Why is the gluteus maximus the best (and my favorite) muscle? And how does it relate to the pelvic floor?
Although I focus the majority of my energy on treating with a biopsychosocial model, I am an anatomy and biomechanical enthusiast. Anatomy is my science foundation to the art that is physical therapy.
The glute max is a primary extensor and external rotator of the hip and affects the low back, the hips, pelvis, and knees. Not only it is a power house, but it also stabilizes everything above and below the chain.
Usually, what we see with short and weak pelvic floor muscles that are consistent with pelvic floor dysfunction, are short and weak glutes as well. Based on functional and anatomical proximity, therapy should focus on making both groups of muscles LONG AND STRONG. The glute max will help stabilize the sacrum and the femur. This will keep the body and pelvis in a neutral position.
As the glute max stabilizes and provides the major moving force, this allows our good buddy the obturator internus to do its thing in stabilizing the pelvic floor muscles.
If the glute max is short and weak, this will require the obturator internus to try and help stabilize the hips in addition to external rotation of the femur and stabilizing the pelvic floor. Muscles do not like having jobs outside their original contract. This often leads to pain and dysfunction and a cascading effect that will likely change the mechanics above and below the problem area.
(See how the glute max just fits right in with the gang?)
I should note the condition sometimes referred to as "gluteal amnesia". Where we lose the ability to accurately, strongly, and consistently contract the glute max. This can occur secondary to chronic pain, low back pain, or impingement of the L5-S2 nerve roots. The most common area of compression in the spine is L5/S1. The S2 nerve root, for most people, is the start of the pudendal nerve which innervates the pelvic floor muscles.
Having strong glutes will help set the foundation for whole body wellness. I love strengthening the glutes because you can easily incorporate functional movements and make it a more global experience, which tends to be more fun and engaging. I hope through these blog posts, I am starting to paint the picture of how the body in interconnected and there is rarely just one issue. We need to look deeper and more holistically to treat the entire person.
A nice global start can begin with elongating and strengthening the glute max
The glute max goes hand in hand with pelvic floor dysfunction and should be treated at the same time
Rob
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I really dig this simple stretch for the glute max. Remember the glute max externally rotates and extends the hips, so we do the opposite to stretch it.
Two nice strengthening exercises are the bridge and the body weight deep squat.
The deep squat helps elongate the pelvic floor as well as strengthens the posterior train. If pregnant, a beginner, or just unsteady, the use of a physioball (or a stool under the bottom) in front to lean on can help
ease into full range.
Squeeze the butt and lift the hips. Note the knees, hips and arm pits are on a mostly linear line. You can add extra bang for your buck by adding a band around the knee and pushing out slightly against the resistance.
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