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Integrated functional anatomy of the gluteus maximus. Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Common activation exercises, subsystems, and strength exercises for the glutes.

Gluteus Maximus

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Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

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This course describes the anatomy and integrated function of the gluteus maximus muscle (a.k.a. glutes, glute max, gluteal muscles, buttocks). This muscle is the largest muscle of the human body (by mass), is composed primarily of type I muscle fibers, and crosses the hip joint and sacroiliac joint. The gluteus maximus is the primary hip extensor, may contribute to hip external rotation, and potentially hip abduction. This course also describes the influence of the gluteus maximus on sacroiliac joint and hip joint arthrokinematics, fascial integration (iliotibial band and thoracolumbar fascia), postural dysfunction, and subsystem integration. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the muscles of the gluteal region for the analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation (e.g. low back pain, sacroiliac joint pain, hip pain, knee pain, iliotibial band syndrome, and hip impingement syndrome, etc.) and gluteus maximus exercises and techniques for enhancing sports performance (e.g. lower body (leg) stability, strength, power, and hypertrophy training).

Brookbush Institute’s most recommended techniques for the Gluteus Maximus (see videos below):

Glute Bridge on Ball with Resisted Abduction

The gluteus maximus muscle in a cadaver dissection

 Course Description: Gluteus Maximus

Introduction

Introducing the Gluteus Maximus - Snippet from Functional Anatomy 1 at Rowan University

 "buttocks muscle," 1680s, from Modern Latin glutaeus, from Greek gloutos "the rump," in the plural, "the buttocks." (

 1740, from French maximum and directly from Latin maximum (plural maxima), neuter of maximus "greatest," which is superlative of magnus "great, large" (see 

The attachment and fascial connections of the gluteus maximus muscle

Attachment and Innervation

Attachment & Innervations: Gluteus Maximus

Relative Location

Location of the gluteal muscles on the posterior side of the body

Where is the Gluteus Maximus Located

Palpation

A cross-sectional view of the hip muscles including the gluteus maximus

Palpating the Gluteus Maximus

Introduction to the Gluteus Maximus

Actions

Lower fibers provide the greatest hip extension force (16).

The gluteus maximus is nearly twice the weight of the gluteus medius and minimus combined (8), is comprised of roughly 70% type I fibers and 30% type II fibers (8).

Note: despite being the strongest hip extensor, the gluteus maximus can only be called the "prime mover" when large amounts of force are required for hip extension, i.e. stair climbing, running, jumping, and squatting. The gluteus maximus is much less active during leisurely walking and standing; during these activities, more activity is noted in the 

, semitendinosus, and semimembranosus (8).

The gluteus maximus is a strong external rotator of the hip.

Upper fibers assist in abduction against considerable resistance, while the lower fibers contribute to horizontal abduction during considerable resistance (8).

The gluteus maximus will posteriorly tilt the pelvis and research has shown that cueing a posterior pelvic tilt may increase glute activity (18).

The gluteus maximus may be capable of sacroiliac nutation (a.k.a. sacral flexion) relative to posterior rotation of the pelvis (see Sacroiliac Joint Motion and Predictive Model of Dysfunction).

 The gluteus maximus assists in the stabilization of the hip, knee, SIJ, and potentially the lumbar spine  

Sacroiliac Joint: Superior fibers (horizontal orientation) provide the greatest compressive force at SIJ. The average maximum force calculated for fibers crossing the SIJ = 891N. Fibers of sacral origin contributed most to SIJ compression (35%) followed by fibers attaching to the sacrotuberous ligament (23.5%) and with an even split among the rest of the fibers. (16)

Knee: Roughly 67% of the gluteus maximus fibers insert into the iliotibial band and are capable of a cranially directed force (15). Although current research does not provide estimates of the percent contribution to knee stability, this attachment and the force on the ITB undoubtedly play a role.

Low Back: Fibers originating from the thoracolumbar fascia and erector spinae aponeurosis can produce an extension of the lower lumbar spine with a force of 4N with a maximum sagittal shear force of 59N (16). Although this may not result in significant motion, this may imply a role in stabilization.

