In treating lower back pain, mid back and neck pain, the gluteus maximus muscle must be routinely included.

Anantomy: This muscle arises from the iliac bone, sacrum and tailbone (coccyx). It also has attachments to the thoracolumbar fascia into which the latissimus dorsi and trapezius muscles are also attached. Gluteus maximus inserts into the thigh bone and the thick fascia at the side of the thigh known as the iliotibial tract.

On its contraction, the thigh moves backward (extension). It is also used for bringing the thighs together (adduction) and in rolling the thigh outward (external rotation). It is responsible for keeping the spine erect. Its contraction is necessary to return to the erect position from a crouched or squat position.

Gluteus maximus is used (actually over used) daily in stabilizing or lengthening contractions. During ambulation, as the heel strikes the ground, this muscle must undergo a lengthening contraction to stabilize the hip. Weakness in this muscle causes the hip to collapse making the person fall forward. Therefore, patients who have severe weakness of this muscle tend to keep the head and spine backward so that the weight line can fall behind the hip as they walk. This characteristic gait is called the lordotic gait.

When a person is sitting, this muscle is stretched due to having to contract in a lengthening contraction. Since lengthening contractions are injurious to the muscle, gluteus maximus is usually weak in most people.

Nerve related weakness in this muscle occurs easily since this muscle is supplied by the S1 nerve root which is commonly injured or irritated from presence of degenerative arthritis of the spine, slipped disc, bulging disc etc. S1 nerve root irritation compounded by spasm leading to tightening and shortening of the gluteus maximus can give rise to symptoms of pain, tingling and numbness from compressing the sciatic nerve (sciatica).

Sciatic nerve irritation from pyriformis syndrome is very rare. Usually, the sciatica symptoms are due to tightening and shortening of the gluteus maximus which pushes on the if pyriformis muscle to press on the sciatic nerve.

Pain and weakness in the gluteus maximus will aggravate low back pain. Symptoms of pain in the sacroiliac joint region is primarily due to S1 nerve root irritation causing pain and spasm in the gluteus maximus muscle.

Treatment of neck, mid back pain and pain in the upper and lower limbs is never complete without treating the gluteus maximus due to the connections through the thoracolumbar fascia.

To relax the gluteus maximus, massage regularly by pounding this muscle or using an electric massager.

To strengthen the gluteus maximus muscle for patients with chronic pain, the exercises include pelvic tilt and bridging exercises. Patients can also perform pelvic tilt exercises while walking, sitting or standing. Partial squats by bending the knees for about 30° and returning to the erect position while keeping the spine straight and supported against a wall can be performed.

Since the gluteus maximus is rarely used in shortening contractions, the principle is to help this muscle contract actively. Training to walk backwards while holding onto a railing or a wall is also necessary for getting this muscle to actively contract. The most efficient way to selectively activate this muscle is to perform motor point stimulation choosing eToims Twitch Relief Method.