01/22/2020
This is the posterior musculature of an adult human male (if it wasn’t obvious).
Visible here is the spinal column with spinal cord visibility (center).
Trapezius (top left and right)
Latissimus dorsi (middle left and right),
Thorocolumbar fascia (white aponeurosis).
Lower Left Cutaway: A special treat this cutout allows a visualization of the deep hip rotators AND the sciatic nerve (small yellow strip at the middle muscle border).
And finally in the lower right and left portion of the picture we have the gluteal region.
We are focusing on this muscle group in this post.
The gluteal muscles are a set of three individual muscles which make up the hip and buttock.
The three muscle in order of largest to smallest are: Gluteus maximus, gluteus medius and gluteus minimus all originate from the ilium and sacrum and insert on the femur.
These muscles play a vital role in extension, abduction, external rotation, and internal rotation of the hip joint.
Clinical Curiosity : The gluteus Maximus has origins from the aponeurosis of the erector spinae (lumbodorsal fascia), the sacrotuberous ligament, and the fascia covering the gluteus medius.
There is also an interesting connection between the superior clunial nerves and unilateral back pain. It can be bilateral too and presents as a rainbow of sensitivity across the skin of the upper flute and low
back.
These nerves are superficial and enervate the skin of the buttock. They are prone to being entrapped (not my favorite term, they aren’t actually trapped) in the fascia of the posterior Iliac crest. This can cause these small nerves to become stretched, irritable, or both and that’s when they start sending signals.
Those signals can interpreted by the brain as a felling or tightness, heaviness, itching, or pain.
Enervation for this muscle group comes from the Superior and inferior gluteal nerves originating at the L4, L5, S1 and S2 nerve roots.
This nerve pathway lies deep to glute and is usually protected from normal massage pressure.
However, if you have ever sat for an extended period of time you have likely experience the numbness/heaviness/ache that come with compression of this nerve.
Extended compression, physical injury, or surgical interventions to this area can sometimes result in disturbed sensation or loss of strength due to nerve damage. Left unaddressed this can lead to muscle atrophy.
With proper lifestyle changes and focus on movement most cases will resolve over a period of days to weeks. Recovery CAN BE MUCH longer in cases of injury or surgery.
Remember movement is just as important as massage. Movement is medicine and it engages the nervous system on a powerful level and ultimately nerves are what control everything.
Working with this Muscle Group
First and foremost as a therapist take the time properly go through this area. That’s my number one tip. Work the butt.
I cannot tell you how many clients I have had who have reported either never having received glute massage or told me they were disappointed that it was not more comprehensive.
Your clients want this. And it’s as easy as asking...
“Are you comfortable with work in your hip and glute?”
Challenge yourself to spend 30 minutes to an hour working this area. I recommend starting at the area just above the iliac crest (low back) and working down to the top of the hamstrings. Don’t forget the lateral portions either.
This can be done through clothes, over the sheet, or skin to skin. Communicate with your client about this during the intake and again before you actually start.
I have found fists, forearms, elbows, or just humble compressions are great ways to approach this muscle group. Pulls, skin rolling, and myofascial tensioning can feel VERY GOOD. These are also the perfect way to work with those clunial nerves described earlier.
Lean, don’t push. It’s slow and lazy. Try alternating pressure toward the head, toward the feet, and toward midline in each spot you put your hand down.
This has been particularly well received by my clients.
Do be conscious of the sciatic nerve. It’s the funny bone of the leg and it’s just as not funny as the one in your arm. This nerve is pictured on the cut out portion of the muscle on the lower left of the photo.
If your client jumps or tells you they have electric pain going down their leg adjust your pressure an inch or two to either side of where your at.
That should alleviate the issue.
If you are so inclined this muscle group can almost always benefit from strengthening.
I generally don’t recommend stretching because it isn’t a muscle group that needs flexibility, it needs strength and stability.
Many exercise that work the buttocks and don’t even require a gym or a machine.
This makes them perfect suggestions for a client. I would also recommend they work with a personal trainer to gun confidence.
Lunges, hip thrusts, climbing stairs, bicycling, squats, and hill climbing will all target the glutes naturally. Weight training exercises which are known to significantly strengthen the gluteal muscles include the squat, deadlift, hip thrusts, and leg press.
If you read this far YAY! Would a technique video about this be helpful?
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References: Seely’s Anatomy and Physiology, 3D4 Medical, PhysioPedia
Photo Credit: Josh Cottle, Denver Museum of Nature and Science
Denver, Colorado Boulder, Colorado
