What is gluteus maximus

Gluteus maximus is the largest of the three gluteal muscles and most superficial of gluteal muscles ¹. Gluteus maximus makes up most of the shape and form of your buttock and hip area. The gluteus maximus is a thick fleshy muscle with a quadrangular shape. Gluteus maximus is a large muscle and plays a prominent role in the maintenance of keeping the upper body erect. Gluteus maximus is also a site of intramuscular injection. Gluteus maximus overlies large sciatic nerve; covers ischial tuberosity only when standing; when sitting, moves superiorly, leaving ischial tuberosity exposed in the subcutaneous position.

Gluteus maximus principal function is the major extensor of the hip and it also externally rotates and abducts your thigh. Hip extension is an important action in daily activities (standing, stepping and walking) and sporting actions (running, sprint-running and jumping).

Gluteus maximus is innervated by the inferior gluteal nerve (L5–S2). Gluteus maximus dysfunction is most likely due to inferior gluteal nerve dysfunction; this would cause difficulty in rising from a seated position, climbing up stairs and loss of hip extension. The most common cause of inferior gluteal nerve dysfunction is a posterior hip dislocation. Another etiology is incorrect intramuscular (IM) injection placement. Intramuscular (IM) injection placement should be in the upper outer quadrant of the buttock. Otherwise, both the inferior and superior gluteal nerves are at risk of injury ². Paralysis of the gluteus maximus does not affect walking on a plane surface ¹. The gluteus maximus only contracts during a part of the stance phase. This phase occurs when the heal strikes the ground to when the foot is flat. The gluteus maximus works by resisting further flexion of the hip and initiate extension. The gluteus maximus actively functions when climbing upstairs or lifting from a seated position ³.

The gluteal muscles are a grouping of muscles that make up the buttock area. These muscles include:

• Gluteus maximus
• Gluteus medius
• Gluteus minimus

Figure 1. Gluteus maximus anatomy

Gluteus maximus origin and insertion

Gluteus maximus originates from the dorsal ilium, sacrum, and coccyx.

The gluteus maximus has two insertion points: superficial fibers to the greater trochanter and a band of the fascia lata (iliotibial tract) and the deep fibers that insert into the gluteal tuberosity of femur between the adductor magus and vastus lateralis. It originates in the gluteal surface of the ilium ⁴.

The gluteus maximus also has associations with three bursae ⁵. These include:

• The trochanteric bursa – separates the gluteus maximus from the greater trochanter
• Ischial bursa – separates the gluteus maximus from the ischial tuberosity
• The gluteofemoral bursa – separates the iliotibial tract from the vastus lateralis

Gluteus maximus blood supply and lymphatics

The gluteus maximus receives vascular supply by both the inferior and superior gluteal artery. These vessels enter the gluteus maximus at the center of the muscle. The inferior gluteal artery proceeds to descend along the greater trochanter of the femur. It accompanies the descent of the sciatic nerve, which proves to be critical as rupture of the inferior gluteal artery can cause gluteal compartment syndrome and sciatic nerve palsy ⁶. The artery supplies the superficial skin and anastomoses with the perforating arteries of the lower limb. The inferior gluteal artery is also susceptible to pseudoaneurysm formation following intramuscular injection ⁷.

Gluteus maximus innervation

The innervation of the gluteus maximus muscle is from the inferior gluteal nerve. The inferior gluteal nerve originates from the ventral rami of L5, S1, and S2. Classically, the inferior gluteal nerve was thought not to provide cutaneous innervation. However, the recent literature describes findings of cutaneous branches of the nerve which might contribute toward gluteal pain during lumbar disk herniation. Surgeons must also be aware of this nerve as injury might result in compression ulcers and various pain syndromes ⁸.

Gluteus maximus function

Gluteus maximus principal function is the major extensor of the thigh and it also externally rotates and abducts your thigh. Although a powerful extensor, gluteus maximus only acts when force is necessary. Gluteus maximus is most effective when thigh is flexed and force is necessary, as in rising from sitting, climbing stairs, straightening from a bending position, walking up stairs or on a hill and running. Gluteus maximus also acts on the pelvis, supports it and the trunk which is vital when a person is standing on one leg. By attaching to the tensor fascia lata, the gluteus maximus also steadies the femur ⁹. Gluteus maximus is generally inactive during standing and walking.

The gluteus maximus works with the semitendinosus and semimembranosus muscles to extend the hip. The muscle also works in conjunction with the iliopsoas, piriformis, and the obturator muscles to externally rotate the hip.

Gluteus maximus action

In athletes, the gluteus maximus muscle is among the most important to train due to its action of extension of the hip joint which translates to explosive movements ¹. A 2018 study looked at the correlation between gluteus maximus muscle to quadriceps femoris ratio in faster athletes compared to slower athletes. Results yielded that the larger the ratio, the faster the athlete ¹⁰.

