Gluteus Maximus - Evidence for its Multitasking Functional Roles

on Monday, 10 February 2014. Posted in Blog

This blog discusses the multitasking Roles of Gluteus Maximus and is a summary of a presentation that I gave at the Kinetic Control Movement Therapist (KCMT) day in November 2013.

 

 If we examine the:

·         1.  Anatomy and Structure

·         2. Biomechanical Potential

·         3. Neurophysiology

·         4.  Changes in Dysfunction

 

of any particular muscle, we can understand it’s role in function (Comerford & Mottram, 2012 p. 29).

 

This article will review the literature and examine each of these features for each portion of Gluteus Maximus.

The evidence will support that Gluteus Maximus has 3 distinct portions, each with a different functional role.

 

1.       The Anatomy and Structure of Gluteus Maximus

 

Classic texts such as ‘Gray’s, Grant’s and Clinically Oriented Anatomy’ describe Gluteus Maximus as having 2 layers.


Fig 1. Attachments of Gluteus Maximus

 

 

Both arising from the posterior gluteal line of the illium, the sacrum and side of the coccyx (pictured in dark green) on figure 1 with the deeper more distal fibres inserting into the gluteal tuberosity – (pictured on the femur in light green).

The more superficial fibres insert into the illiotibial band (ITB) as pictured below:

 

Fig 2. Relations to the ITB (note the insertions of Superficial Gluteus Maximus).

 

However a dissection study by Gibbons and Mottram (2004) found a 3rd layer situated deep to the previous 2 described with short fibres that cross the sacroiliac joint (SIJ) and have relations with multifidus, the deep hip intrinsics and the pelvic floor.

 

2.       The Biomechanical Potential

 

The anatomy of this third deepest layer – often termed Deep Sacral Gluteus Maximus (DSGM) suggests a functional role in local stability, as its short fibres are situated across the SIJ with the biomechanical potential to control joint translation.

 

The deep distal fibres (the deep illium portion) appear to be suited to a global stabilising role as its broad, obliquely oriented fibres have the biomechanical potential to decelerate flexion and medial rotation at the hip.

 

Whereas the superficial layer via it’s attachment to the ITB has a long, multi-joint lever; suggesting a global mobiliser role , suited to power and force generation.

 

3.       Neurophysiology

Few studies look at the various portions of Gluteus Maximus. Rather, most compare the muscle as a single unit to other muscles such as the biceps femoris to look at timing sequences.

However one pilot study reported in a text (Gibbons et al 2004) examined each layer of the Gluteus Maximus using fine wire EMG. It was found that the deepest layer fired independent of direction, further lending weight to it having a local stabiliser role.

 

4.       Changes in Dysfunction

 

Changes in Gluteus Maximus were reported to occur in pain and dysfunction - these included

—  Timing delays

—  A shorter duration of firing

—  Earlier offset

—  Reduced activity (%MVC)

—  Substitution strategies

 

The table below outlines the various findings

Study

Condition

Task

Finding

Gibbons et al (2003)

(pilot study)

History of low back pain (LBP)

DSGM Activation

Increased Rectus Femoris & Biceps Femoris (BF) activity in subjects with a LBP history

 

Hungerford et al. (2003)

SIJ Pain

Contralateral hip flexion

Glut Max delay on the side of pain in SIJP subjects

compared with their unaffected side and compared with controls.

BF also fired more throughout

 

Bullock Saxton (1994)

History of severe unilateral ankle sprain.

 

Hip extension in prone

 

Gluteus Maximus delay both sides

Correlated with reduced vibration threshold

 

Webster & Gribble (2013)

Chronic ankle instability

Rotational Squat

 

Reduced Glut Max (%MVC)

 

Smith et al (2013)

Achilles Tendinopathy

 

Running

 

Delay in onset, Shorter Duration, Early Offset

 

Grimaldi et al (2008)

Mild and advanced hip OA

 

Muscle Volume measures taken (MRI)

1.       Upper Glut Max (UGM)

2.       Lower Glut Max (LGM)

3.       TFL

 

UGM and LGM were smaller on the affected side

But UGM asymmetry was due hypertrophy on the unaffected side (as compared with matched controls)

Whereas LGM asymmetry was due to atrophy on the affected side – as evidenced by fat atrophy commonly found in LGM but not in UGM

 

 

Taken together, these findings suggest that the different portions of Gluteus Maximus behave differently in dysfunction. The DSGM and illium portions down regulate and the superficial portion upregulates; lending further support to the functional divisions of this muscle.

