Therapist Notes include:
Anatomy review,
Syndromes and Conditions,
Assessment notes,
Treatment Preparation,
NMT protocols and more…
Overview
Here, you will find massage and bodywork notes for the gluteus maximus muscle. This includes treatment sequencing, craniosacral, joint mobilizations, and detailed trigger point work. Also, there are links to self-care and stretching for your patient.
Musculoskeletal Anatomy
This post on anatomy contains the standard information about origin, insertion, function, and innervation. It also includes information on functional considerations and anomalies. This is also the place to find all posts related to this muscle.
Assessment
Gluteus maximus can restrict the range of motion when flexing the knee while flexing and adducting the hip. This restriction, combined with a matching referral pattern, indicates the specific trigger point.
Range-of Motion Test
This is the classic range of motion test for the gluteus maximus muscle. Typically, the practitioner directs the knee toward the opposite costal cartilage. Changing the angle to be a bit more lateral or superior can help to single out the taut fibers.
Gluteus maximus refers mostly to the buttock where many other trigger points refer. The trigger points of the gluteus maximus have overlapping referrals. Distinguished the GMax trigger points from the referral of other gluteus maximus trigger points, gluteus medius, gluteus minimus, piriformis, quadratus lumborum, sacral multifidi, lumbosacral multifidi, medial hamstring, iliacus, iliocostalis lumborum, longissimus thoracis, and soleus. Because of the complexity of overlapping patterns, pelvic balancing, releasing displaced local joints, and
releasing immobile lumbar vertebrae is important before direct treatment.
It is important to note that the gluteus maximus crosses the knee joint. Therefore, knee problems perpetuate tension in the GMax. Addressing lumbar displacement sacroiliac joint displacement and trigger points in the piriformis is important for restoring nerve function. Gluteus maximus has primary trigger points for several reasons. Blunt trauma as when falling on the hip, receiving a blow to the buttock, or receiving
an injection is common. Sitting on chilled surfaces creates primary trigger points. The body tightens hip muscles to create heat for the pelvis making gluteal trigger points more prevalent in cold weather.
Integrative Treatment Sequencing
Integrative CranioMuscular
Two of the three global SBS patterns in the typical postural distortion impact the left gluteus maximus. These show impressive, lasting improvements with craniostructural releases.
Right Torsion Pattern
As noted in the typical pattern, the left gluteus maximus is flatter and less developed than the right GM at the gluteal fold. Therefore, it tests as weak in the typical pattern. Hancock indicated that this is part of the right torsion pattern and should be addressed first in his structural protocol. Direct technique, using the left torsion release with walk-through releases trigger points in the left gluteus maximus.
Right Lateral Strain
Even after the structural left torsion technique, the left gluteus maximus remains restricted in the range of motion. Using the left lateral strain release with walk-through, direct technique releases these other trigger points in the left gluteus maximus.
Functional Organization
Occasionally, these trigger points arise in the right gluteus maximus. Typically, they release with Functional Organization.
Pelvic Balancing
Pelvic imbalance perpetuates trigger points in the gluteus maximus. There are two patterns that are particularly impacting:
- The GMax weakens, is more flacid and develops trigger points when the os coxae rotates anteriorly. The Integrative CranioMuscular releases that are listed above can resolve this. However, most therapists prefer blocking or muscle energy techniques.
- The GMax is also restricted in its range-of-motion when the os coxae shears anteriorly on the sacrum. Again, the Integrative CranioMuscular releases that are listed above can resolve this. However, the pelvic shear mobilization is quicker and simpler. On the other hand, the craniostructural releases are longer lasting and resolve other dysfunctions.
As usual, use the pelvic balancing approach that fits with your technique.
Local Joints
After pelvic balancing, make sure that the hip joint is free of restrictions. Often, the femur is anterior in the acetabulum. Then, you can use direct technique or the Leg Slap. The Leg slap is easier to implement, evaluate, and resolves some other joint restrictions.
Detailed Trigger Point Work
This protocol from The Workbook of Classical Neuromuscular Therapy is a more complete treatment of all the gluteals. I’ve taught this routine many times. Here are a few pointers:
- Every student remarks that it is more effective directly on the skin than through clothing. However, it can be done either way to accommodate the patient.
- If you’ve identified the specific trigger point pattern, focus on the fibers in that area.
- If the trigger points are resistant to release, rebalance the pelvis, use heat or use ice to facilitate the release.
- It is worth noting that some cases have a broad pain across the hip from trigger points along the crest of the ilium.
Self-Care Follow-up
This post is a great follow-up for stubborn gluteal trigger points. They range from yoga to using a tennis ball to press out trigger points. Refer your patient to these useful self-care strategies.
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Tony Preston has a practice in Atlanta, Georgia, where he sees clients. He has written and taught about anatomy, trigger points, and cranial therapies since the mid-90s.
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*This site is undergoing significant changes. We are reformatting and expanding the posts to make them easier to read. The result will also be more accessible and will include more patterns with better self-care. In the meanwhile, there may be inconsistencies in formatting, content presentation, and readability. Until we get older posts updated, please excuse our mess.
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