Hip adduction, internal rotation, and flexion (functional knee valgus) - the inability to eccentrically decelerate this movement pattern is highly correlated with knee injury (19)

SI Joint Counter-nutation (a.k.a. sacral extension)

The gluteus maximus is the strongest hip extensor with synergistic contribution from the 

The gluteus maximus is a strong external rotator of the hip, along with the posterior fibers of the gluteus medius. Often these muscles become under-active, giving way to synergistic dominance of the piriformis, deep rotators, 

As mentioned above, fibers originating from the thoracolumbar fascia and erector spinae aponeurosis can produce extension of the lower lumbar spine with a force of 4N with a maximum sagittal shear force of 59N (16). This may imply a synergistic relationship with the multifidus and 

In a closed kinetic chain, the gluteus maximus can assist with knee extension and femur-on-tibia external rotation (tibial internal rotation) - this implies a complex synergistic relationship with the quadriceps, and the tibial internal rotators (semitendinosus, semimembranosus, sartorius, 

A Cadaver Dissection of the Gluteus Maximus

Gluteus Maximus Cadaver Dissection via http://www.rvuanatomy.com/index.html

Primary Mechanism of Propulsion and Deceleration:

The gluteus maximus is the prime mover for most functional activities that require you to quickly accelerate your body forward/up, overcome considerable resistance, and/or decelerate forward motion of the trunk. Thankfully, the gluteus maximus is the largest muscle in the human body with an impressive cross-sectional area (12.5% of lower body muscle mass (11)). The idea that the gluteus maximus plays such a large role in all functional movement patterns may come as a surprise, but only until you consider how important hip extension (and eccentric control of hip flexion) is to daily activity. Getting out of a chair, walking up stairs, squatting, running, jumping, and reducing force during the eccentric phase of each of these movement patterns requires immense hip extension torque and a tremendous amount of force production from the gluteus maximus. Whether, it is to overcome inertia, the force imparted by gravity, additional load, and/or reduce the additional force created by the momentum of your body mass the gluteus maximus is the primary mechanism of performance. During courses, I often ask the question "who would want a smaller butt?" If you want to jump higher, run faster, or stop on a dime, a smaller butt ain't gonna cut it.

How the Gluteus Medius Optimizes Gluteus Maximus Function:

Clinically I have noted that activating the gluteus medius will often improve gluteus maximus function, both during 

 and functional movement patterns. It is my hypothesis, that this at least in part, is due to the ability of the gluteus medius to maintain optimal alignment of the femur relative to the pelvis (x-axis = ASIS to ASIS, y-axis = ASIS to center of patella). Optimal alignment maintains the oblique fiber direction and optimal length/tension of the gluteus maximus, resulting in optimal production from force couples during hip extension. It has been my observation that optimal function of the gluteus medius is required for optimal performance of the gluteus maximus - and a more productive gluteus maximus will always lead to better performance.

Gluteus maximus contributing as the prime mover during sprints

Arthrokinematics

A cadaver dissection showing the gluteus maximus, tensor fascia latae, and gluteal fascia

Gluteus Maximus Actions

Fascial 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 nature's “motherboard.” 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.

Image of the fascial system of the body connecting muscles

Origin on the Thoracolumbar Fascia and Gluteal Aponeurosis

 - The gluteal aponeurosis is a thickening of the fascia extending from the posterior iliac crest to the gluteus maximus and part of the gluteus medius. The investment of the gluteus maximus and medius into this fascial sheath may reinforce the assertion made above that these muscles are recruited synergistically, perhaps in relation to tension created activating mechanoreceptors in this fascial tissue and providing sensory input to the central nervous system (CNS). The gluteus maximus (along with the gluteus medius and force transfer via the gluteal fascia) also plays a key role in creating tension in the thoracolumbar aponeurosis. This fascia runs continuous from the gluteus maximus, through the 

. This connection to the thoracolumbar fascia is unique in humans and assists in increased lumbar spine stability, force closure of the sacroiliac joint, and bi-directional load transfer between the trunk and lower extremities (16).

