Anatomy
The gluteus maximus (or glutæus maximus) is the largest and most superficial of the three gluteal muscles. It makes up a large portion of the shape and appearance of the buttocks. It is a broad and thick fleshy mass of a quadrilateral shape, and forms the prominence of the nates. Its large size is one of the most characteristic features of the muscular system in humans, connected as it is with the power of maintaining the trunk in the erect posture.
The gluteus maximus is also a main muscle used in many sports such as volleyball, hockey, basketball, soccer, and football. When the gluteus maximus takes its fixed point from the pelvis, it extends the femur and brings the bent thigh into a line with the body.
Taking its fixed point from below, it acts upon the pelvis, supporting it and the trunk upon the head of the femur; this is especially obvious in standing on one leg.
Its most powerful action is to cause the body to regain the erect position after stooping, by drawing the pelvis backward, being assisted in this action by the biceps femoris, semitendinosus, semimembranosus, and adductor magnus.
The gluteus maximus is a tensor of the fascia lata, and by its connection with the iliotibial band steadies the femur on the articular surfaces of the tibia during standing, when the extensor muscles are relaxed. The lower part of the muscle also acts as an adductor and external rotator of the limb.
Common Problems
Ischiogluteal bursitis causes inflammation of the ischial bursa, which lies between the bottom of the pelvic bone and the overlying gluteus maximus muscle (one side of the buttocks). Inflammation can come from sitting for a long time on a hard surface or from bicycling.
- The pain occurs when sitting and walking.
- There will be tenderness over the pubic bone, which may be made worse by bending and extending the leg.
- The pain may radiate down the back of the thigh.
- Direct pressure over the area causes sharp pain.
- The person may hold the painful buttock elevated when sitting.
- The pain is worse when person is lying down and the hip is passively bent.
- The person may have difficulty standing on tiptoe on the affected side.
Hip bursitis
- The iliopsoas bursa is the largest in the body and lies in front of, and deep to, the hip joint. Bursitis here is usually associated with hip problems such as arthritis or injury (especially from running).
- The pain of iliopsoas bursitis radiates down the front and middle areas of the thigh to the knee and is increased when the hip is extended and rotated.
- Extension of the hip during walking causes pain so the person may limit the stride on the affected side and take a shorter step.
- There may be tenderness in the groin area.
- Sometimes a mass may be felt resembling a hernia. The person may also feel numbness or tingling if adjacent nerves are compressed by the inflamed bursa.
Be-Your-Own Therapist Home Treatment
The treatment for bursitis can be remembered with the following memory device: P-R-I-C-E-M.
Protection includes padding especially for bursae close to the surface of the skin on the ankles and knees.
Relative rest of the affected area if possible may help symptoms. Choose alternate types of exercise activities that eliminate painful motions. Swimming may help rather than hurt.
Ice is a very effective anti-inflammatory and pain-relieving agent. Small ice packs, such as packages of frozen vegetables or water frozen in foam coffee cups, applied to the area for about 10 minutes at least twice a day may help decrease inflammation.
Compression and Elevation are helpful when it is feasible to compress the area. An elastic bandage can be applied (especially to knees and elbows). Keep the area elevated above the heart to keep blood from pooling there.
Medications such as aspirin or ibuprofen may be helpful to reduce inflammation. Consult your doctor before taking these if you are on any blood-thinning medications or have a history of stomach ulcers.
Medical Treatment
If your bursitis is not infectious, the doctor may inject the bursa with a corticosteroid to reduce inflammation. The results last for varying lengths of time. Because of potential complications, injections are usually given no more than 3 times per year at least 30 days apart. If your bursitis is infectious, the bursa will be drained with a needle. The doctor will prescribe antibiotics to be taken in pill form. If the infection is very serious, or does not respond to oral antibiotics, or if your immune system is weakened for another reason, you may be admitted to the hospital for IV antibiotics. Most causes of infectious bursitis, however, can be managed safely at home.
Follow-up
After you leave the doctor's office try to change whatever caused the bursitis in the first place. Wear different shoes. Use kneepads when kneeling for activities or work.
Rest the area and apply ice at least twice a day, keeping the area elevated when possible. Schedule a follow-up visit with your doctor in 1 week. If your bursitis is infectious, a follow-up visit in 3-4 days is appropriate for re-evaluation and possible fluid removal.
Prevention
If a certain activity causes you to develop bursitis, then limit that activity or use protective measures. Use kneepads or cushioning for gardening and scrubbing floors. Workers such as plumbers, roofers, and carpet layers should wear knee protection. Choose more appropriate shoes or cushion the ankles with pads.
You can improve your flexibility and strengthen muscles involved in joint motion through rehabilitative exercise.
Be concerned about muscle tone if you have bursitis that tends to return. A physical rehabilitation program can guide you in the proper exercises to strengthen weak muscles.