Another 2018 study suggests that associated hip muscles may become more atrophied after hip arthroplasty, but larger cohorts would be needed to clarify the results ¹¹. Variability in the neuromuscular activity of the gluteus maximus in patellofemoral pain syndrome compared to healthy individuals was also documented ¹².

Gluteus maximus exercises

Though several different gluteus maximus exercises exist, a comprehensive understanding of which exercises best target the gluteus maximus and the magnitude of muscular excitation associated with each exercise is yet to be established ¹³. The findings from this review ¹³ provide an indication of gluteus maximus excitation generated by a variety of hip extension body weight exercises, which may assist practitioners in making exercise selection decisions for programming.

Figure 2. Gluteus maximus workout

Table 1. Summary of all different gluteus maximus exercise studies reviewed

Though several limitations exist within this review, some general observations can be made as follows:

1. Body weight hip extension exercises provided a wide range of gluteus maximus electromyography excitation ranging from 6.1% to 106.2% maximum voluntary isometric contraction (MVIC);
2. When pooled as an average, similar levels of excitation were found between force vectors though the range of excitation levels differed between vectors;
3. Unilateral exercises produced higher electromyography values compared to the bilateral version of the same exercise;
4. Females exhibited greater electromyography excitation than males in all hip extension exercises,
5. Verbal and tactile cues increase gluteus maximus electromyography excitation, while bracing and drawing-in the abdominals also increase excitation levels; and,
6. Hip extension exercises performed in greater degrees/angles of hip flexion, hip abduction or hip external rotation result in higher measured electromyography excitation levels.

The pooled averaged values for the same exercises should be interpreted as a guideline and caution should be used for interpreting their findings with further research into each exercise with the same methodology required to verify these results. Moreover, this review focused on body weight exercises, therefore, whether the loaded version of the same exercises in this review results in similar findings requires investigation. When strengthening a weaker muscle or muscle group, practitioners may wish to prescribe a gradual and progressive exercise program to ensure the targeted area is developed. Practitioners should initially consider exercises performed in the horizontal vector as they provide a large base of support and are less challenging compared to vertical vector exercises. Moreover, bi-lateral exercises should be mastered before prescribing unilateral versions. This may be of importance if individuals seek and implement a compensatory movement pattern when faced with weakness or dysfunction. Individuals may benefit from being prescribed exercises that they can perform with good technique without substitution. Subsequently, once this can be achieved, exercise difficulty can be progressed with more demanding exercises.