 The gluteus maximus attachment to the sacrotuberous ligament leads to a contradiction with an observation I made in a previous article regarding other muscles that attach to this ligament. The 

, and piriformis all have a propensity toward over-activity, whereas the gluteus maximus has a propensity toward under-activity. This leads to some confusion relative to the role of the sacrotuberous ligament in force transfer and recruitment of muscular synergies; more research is needed. The attachment of the gluteus maximus to the sacrotuberous ligament does, however, reinforce its role in sacroiliac joint motion and stability.

 - Most of the gluteus maximus inserts into one of the most complicated fascial structures; the iliotibial band (ITB) (17) (The role of which was is discussed in detail in the article 

.) The role of the gluteus maximus on the ITB is likely to create a posteriorly directed force that balances the anterior force created by of the 

, vastus lateralis, and anterior glide of the ITB during hip flexion. This may result in optimizing tension in the ITB and length/tension of muscles invested in the ITB resulting in more optimal synergistic patterns.

 Although this attachment lies between the origins of the vastus lateralis and 

, the gluteus maximus insertion into the gluteal tuberosity is fairly isolated. It is unlikely that the force generated has a large impact on the fascia or tendons of these close neighbors.

The fascial attachments of the glute muscles on the pelvis and leg

By Dr. Johannes Sobotta - Sobotta's Atlas and Text-book of Human Anatomy 1909, Public Domain, https://commons.wikimedia.org/w/index.php?curid=29822832

Subsystems

The posterior oblique subsystem including the gluteus maximus, latissimus dorsi, and thoracolumbar fascia

Behavior in Postural Dysfunction

 Several studies have demonstrated a relative decrease in activity and latent firing of the Gmax in the presence of sacroiliac joint pain, knee valgus, and an anterior pelvic tilt (20, 21, 22), with a coinciding dominance/over-activity of the 

 (21, 22). Two studies have attempted to better activate the 

 while reducing the activity of over-active synergists (

 this muscle does not play a significant role. Occasionally, a loss of shoulder range is related to over-activity and adaptive shortening of the 

 related to Sacroiliac Joint Dysfunction (SIJD) or Lumbo Pelvic Hip Complex Dysfunction (LPHCD) in which case altered gluteus maximus activity may be playing a role. However, in these individuals, intervention should be focused on improving LPHCD and SIJD. In essence, the “upper body dysfunction” in these individuals is a distraction from the root issue of LPHC dysfunction.

 the gluteus maximus plays a lesser role than the gluteus medius, but is still significant and will require attention. A decrease in gluteus maximus (and gluteus medius) activity may result in excessive femoral internal rotation and adduction (functional knee valgus or "knees bow in") resulting in dyskinesis of the hip and knee. This is often paired with over-activity of the tibial external rotators and/or the 

. In a variation of the commonly seen “knees bow in” dysfunction, “knees bow out” masks the weakness of gluteus maximus and medius. Don’t be fooled – the knees bowing out is the result of synergistic dominance by the piriformis, 

, and post-release and lengthening techniques for these over-active structures, the gluteus maximus, and medius will still require attention.

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

 this gluteus maximus plays its most significant role. In the most common presentations of these dysfunctional patterns the pelvis rotates anteriorly, the sacrum often counter-nutates, and the femur is relatively flexed and internally rotated (note this may be unilateral in SIJD). As mentioned above, research has noted that adopting these compensatory movement patterns will result in decreased gluteus maximus activity (20, 21, 22). Increasing neural drive to the gluteus maximus is essential to correcting these dysfunctions, although it is most often necessary to start with a release, lengthening, and mobilization techniques.

