The most powerful muscle in the body is the gluteus maximus. Previously we have commented on its origin, insertion, innervation and its actions. We should now discuss the concept and importance of this muscle in creating chronic myofascial pain, especially how it can develop into total body pain (fibromyalgia) and chronic fatigue with or without pain.
Low back pain due to L5 and S1 nerve root irritation is very common and starts young. So when the patient presents with low back pain in middle age or old age, although the pain may be acute due to sudden or insidious trauma, the pain symptoms may progress to a stage of chronic pain, often involving the entire the body. body as in fibromyalgia with accompanying fatigue. This is because the L5 and S1 nerve roots may have had chronic changes for several decades before the onset of acute symptoms.
The gluteus maximus comes into play to shorten contractions, such as the act of standing up, squatting, cycling, or swimming while the hip and thigh move backwards (hip extension), etc. Although these movements strengthen the gluteus maximus, the fact that there are reciprocal movements of hip extension in hip flexion that require its lengthening contraction makes it prone to injury.
Your actions are most important during lengthening contractions to stabilize the hip in flexion, such as walking, sitting, lunging forward, squatting, hip flexion while riding a bike, etc. predisposes you to injury.
These frequent lengthening contractions in the presence of L5 and/or S1 nerve root irritation (the gluteus maximus has very strong S1 nerve root innervation) cause weakness in this most powerful muscle in the body.
Pain and spasm in the gluteus maximus will add more weakness to the underlying nerve related weakness in this muscle due to irritation of the spinal nerve root. Uncoordinated contraction of the gluteus maximus due to pain and spasm can cause the hip and knee to bend and the person to fall and cause further injury to other segments of the spine.
Shortening of gluteus maximus contractions with very little reciprocal movement in hip flexion can be stimulated by walking backwards. This is an exercise activity that is extremely helpful in strengthening the gluteus maximus as it does not require reciprocal hip flexion.
The most optimal method for having gluteus maximus shortening contractions without reciprocal hip flexion movements is the eToims Contraction Relief Method. Nerve contractions produce an internal stretching exercise and promote local blood flow, allowing the nerves to heal.
The importance of correctly treating the gluteus maximus relates to the myofascial connection to the mid-back and neck through the thoracolumbar fascia and to the other muscles of the lower extremities, such as the tensor fascia lata, through the thoracolumbar fascia. of the iliotibial tract.
Muscles innervated by cervical nerve roots, such as the latissimus dorsi and trapezius muscles, are connected to the gluteus maximus via the thoracolumbar fascia.
At the same time or eventually, patients with lower back problems, especially at the L5 and S1 levels, will develop pain in the neck, mid-back, and lower back due to tension from the thoracic fascia.
There will often be pain in the upper extremities from cervical nerve root irritation and in the lower extremities from lumbosacral nerve root irritation. This picture of total body pain results in fibromyalgia and fatigue due to the presence of multiple focal muscle spasms in many muscles innervated by many cervical and lumbosacral nerve roots.