 

In summary, the available evidence supports that Gluteus Maximus has 3 distinct portions, each with a different functional role:

 

1.    The DSGM has the following properties:

·         Deepest, one joint layer

·         Short fibres biomechanically suited to control translation

·         Direction independent activation

·         Down regulates in dysfunction

Which supports its role as local stabiliser(Mottram & Comerford, 1998)

2.   

2. The Deep Illium Portion has the following properties:

·         One joint,

·         Broad aponeurotic insertions

·         Biomechanically suited to generates force to control range of motion

·         Down regulates in Dysfunction

Which supports its role as a global stabiliser (Mottram & Comerford, 1998)

 

3.    The Superficial Gluteus Maximus has the following properties:

·         Superficial layer

·         longer lever, multi-joint

·         Biomechanically suited to leverage for range and speed

·         Up regulates in dysfunction

Which supports its role as a global mobiliser (Mottram & Comerford, 1998)

 

References

Agur, A.M.R. & Dalley, A.F. (eds.) Grant’s Atlas of Anatomy .12th Edition. USA: Lippincot Williams & Wilkins.

Bullock-Saxton, J.E. (1994). Local sensation changes and altered hip function following severe ankle sprain. Physical Therapy. 74(1): 17-31.

Comerford, M. & Mottram, S. (2012). Kinetic Control: The Management of Uncontrolled Movement. Australia: Elsevier.

Comerford, M.J. & Mottram, S.L. (2001). Movement and stability dysfunction - contemporary developments. Manual Therapy. 6(1): 15-26.

Gibbons, S. (2007). Clinical anatomy and function of psoas major and deep sacral gluteus. In: Vleeming, A., Mooney, V. & Stoeckhart, R. (eds.) Movement, Stability & Lumbopelvic Pain: Integration of Research and Therapy. 2nd EditionUSA: Churchill Livingstone Elsevier.

Gibbons, S.G.T. & Mottram, S.L.(2004). Functional anatomy of gluteus maximus: deep sacral gluteus maximus - a new muscle? In: Proceedings 5th International World Congress on Low Back and Pelvic Pain, Melbourne, Australia 7-11th November.

Grimaldi, A., Richardson, C, Durbridge, G., Donnelly, W., Darnell, R. & Hides, J. (2009). The association between degenerative hip joint pathology and size of the gluteus maximus and tensor fascia lata muscles. Manual Therapy. 14: 611–617.

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

Moore, K.L., Dalley, A.F. & Agur, A.M.R. (eds.) (2010). Clinically Oriented Anatomy.6th Edition. USA: Lippincot Williams & Wilkins.

Mottram, S. & Comerford, M. (1998). Stability dysfunction and low back pain. The Journal of Orthopaedic Medicine. 20(2): 13-18.

Smith MM, Honeywill C, Wyndow N, Crossley KM, Creaby MW (2013). Neuromotor control of

gluteal muscles in runners with achilles tendinopathy. Med Sci Sports Exerc. 2013 Oct 10. 

Standring, S. (ed.), Borley, N.R., Collins, P., Crossman, A.R., Gatzoulis, M.A., Healy, J.C., Johnson, D., Mahadevan, V., Newell, R.L.M. & Wigley, C.B. (2008). Gray’s Anatomy. 40th Edition. U.K. Churchill Livingstone Elsevier.

Webster, K. & Gribble, P. (2013). A comparison of electromyography of gluteus medius and maximus in subjects with and without chronic ankle instability during two functional exercises. Physical Therapy in Sport. 14: 17-22.

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