Editors Note: What I love about this website is that it allows for interaction with some of the best professionals in the business, and today’s guest post is from somebody who is no exception. Moons ago I wrote an article on the Deep Sacral Gluteus Maximus inspired by the work of Sean Gibbons and colleagues, and today, Luke has offered to expand on how it is tested and treated if its your cup of tea. Enjoy!
The Deep Sacral Gluteus Maximus
The Deep Sacral Gluteus Maximus can be tested and treated with a variety of techniques depending on your expertise. This muscle is dysfunctional in a variety of conditions including Sacral Lesions and instabilities, hip impingement syndromes and so called Piriformis syndromes.
An early reference to the notion that the Gluteus Maximus has different functional segments comes from Manual Medicine Diagnostics by Dvorak, Dvorak 1984. In this text the Glute Max is divided into the tibial portion and femoral portion with the femoral portion attachment deep on the sacrum and is affected by Spodylogenic Reflex Syndromes (SRS) of L1 to L5.
The theory is that a facilitated segment or rotational dysfunction in L1 to L5 can cause myotendinosis of the deep sacral glute max fibers causing altered sacral mechanics or muscle inhibition. This theory is best related to Osteopathic principles of segmental abnormal position and somatic lesions.
Testing can be simple to complex. The simple way is to palpate along the border of the sacrum and looking for zones of irritation compared to the non involved side. I correlate this with a hip extension or hip lateral rotation strength test in which the involved side can not hold with first pressure and gets weaker with repeated testing. This was a suggested test of neurological inhibition by Jim Meadows in course notes. Complex assessment utilizes the Osteopathic principles of sacral dysfunction to determine various torsions and tilts and then correcting the positional fault.
Another reference to testing the Deep Sacral Gluteus Maximus comes from Chad Brenzikofer and Kinetic Control. Their theory, which is supported by Diane Lee and Vleeming, is that this muscle along with the Multifidus, pelvis floor muscles and tranversus abdominus control sacral stability. To test use simple palpation between the lateral border of the Sacrum and Ischial Spine while the client attempts to facilitate an isolated contraction without bulging the lateral aspect of the muscle. It should be relatively easy for patient to accomplish without altered breathing or recruitment of other muscles including hamstring, lateral glute or erector spinae. When using this test I also correlate it with the single leg bridge test for pelvic stability described in McGill, Low Back Disorders.
Treatment can involve normalizing sacral and lumbar mechanics with your choice of manual treatments and then retest the palpation and strength to see if the muscle is now able to hold against resistance. Treatment can also be focused on the muscle itself with attempting to normalize the contractile aspects of the tissue through eccentric loading Muscle Energy Techniques described by Chaitow. I tend to use Trigger Point Dry Needling to affect the tissue quickly then use foam rollers or myofascial therapy balls as a home program.
These tests are useful in the chronic sacral/pelvic pain patient who always describe their sacrum as “out”. Treatment involves retraining the muscle to fire independently and then integrating it into functional patterns. There are so many theories on treating the sacrum and hip that I tend to group testing according to the clients report, but in one form or another I always get around to testing the Deep Sacral Gluteus Maximus.
Luke Angel PT, CMPT
Director of Rehabilitation