1. Elzanie A, Borger J. Anatomy, Bony Pelvis and Lower Limb, Gluteus Maximus Muscle. [Updated 2019 Feb 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538193[↩][↩][↩]
2. Apaydin N, Bozkurt M, Loukas M, Tubbs RS, Esmer AF. The course of the inferior gluteal nerve and surgical landmarks for its localization during posterior approaches to hip. Surg Radiol Anat. 2009 Jul;31(6):415-8[↩]
3. DeJong AF, Mangum LC, Resch JE, Saliba SA. Detection of Gluteal Changes Using Ultrasound Imaging During Phases of Gait in Individuals With Medial Knee Displacement. J Sport Rehabil. 2018 Dec 17;:1-11.[↩]
4. Barker PJ, Hapuarachchi KS, Ross JA, Sambaiew E, Ranger TA, Briggs CA. Anatomy and biomechanics of gluteus maximus and the thoracolumbar fascia at the sacroiliac joint. Clin Anat. 2014 Mar;27(2):234-40.[↩]
5. Mu A, Peng P, Agur A. Landmark-Guided and Ultrasound-Guided Approaches for Trochanteric Bursa Injection: A Cadaveric Study. Anesth. Analg. 2017 Mar;124(3):966-971.[↩]
6. Rocos B, Ward A. Gluteal compartment syndrome with sciatic nerve palsy caused by traumatic rupture of the inferior gluteal artery: a successful surgical treatment. BMJ Case Rep. 2017 Jan 25;2017[↩]
7. Saad PF, Saad KR, Armstrong DM, Soares BL, de Almeida PH, Razuk Filho Á. Inferior gluteal artery pseudoaneurysm related to intramuscular injection. Int J Surg Case Rep. 2015;6C:29-32.[↩]
8. Iwanaga J, Simonds E, Vetter M, Patel M, Oskouian RJ, Tubbs RS. The inferior gluteal nerve often has a cutaneous branch: A discovery with application to hip surgery and targeting gluteal pain syndromes. Clin Anat. 2018 Sep;31(6):937-941[↩]
9. Kim SM, Yoo WG. Comparison of trunk and hip muscle activity during different degrees of lumbar and hip extension. J Phys Ther Sci. 2015 Sep;27(9):2717-8[↩]
10. Sugisaki N, Kobayashi K, Tsuchie H, Kanehisa H. Associations Between Individual Lower-Limb Muscle Volumes and 100-m Sprint Time in Male Sprinters. Int J Sports Physiol Perform. 2018 Feb 01;13(2):214-219.[↩]
11. Navandar A, Veiga S, Torres G, Chorro D, Navarro E. A previous hamstring injury affects kicking mechanics in soccer players. J Sports Med Phys Fitness. 2018 Dec;58(12):1815-1822[↩]
12. Orozco-Chavez I, Mendez-Rebolledo G. Effect of squatting velocity on hip muscle latency in women with patellofemoral pain syndrome. J Phys Ther Sci. 2018 Mar;30(3):381-386[↩]
13. Macadam P, Feser EH. EXAMINATION OF GLUTEUS MAXIMUS ELECTROMYOGRAPHIC EXCITATION ASSOCIATED WITH DYNAMIC HIP EXTENSION DURING BODY WEIGHT EXERCISE: A SYSTEMATIC REVIEW. Int J Sports Phys Ther. 2019;14(1):14-31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350668/[↩][↩]
14. Worrell TW Crisp E LaRosa C. Electromyographic reliability and analysis of selected lower extremity muscles during lateral step-up conditions. J Athl Train. 1998;33(2):156.[↩]
15. Zeller BL McCrory JL Ben Kibler W, et al. Differences in kinematics and electromyographic activity between men and women during the single-legged squat. Amer J Sports Med. 2003;31(3):449-456.[↩]
16. Ayotte NW Stetts DM Keenan G, et al. Electromyographical analysis of selected lower extremity muscles during 5 unilateral weight-bearing exercises. J Orthop Sports Phy Ther. 2007;37(2):48-55.[↩]
17. Ekstrom RA Donatelli RA Carp KC. Electromyographic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises. J Orthop Sports Phys Ther. 2007;37(12):754-762[↩]
18. Ekstrom RA Osborn RW Hauer PL. Surface electromyographic analysis of the low back muscles during rehabilitation exercises. J Orthop Sports Phys Ther. 2008;38(12):736-745.[↩]
19. Farrokhi S Pollard CD Souza RB, et al. Trunk position influences the kinematics, kinetics, and muscle activity of the lead lower extremity during the forward lunge exercise. J J Orthop Sports Phys Ther. 2008;38(7):403-409[↩]
20. Boudreau SN Dwyer MK Mattacola CG, et al. Hip-muscle activation during the lunge, single-leg squat, and step-up-and-over exercises. J Sport Rehab. 2009;18(1):91-103[↩]
21. Distefano LJ Blackburn JT Marshall SW, et al. Gluteal muscle activation during common therapeutic exercises. J Orthop Sports Phys Ther. 2009;39(7):532-540[↩]
22. Lewis CL Sahrmann SA. Muscle activation and movement patterns during prone hip extension exercise in women. J Athle Train. 2009;44(3):238-248[↩]
23. Sakamoto A Teixeira-Salmela L Rodrigues dPF, et al. Gluteus maximus and semitendinosus activation during active prone hip extension exercises. Brazilian J Phys Ther. 2009;13(4):335-342[↩]
24. Lubahn AJ Kernozek TW Tyson TL, et al. Hip muscle activation and knee frontal plane motion during weight bearing therapeutic exercises. Int J Sports Phys Ther. 2011;6(2):92.[↩]
25. Boren K Conrey C Le Coguic J, et al. Electromyographic analysis of gluteus medius and gluteus maximus during rehabilitation exercises. Int J Sports Phys Ther. 2011;6(3):206[↩]
26. Bouillon LE Wilhelm J Eisel P, et al. Electromyographic assessment of muscle activity between genders during unilateral weight-bearing tasks using adjusted distances. Int J Sports Phys Ther. 2012;7(6):595.[↩]
