Issue link: https://www.massageandbodyworkdigital.com/i/530196
on the gluteals. The tensor fasciae latae is always involved in iliotibial band tightness and in torsion of the femur and knee if its borders are pulled either anterior or posterior. • Virtually all those who participate in athletics, dance, yoga, Pilates, and other physical pursuits, along with the sedentary population, complain of iliotibial band tenderness and tightness. Although most anatomy descriptions emphasize the tensor fasciae latae as the attachment to the iliotibial band, look at the distal attachment of fibers of the gluteus maximus to the posterior border of the iliotibial band and how that will pull the band posterior and cause iliotibial band tightness and tracking problems in the legs. Any work to provide release and balance to the iliotibial band should include general work to relax the gluteus maximus and also precise work at its lower attachment to release this muscle's tendency to misalign the band. • For low-back pain, the posterior pelvis is a gold mine for relief. An imbalance in the gluteal muscles causes a rotation of the pelvis that generates a twist of the spine, as a cause of, or as compensation for, back pain. Especially for people with acute low-back pain, it is often safest to stay away from the epicenter of pain and the lumbar vertebrae, but almost all clients will feel relief from gluteal work, especially when you pay particular attention to left/right balance. • Look at the insertions, fiber direction, and depth of the gluteus medius and gluteus minimus compared to the gluteus maximus. These smaller muscles have a very different function from the gluteus maximus and are often a factor in hip pain because of their attachment to the trochanter. Their complex actions vary, depending on hip and knee position, and require different strategies than the gluteus maximus. There is some disagreement on the gluteus medius' and gluteus minimus' rotational role for the femur (depending on hip flexion or extension), but there is general agreement that they are primary internal rotators to counter the force of the external rotators. These smaller gluteal muscles are most important for their action of abduction, particularly in stabilizing the leg to remain directly under the pelvis, preventing left/right pelvic deviation during the single-support phase of walking or running. • The gluteus maximus originates from the iliac crest and the lateral border of the posterior sacrum all the way down to the coccyx. Your work in creating left/right balance and relaxing the fibrous attachments at the sacrum can be very helpful in relieving sacroiliac issues. • The deep rotators are, of course, extremely important for their role of externally rotating the femur and are often tight and overworked in sports that require rotation, such as golf, tennis, and baseball. In addition, the deep rotators stabilize the leg in walking, and work in tandem with the internal rotators to keep legs and knees tracking well. All therapists should be able to precisely work on these muscles by sinking through the gluteus maximus. • Sciatica is one of the most common complaints massage therapists and bodyworkers encounter. Although sciatic pain is a complex condition with multiple causes, 1. Freeing the gluteus maximus to slide easily. 2. Freeing and aligning the gluteus maximus at the iliotibial band. 3. The Frog Position. 4. External rotation of the femur. 5. Working on the rotators. 6. Working rotators in a side-lying position. Images courtesy Art Riggs.