In short, the gluteus maximus is prone to under-activity and adaptive lengthening and should be addressed with isolated activation, core, reactive activation, and integration techniques. For more on gluteus maximus activation see the videos below or review "

Signs of Altered Length Tension

The gluteal trigger points of the body

Signs of Altered Length/Tension and Tone: 

Postural Dysfunction and the Gluteus Maximus

Techniques and Ending Info

Prone Hip Extension

Gluteus Maximus and TVA Integrated Activation

Quick Glute Activation Progression

Resisted Side-stepping

Resisted Side-stepping Progressions

Exercises and Techniques for the Gluteus Maximus

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach

NASM Essentials of Corrective Exercise Training

NASM Essentials of Personal Training: 4th Edition

Diagnoses and Treatment of Movement Impairment Syndromes,

David G. Simons, Janet Travell, Lois S. Simons, 

Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 2. Lower Half of Body: Second Edition

Joint Structure and Function: A Comprehensive Analysis: Fifth Edition

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Manipulative Therapy: Musuloskeletal Medicine

Carolyn Richardson, Paul Hodges, Julie Hides. 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

Gibbons, S.G.T. (2004) The anatomy of the deep sacral part of the gluteus maximus and the psoas muscle: A clinical perspective. Proceeds of: The 5th Interdiciplinary World Congress on Low Back Pain. November 7-11, Melbourne, Australia.

Barker, PJ., Hapuarachchi, K.S., Ross, J.A., Sambaiew, E., Ranger, T.A., and Briggs, C.A. (2013). Anatomy and biomechanics of gluteus maximus and the thoracolumbar fascia at the sacroiliac joint. Wiley Online Library. DOI: 10.1002/ca.22233

Stecco, A., Gilliar, W., Hill, R., Fullerton, B., Stecco, Carla. (2013). The anatomical and functional relation between gluteus maximus and fascia lata. 

Journal of Bodywork & Movement Therapies.

Queiroz, BC., Cagliari, MF., Amorim, CF., Sacco, IC. Muscle Activation During Four Pilates Core Stability Exercises in Quadruped Position. Arch Phys Med Rehabil 2010;91:86-92.

Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., & Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. 

Hungerford, B., Gilleard, W., Hodges, P. (2003) Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine 28(14), 1593-1600

Padua, D. A., Bell, D. R., & Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. 

Tateuchi, H., Taniguchi, M., Mori, N., Ichihashi, N. Balance of hip and trunk muscle activity is associated with increased anterior pelvic tilt during prone hip extension (2013) 

Journal of Electromyography and Kinesiology

Selkowitz, D. M., Beneck, G. J., & Powers, C. M. (2013). Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? electromyographic assessment using fine-wire electrodes. journal of orthopaedic & sports physical therapy, 43(2), 54-64

Kan, S., Jeon, H., Kwon, O., Cynn, H., Choi, B. (2013). Activation of the gluteus maximus and hamstring muscles during prone hip extension with knee flexion in three hip abduction positions. 

Bibliography

Questions, comments, and criticisms are welcome and encouraged

Gluteus Maximus

Related Courses:

Course Description: Gluteus Maximus

Introduction to the Gluteus Maximus
3 Sub Sections

Gluteus Maximus Actions
1 Sub Section

Fascial Integration
1 Sub Section

Postural Dysfunction and the Gluteus Maximus
1 Sub Section

Exercises and Techniques for the Gluteus Maximus
5 Sub Sections

Bibliography

Related Courses:

Comments

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Gluteus Maximus

Related Courses:

Course Description: Gluteus Maximus

Introduction to the Gluteus Maximus3 Sub Sections

Gluteus Maximus Actions1 Sub Section

Fascial Integration1 Sub Section

Postural Dysfunction and the Gluteus Maximus1 Sub Section

Exercises and Techniques for the Gluteus Maximus5 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Introduction to the Gluteus Maximus
3 Sub Sections

Gluteus Maximus Actions
1 Sub Section

Fascial Integration
1 Sub Section

Postural Dysfunction and the Gluteus Maximus
1 Sub Section

Exercises and Techniques for the Gluteus Maximus
5 Sub Sections