27. Nakagawa TH Moriya ET Maciel CD, et al. Trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during a single-leg squat in males and females with and without patellofemoral pain syndrome. J Orthop Sports Phy Ther. 2012;42(6):491-501[↩]
28. Tateuchi H Taniguchi M Mori N, et al. Balance of hip and trunk muscle activity is associated with increased anterior pelvic tilt during prone hip extension. J Electrom Kin. 2012;22(3):391-397[↩]
29. De Ridder EM Van Oosterwijck JO Vleeming A, et al. Posterior muscle chain activity during various extension exercises: an observational study. BMC Muscul Dis. 2013;14(1):204[↩]
30. Kang S-Y Jeon H-S Kwon O, et al. Activation of the gluteus maximus and hamstring muscles during prone hip extension with knee flexion in three hip abduction positions. Man Ther. 2013;18(4):303-307.[↩]
31. Lee KS Ko E Lim CG. Effect of pelvic belt on gluteal muscles activity during therapeutic exercise. J Physl Ther Sci. 2013;25(3):337-340.[↩]
32. Webster K Gribble P. A comparison of electromyography of gluteus medius and maximus in subjects with and without chronic ankle instability during two functional exercises. Phys Ther in Sport. 2013;14(1):17-22[↩]
33. Bolgla L Cook N Hogarth K, et al. Trunk and hip electromyographic activity during single leg squat exercises do sex differences exist? Int J Sports Phys Ther. 2014;9(6):756.[↩]
34. Hollman JH Galardi CM Lin I-H, et al. Frontal and transverse plane hip kinematics and gluteus maximus recruitment correlate with frontal plane knee kinematics during single-leg squat tests in women. Clin Biomech. 2014;29(4):468-474[↩]
35. Emami M Arab AM Ghamkhar L. The activity pattern of the lumbo-pelvic muscles during prone hip extension in athltes with and without hamstring strain injuy. Int J Sports Phys Ther. 2014;9(3):312.[↩]
36. MacAskill MJ Durant TJ Wallace DA. Gluteal muscle actvity during weightbearing and non-weightbearing exercise. Int J Sports Phys Ther. 2014;9(7):907[↩]
37. Park S-y Yoo W-g. Effects of hand and knee positions on muscular activity during trunk extension exercise with the Roman chair. J Electrom Kin. 2014;24(6):972-976[↩]
38. Suehiro T Mizutani M Okamoto M, et al. Influence of hip joint position on muscle activity during prone hip extension with knee flexion. J Phys Ther Sci. 2014;26(12):1895-1898[↩]
39. Kim TW Kim YW. Effects of abdominal drawing-in during prone hip extension on the muscle activities of the hamstring, gluteus maximus, and lumbar erector spinae in subjects with lumbar hyperlordosis. J Phys Ther Scie. 2015;27(2):383-386[↩]
40. Kim S-m Yoo W-g. Comparison of trunk and hip muscle activity during different degrees of lumbar and hip extension. J Phys Ther Sci. 2015;27(9):2717-2718[↩]
41. Mills M Frank B Goto S, et al. Effect of restricted hip flexor muscle length on hip extensor muscle activity and lower extremity biomechanics in college-aged female soccer players. Int J Sports Phys Ther. 2015;10(7):946[↩]
42. Yoon J-Y Lee M-R An D-H. Effect of initial position on the muscle activity of the hip extensors and amount of pelvic tilt during prone hip extension. J Phys Ther Sci.. 2015;27(4):1195-1197[↩]
43. Youdas JW Hartman JP Murphy BA, et al. Magnitudes of muscle activation of spine stabilizers, gluteals, and hamstrings during supine bridge to neutral position. Physio Theory Pract. 2015;31(6):418-427[↩]
44. Choi K Bak J Cho M, et al. The effects of performing a one-legged bridge with hip abduction and use of a sling on trunk and lower extremity muscle activation in healthy adults. J Phys The Sci. 2016;28(9):2625-2628[↩]
45. Jeon I-c Kwon O-y Weon J-h, et al. Comparison of Hip and Back Muscle Activity and Pelvic Compensation in Healthy Subjects During Three Different Prone Table Hip Extension Exercises. J Sport Rehab. 2016:1-19[↩]
46. Lee T-S Song M-Y Kwon Y-J. Activation of back and lower limb muscles during squat exercises with different trunk flexion. J Phys The Sci. 2016;28(12):3407-3410[↩]
47. Selkowitz DM Beneck GJ Powers CM. Comparison of Electromyographic Activity of the Superior and Inferior Portions of the Gluteus Maximus Muscle During Common Therapeutic Exercises. J Orthop Sports Phys Ther. 2016;46(9):794-799[↩]
48. Chan MK Chow KW Lai AY, et al. The effects of therapeutic hip exercise with abdominal core activation on recruitment of the hip muscles. BMC Muscul Dis. 2017;18(1):313[↩]
49. Hollman JH Berling TA Crum EO, et al. Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging Exercise in Active Females? A Randomized Controlled Trial. J Sport Rehab. 2017:1-22.[↩]
50. Lehecka B Edwards M Haverkamp R, et al. Building a better gluteal bridge: Electromyographic analysis of hip muscle activity during modified single-leg bridges. Int J Sports Phys Ther. 2017;12(4):543.[↩]
51. Van Oosterwijck J De Ridder E Vleeming A, et al. Applying an active lumbopelvic control strategy during lumbar extension exercises: Effect on muscle recruitment patterns of the lumbopelvic region. Human Move Sci. 2017;54:24-33[↩]
52. Youdas JW Hartman JP Murphy BA, et al. Electromyographic analysis of gluteus maximus and hamstring activity during the supine resisted hip extension exercise versus supine unilateral bridge to neutral. Physio Theory Pract. 2017;33(2):124-130.[↩]