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Gluteus Maximus: Pain & Trigger Points

The gluteus maximus is your big buttock muscle, and can contribute to pain and movement impairments in the lower back and sacral region.

It is often tender and tense in persons that suffer from low back pain or stiffness in the lower back.

It can cause problems and pain, especially if you are not well trained, if you have a sedentary lifestyle, or if you use it excessively.

1. Pain Patterns, Symptoms & Differential Diagnoses

1.1 Pain patterns

Tensions in the gluteus maximus can trigger local pain in the buttocks.

Even with trigger points, the muscle does not refer pain to other areas, like trigger points in the gluteus medius often do.

Additionally, tensions and trigger points in this muscle, located near the iliac crest, often result in pain and stiffness in the lower back.

However, with a self-massage and long-term strengthening exercises, the problems can be controlled “relatively easily”.

Trigger Points and illustration of pain patterns

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gluteus-maximus-schmerzen-480px
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1.2 Symptoms and ailments

Besides the pains displayed above, which can also occur at rest, people with tensions and trigger points in the gluteus maximus often report that the pain is particularly severe and gets worse when:

  • Sitting.
  •  Walking uphill.
  • Climbing stairs.

This is because the already “overworked” muscle is put under even more mechanical stress as you either lengthen its fibers or use it heavily in its function.

What is more, it is often painful and can lead to cramps in the buttocks if you shorten the muscle and then contract it vigorously.

This happens in strengthening exercises for your bottom, for example. Here you usually stretch the front of your hip and contract strongly your bottom, hence also the gluteus maximus.

2. Origin, Insertion & Innervation

The attachment points of this muscle are fairly complex. For you, it is enough to know that the muscle extends from your iliac crest, sacrum and coccyx to the lateral side of your thigh.

3. Functions of the Gluteus Maximus

The functions of the muscle are diverse.

  • External rotation at the hip
  • Abduction
  • Adduction
  • Hip extension
  • Hip stabilization of the standing leg during the gait cycle

Note on the hip extension: Our hamstrings work closely together with the gluteus maximus and are usually more involved in hip extension than the gluteus maximus. The gluteus gets very active when…

… the hip extension is done out of a hip flexion.

  • Climbing up mountains and stairs with the body slightly inclined forward.

… the thighs are fixed.

  • Missionary position during sexual intercourse

… the hip extension is done out of a hip flexion and knee flexion.

  • Cross lifting or lifting heavy objects with straight back and bent knees

… the hip extension is accompanied by a back extension.

  • Leg strike during crawl swim
  • Lifting of the stretched leg in a prone position
Hüfte-flexion-aussenrotation
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External rotation (here in combination with hip flexion)

Hüfte-abduktion
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Abduction

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Adduction

Hüfte-extension
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Hip extension

4. Gluteus Maximus – Trigger Point Activation

Tensions and trigger points in the gluteus maximus usually develop due to too much or too little load on the muscle:

  • Sudden contraction with simultaneous extension of the muscle. In this case, the hips and knees are bent while the buttocks are tensed. Example: Cushioning a fall.
  • Side lunges. Example: Tennis.
  • Permanent activity. This is only “harmful” if the muscle is not used to it and you are not performing any balancing activities. Examples: Mountaineering, climbing stairs, strength training, …
  • Constant stretching: All activities where you either sit or bend forward for longer periods of time and thus flex your hips. For example when driving a car, working at a desk, hairdressing, assembly-line work, etc.

5. Palpation

Feeling the gluteus maximus will not be a problem. Just stand upright and contract your buttocks. Now feel the entire muscle with your hand.

That is, from your coccyx, through the sacrum, the iliac crest, to the outside of your thigh and down to your sit bones.

6. Self-massage of the Gluteus Maximus

For the self-massage, I recommend a hard massage ball. I use a cork massage ball.

There are several options how to perform the massage, depending on the level of intensity you desire.

You can perform the massage standing (i.e. with a ball against the wall), or in a lying position.

The standing variant is certainly the less intensive and especially suitable if the muscle reacts very sensitively to pressure.

  • Bend your knees and place the ball on the muscle.
  • Lean against a wall.
  • Systematically roll over the entire area of your bottom and search for painful points.
  • Especially at the iliac crest and in the outer middle of the buttocks, i.e. at the ischium, tensions are often found.
  • Very slowly roll over each painful spot a few times.

Other possible massage positions

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Massage in the area of the iliac crest

gluteus-maximus-triggerpunkt-massage
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Massage in the area of the buttocks

6.1 Self-massage whilst lying down

I will now show you the massage in a lying position, as it is very effective. As always, make sure you work concentrated and slowly!

  • Lie on the floor and place the ball directly under your iliac crest.
  • Roll over this area very slowly.
  • Work every painful point with a few rolling movements.

Now we go into the fleshy part of the muscle.  The way you massage this area is the same as described above. However, I must point out that the sciatic nerve might be exposed to slight pressure.

Personally, I’ve never had a problem with that before. But in people with weakly developed gluteal muscles, the nerve is exposed to stronger pressure, since there is less musculature which could serve as a buffer zone.

If you pressurize the nerve too long, it may cause you pain in the following one or two weeks. Possibly, this pain transmits to the leg and even if it is temporary, it is highly unpleasant.

Therefore: Start the massage slowly. Keep its duration short and its pressure low, especially in the beginning, and wait for the reactions of your body. This way you will probably be fine.

References

  • Calais-German, Blandine. Anatomy of Movement. Seattle: Eastland Press, 1993. Print
  • Davies, Clair, and Davies, Amber. The Trigger Point Workbook: Your Self-Treatment Guide For Pain Relief. Oakland: New Harbinger Publications, Inc., Print
  • Simons, David G., Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, MD: Williams & Wilkins, 1999. Print.
  • Schünke, Michael., Schulte, Erik, and Schumacher, Udo. Prometheus: Lernatlas der Anatomie. Stuttgart/New York: Georg Thieme Verlag, 2007. Print