yourself check out this link to a wonderfully written study - [Greater Trochanter](http://www.sciencedirect.com/science/article/pii/S0749806307010882 "Pics of GT")

Gmin = Gluteus Minimus - Note how the tendon blends with the ischiofemoral ligament - http://files.abstractsonline.com

Behavior in Postural Dysfunction:

**This muscle has a tendency toward *adaptive shortening and over-activity.*** Due to the propensity towards a decrease in length and an increase in activity, the gluteus minimus is generally released and stretched (exercises below). Note that stretching the gluteus minimus is generally accomplished using hip flexor stretches with the same modifications used to target the TFL .

  • In Upper Body Dysfunction (UBD)  this muscle does not play a significant role. Occasionally, a loss of shoulder range is related to over-activity and adaptive shortening of the latissimus dorsi  related to Sacroiliac Joint Dysfunction (SIJD ) or Lumbo Pelvic Hip Complex Dysfunction and this may result in glutues minimus involvement, however, this is not true UBD. In essence, this scenario would be LPHC or SIJD dysfunction masquerading as UBD.
  • In Lower Leg Dysfunction (LLD)  this muscles play its most significant role. In the most common presentation of lower leg dysfunction their is inability to eccentrically decelerate femoral internal rotation and tibial external rotation ("knees bow in" during the Overhead Squat Assessment) . This implies over-activity of the femoral internal rotators including gluteus minimus. In essence, the adductors and gluteus minimus become short/overactive along with the Tibial External Rotators and the Deep Longitudinal Subsystem (DLS) .
  • In Lumbo Pelvic Hip Complex Dysfunction (LPHCD) the gluteus minimus muscle adaptively shortens, resulting in over-activity along with the hip flexor musculature.
  • In Sacroiliac Joint Dysfunction (SIJD)  the gluteus minimus may become short and over-active in the side opposite the sacral dysfunction, as this generally results in an anteriorly rotated innominate.

In short, these muscles should be considered wen selecting release techniques for LLD, LPHCD, and SIJD dysfunction, and it is worth noting that this may be an affected structure during hip flexor stretching.

May Contribute to the Following Impairments:

  • Knee Pain
    • Patellar tendonitis (Jumper's Knee)
    • Lateral knee pain (Runner's Knee)
    • Iliotibial band syndrome
    • Hamstring tendonitis
    • Generalized knee pain
  • Sacroiliac Joint Pain and Dysfunction
  • Hip Pain
    • Impingement Syndrome
    • Ischial tuberosity bursitis
    • Generalized hip pain
  • Lumbar spine pain
    • Excessive lordosis
    • Functional scoliosis
  • Lateral shift of lumbar spine
  • Ankle/Foot Pain
    • Ankle sprain
    • Ankle impingement
    • Achilles tendonitis
    • Plantar fasciitis

Signs of Altered Length/Tension and Tone:

  • Overhead Squat:
    • Knees Bow In: Short/Overactive
    • Anterior Pelvic Tilt: Short/Overactive
    • Excessive Forward Lean: Short/Overactive
    • Asymmetrical Weight Shift: Short/Overactive
  • Goniometric Assessment
    • Limited Internal Rotation at Hips: < 45°

Exercises involving the Gluteus Minimus:

Gluteus Minimus Self-Administered Release:

Static Hip Flexor Stretch (Note: the TFL variation would be effective for addressing Gluteus Minimus dysfunction)

Active Hip Flexor Stretch (Note: the TFL variation would be effective for addressing Gluteus Minimus dysfunction - trunk rotation toward forward leg)

Dynamic Hip Flexor Stretch (Note: the TFL variation would be effective for addressing Gluteus Minimus dysfunction - trunk rotation toward forward leg)

Bibliography:

  • * 3. Phillip Page, Clare Frank , Robert Lardner , Assessment and Treatment of Muscle Imbalance: The Janda Approach © 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner

6. Dr. Mike Clark & Scott Lucette, “_NASM Essentials of Corrective Exercise Training_” © 2011 Lippincott Williams & Wilkins

9. Donald A. Neumann, “Kinesiology of the Musculoskeletal System: Foundations of Rehabilitation – 2nd Edition” © 2012 Mosby, Inc.

12. Michael A. Clark, Scott C. Lucett, _NASM Essentials of Personal Training: 4th Edition_, © 2011 Lippincott Williams and Wilkins

15. Leon Chaitow, _Muscle Energy Techniques: Third Edition_, ©&nbsp;Elsevier 2007

18. Tom Myers, _Anatomy Trains: Second Edition_. © Elsevier Limited 2009

21. Shirley A Sahrmann, _Diagnoses and Treatment of Movement Impairment Syndromes,_ © 2002 Mosby Inc.

24. David G. Simons, Janet Travell, Lois S. Simons, _Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition_,© 1999 Williams and Wilkens

27. Cynthia C. Norkin, D. Joyce White, Measurement of Joint Motion: A Guide to Goniometry – Third Edition. © 2003 by F.A. Davis Company

30. Cynthia C. Norkin, Pamela K. Levangie, _Joint Structure and Function: A Comprehensive Analysis: Fifth Edition_ © 2011 F.A. Davis Company

33. Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani__,_ Muscles: Testing and Function with Posture and Pain: Fifth Edition © 2005 Lippincott Williams & Wilkins_

36. Andrew Biel, Trail Guide to the Human Body: 4th Edition,&nbsp;© 2010

39. Carolyn Richardson, Paul Hodges, Julie Hides.&nbsp; Therapeutic Exercise for Lumbo Pelvic Stabilization - A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004

42. Craig Liebenson, Rehabilitation of the Spine: A Practitioner's Manual, (c) 2007 Lippincott Williams & Wilkins

45. Stuart McGill, Low Back Disorders: Second Ediction&nbsp;© 2007 Stuart M. McGill

48. Robert Schleip, Thomas W. Findley, Leon Chaitow and Peter A. Huijing. &nbsp;Fascia: The Tensiona Network of the Human Body. &nbsp;(c) 2012 Elsevier Ltd.

© 2013 Brent Brookbush

Questions, comments, and criticisms are welcome and encouraged.

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