America has always had something of an infatuation with the rear end, but the last few years have signaled an unprecedented boost in attention to that area (Figure 13-1).
Figure 13-1. Beyoncé.
Perhaps the newfound fascination with the bottom is due to America’s growing knowledge of core health. There’s an awful lot that emanates from the gluteus region—and much of it actually has to do with athletic performance.
Check out a sprinter’s glutes some time. No wonder he/she can blast out of the starting blocks and tear down the track. Golfers’ first movements involve the area. Football linemen must have strength there to drive off the line and overpower their foes. It’s a key to so much activity (Figure 13-2).
Build your “glute-mede” and “glute-max” and perhaps find yourself on the road to the Olympics. Keep in mind, people are still guessing here, but the glutes do seem to have a leadership role in triggering optimal core function (Figures 13-3 and 13-4).1
So, get off your gluteus maximus and build that core.
Figure 13-2. Big glutes are common in sprinters. (A) Olympic champion Tyson Gay. (Reprinted with permission from Getty Images Sport.) (B) Usual depiction of a sprinter. (C) Female sprinter.
Figure 13-3. A simple way to remember the 3 gluteus muscles. The most superficial gluteus maximus is the broadest.
Figure 13-4. Our artist Rob Gordon exhibits the glutes. The muscular anatomy of the left “cheek” is intact. He has eliminated the gluteus maximus on the right.
Have enough electricity in your booty to jump-start the whole of New York City.
Adapted from Irish novelist Colum McCann, Let the Great World Spin.
GLUTEUS MAXIMUS
Of course, we must begin with this one—the largest and thereby strongest muscle in the body. Like most other anatomy of the human body, the muscle names derive from early anatomic dissections in the 15th and 16th centuries. Leonardo da Vinci (15th century) and Andreas Vesalius (16th century) get most of the glory. Let’s go quickly through the anatomy, function, and a few other features of the gluteus maximus.
Implications of the Appellation
First of all, the muscle’s name probably comes originally from Vesalius’s On the Fabric of the Human Body published in 1543.2 Vesalius highlights the muscle in his book owing to its “classic beauty” and large size, 2 things that meant one and the same thing back then, particularly when it came to the Romanesque big butts. It was all about Rome back then. Vesalius, from Brussels, which was then part of the Netherlands, ditched his given name, Andries van Wesel. No doubt, this sounded more Roman, and thus he named many of the muscles.
Gluteus maximus certainly rings of aristocracy and dictatorship. While this muscle is large and strong and beautiful, fitness experts nowadays tend to trash it—relatively speaking—with respect to its functional importance standpoint. They downplay its role in the body’s initiating mechanisms and even in strength, in favor of the glute-mede and other muscles. One thing is for sure, the gluteus maximus is superficial, and as we just mentioned again in the last chapter, the more central the muscle the more important its function in the core. But it is so big, it has to be important.
Our bottom line: Respect the gluteus maximus, the largest of the 3 glutes, for more than just its size and beauty. It definitely has huge roles. Do not discard it.
Anatomy
The gluteus maximus muscle has a thick fleshy bulk that forms much of the shape and appearance of the butt. Its quadrilateral outline comes from its attachments to the inner upper ilium, lower sacrum, base of the spine, and side of the coccyx (the tailbone). It also connects with the back muscles and other fasciae. It inserts on the iliotibial band and fascia lata, as well as what we call the gluteal tuberosity between the vastus lateralis and adductor magnus. It is a “tough” muscle in that it has a lot of thick parallel fascicles separated by thick fibrous tissue.
Functions
In short, the gluteus maximus is big and covers a lot of space. Therefore, it should not be unexpected that it has a number of functions. One of the most important functions is to maintain the trunk in an erect posture. In other words, it is the main extensor muscle of the hip. No doubt it plays a huge role in supporting the pelvis on top of the head of the femur. The latter function becomes obvious when one stands on one leg. It also tenses the fascia lata and steadies the femur on the tibia. Different parts of this grand old muscle also participate in adduction, abduction, and external rotation.
Other Features
Basically, the gluteus maximus is a multifaceted and very forgiving muscle. Owing to its large size, one can strengthen it in many ways and most injuries involving it heal on their own. Even with massive injuries, the muscle can be sewn up easily and it heals.
The most common operation involving this muscle is implant surgery, for purely cosmetic reasons. We won’t go into that. The largest literature on those procedures sits in the criminal sections of newspapers. But interestingly, the muscle can be legitimately transferred (ie, “swung around”) as flaps to serve other purposes such as for preservation or augmentation of glute-mede function.3
In other words, one might consider the gluteus maximus another Rodney Dangerfield muscle. We should learn to love it just like the next muscle we shall talk about. Therefore, we propose to nickname this the king glute or glute-max.
GLUTE-MEDE
Mostly because of its anatomically definable nature and importance in initiating power in proper core movements, the gluteus medius has recently become of the darling of many fitness experts and hip surgeons. Perhaps love spawned its nickname, glute-mede. If not love, then the muscle has, at least, become a best-friend-forever of most therapists.
Our physical therapists go overboard in their love for this muscle. Their passion outstrips reason. Recently, they saw the top running back in the NFL and delighted in his not having great glute-mede function. They were sure they could help improve his yardage for the next year.
Let’s go over some of the same things we did for the aforementioned gluteus maximus.
Anatomy
The glute-mede anatomy is much more definable than the gluteus maximus. This thick muscle radiates broadly from the external ilium to the lateral greater trochanter of the hip. It narrows, thickens even more and flattens as its tendon inserts into an oblique fascia-bony ridge that runs antero-inferiorly, deep to the maximus.
Function
The glute-mede’s function is obvious since it connects the lateral ilium to the greater trochanter of the femur. It abducts the hip and thigh. It does this along with the other glute, the minimus. The 2 muscles also internally rotate the thigh with the hip flexed and externally rotate it with the hip extended. Dysfunction of the glute-mede or paralysis by injury to its innervation, the superior gluteal nerve, leads to a positive Trendelenburg sign.4
Other Features
The recent interest that this muscle has sparked has led to various strengthening techniques and new surgical techniques to repair big tears when they are recognized. In our identification of the importance of this muscle, we must guard against at least 2 dangers. One, we may find ourselves focusing too much on isolated strengthening of the muscle. As we have seen with the harness muscles, too much attention to wear-and-tear injuries leads to serious injury. The other caution is to be aware that we are finding ourselves having to solve new paradoxes. For example, MRI is identifying many older nonathletic patients with severe-looking glute-mede tears. How do these rather sedate people with “hip” pain get these tears? And how do we determine which ones to repair?5,6
GLUTEUS MINIMUS
This muscle deserves a minimal discussion. This is basically a “mini” glute-mede in terms of anatomy and function. The minimus tends to be a little more intimate than the medius with the piriformis muscle and other deep posterior muscles. We don’t know the significance of that. Obviously, the minimus is not as big as the glute-mede, but the same functional considerations hold as for the glute-mede, only a little less so. (See Figure 13-5.)
Figure 13-5. The anatomical relationship between the gluteus medius, gluteus minimus (arrow), and “deep derrière” (see Chapter 29). The minimus (arrow) lies deep, almost shadowing “the mede.”
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