Clinical Anatomy 00:000000 (2013)

ORIGINAL COMMUNICATIONS

Anatomy and Biomechanics of Gluteus Maximus

and the Thoracolumbar Fascia at the Sacroiliac
Joint
P.J. BARKER,1* K.S. HAPUARACHCHI,2 J.A. ROSS,3 E. SAMBAIEW,4
T.A. RANGER,1 AND C.A. BRIGGS5
1

Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria 3800, Australia
2
Department of Orthopaedics, North Shore Hospital, Takapuna 0622, Auckland, New Zealand
3
Department of Surgery, Ballarat Base Hospital, Ballarat, Victoria 3350, Australia
4
Emergency Department, Lismore Base Hospital, Lismore, New South Wales 2479, Australia
5
Department of Anatomy & Neuroscience, The University of Melbourne, Parkville, 3010 Victoria, Australia

Biomechanical models predict that recruitment of gluteus maximus (GMax) will

exert a compressive force across the sacroiliac joint (SIJ), yet this muscle
requires morphologic assessment. The aims of this study were to document
GMaxs proximal attachments and assess their capacity to generate forces
including compressive force at the SIJ. In 11 embalmed cadaver limbs, attachments of GMax crossing the SIJ were dissected and their fascicle orientation,
length and attachment volume documented. The physiological cross-sectional
area (PCSA) of each attachment was gluteus medius fascia, ilium, thoracolumbar fascia, erector spinae aponeurosis, sacrum, coccyx, dorsal sacroiliac calculated along with its estimated maximum force at the SIJ and lumbar spine.
GMax fascicles originated from the and sacrotuberous ligaments in all specimens. Their mean fascicle orientation ranged from 32 to 45 below horizontal
and mean length from 11 to 18 cm. The mean total PCSA of GMax was 26 cm2
(range 1636), of which 70% crossed the SIJ. The average maximum force
predicted to be generated by GMaxs total attachments crossing each SIJ was
891 N (range 5721,215), of which 70% (702 N: range 4501,009) could act
perpendicular to the plane of the SIJ. The capacity of GMax to generate an extensor moment at lower lumbar segments was estimated at 4 Nm (range 2
9.5). GMax may generate compressive forces at the SIJ through its bony and
brous attachments. These may assist effective load transfer between lower
limbs and trunk. Clin. Anat. 00:000000, 2013. VC 2013 Wiley Periodicals, Inc.
Key words: gluteus maximus; sacroiliac joint; lumbar; biomechanics

INTRODUCTION
The proximal attachment of gluteus maximus
(GMax) to the thoracolumbar fascia (TLF) is unique to
humans (Stern, 1972) and proposed to contribute to
sacroiliac stability (force closure) as well as load
transfer between the limbs and trunk (Snijders et al.,
1993a,b; Vleeming et al., 1995). Fascicles of GMax
are reported to be perpendicular to the articular components of the sacroiliac joint (SIJ) (Snijders et al.,
1993a). Despite this, GMaxs TLF attachment has not

C
V

2013 Wiley Periodicals, Inc.

*Correspondence to: Priscilla J Barker, Department of Anatomy

and Developmental Biology, PO Box 13C, Monash University,
Clayton, Victoria 3800 Australia. E-mail: priscilla.barker@
monash.edu
Received 12 July 2012; Revised 22 January 2013; Accepted 27
January 2013
Published online in Wiley Online Library
(wileyonlinelibrary.com). DOI: 10.1002/ca.22233

Barker et al.

been quantitatively documented nor has GMaxs force

generating capacity at the SIJ and lumbar spine been
estimated. Although GMax function may be altered in
patients with ipsilateral SIJ pain (Hungerford et al.,
2003) and pelvic belt placement across this region
(Vleeming et al., 1992) is indicated to brace the joint
for relief of pregnancy-related pelvic girdle pain (Mens
et al., 1996; Nilsson-Wikmar et al., 2005; Mens et al.,
2006) the proportion of GMax fascicles crossing the SIJ
(and dimensions of these attachments) is uncertain.
In vivo Doppler imaging of vibrations (DIV) and
electromyographic (EMG) studies indicate that submaximal isometric voluntary contraction of GMax (and
other muscles including biceps femoris and erector
spinae) increases sacroiliac stiffness (Wingerden
et al., 2004). In addition, GMaxs temporal recruitment is noted to be delayed in patients with ipsilateral
SIJ pain (Hungerford et al., 2003). These ndings
suggest that GMax has an inuence on SIJ movement
that may be impaired in the presence of sacroiliac
pain. The effect of a single muscle on joint stiffness is
however difcult to calculate using in vivo studies,
due to contraction of related muscles (Hungerford
et al., 2003; Wingerden et al., 2004).
Imaging studies can provide accurate estimates of
a muscles total physiological cross-sectional area
(PCSA, 5 volume per unit length) applicable to a
young healthy population (Delp et al., 2001), yet cannot give detail on the contribution of individual muscle
attachments. Morphologic studies are useful for biomechanical modelling since they can isolate individual
muscles and attachments to determine quantitative
estimates of the force that each could generate across
intervening joints. PCSA measurements of muscles
and fascicle angles are required to produce force estimates. Morphological and biomechanical analysis of
latissimus dorsi indicated that its capacity to inuence
the lumbar and SIJs (via the TLF) is minimal (Bogduk
et al., 1998), yet a similar quantitative analysis is
required for GMax.
Several studies have reported the total PCSA for
GMax at 3070 cm2 (Friederich and Brand, 1990;
Klein Horsman et al., 2007; Ward et al., 2009) yet
these did not quantify the contribution that its component attachments make across intervening joints.
Gross measures indicate GMax is the largest muscle
in the lower limb (Ito, 1996; Ward et al., 2009). Anatomical reports indicate it takes origin from the ilium
and fascia over gluteus medius (GMed; also known as
the gluteal aponeurosis). It also originates from structures crossing the SIJ (6 lumbar spine); the TLF, erector spinae aponeurosis (ESA), sacrum, coccyx, and
posterior aspects of the long dorsal sacroiliac ligament
(LDSIL) and sacrotuberous ligament (STL) (Poirier,
1901; Frohse and Frankel, 1913; Testut and Latarjet,
1948; Williams et al., 1995). Distally, two-thirds of
GMax fascicles are reported to insert into the iliotibial
band and one-third to the gluteal tuberosity of the femur (Poirier, 1901; Frohse and Frankel, 1913; Testut
and Latarjet, 1948; Williams et al., 1995). Although
fascicle lengths of GMax are reported as (1118 cm)
(Frohse and Frankel, 1913; Ward et al., 2009), none
of the above descriptions cite data on fascicle orientation of GMax (relative to the SIJ).

The current study aimed to document features

(fascicle orientation, length and volume) of the proximal attachments of GMax crossing the SIJ, to estimate their capacity for force generation at the SIJ and
lumbar spine. The attachment of GMax to the TLF was
documented in detail (for comparison with latissimus
dorsis TLF attachment). Deeper attachments were
noted more generally to give the relative proportion of
GMaxs proximal attachments crossing the SIJ.

MATERIALS AND METHODS

University research on cadaveric material is licensed
under the Human Tissue Act and was approved by the
Melbourne Research Ofce. GMax was exposed (by
removing overlying skin, subcutaneous tissue and
fascia) on eleven sides (bilaterally in ve cadavers and
unilaterally in one) of six elderly embalmed cadavers
(2F, 4M, mean age 80 years, range 5490). It was then
separated into its attachments using blunt dissection.
Authors 15 all contributed to dissection and measurements under supervision of the rst author. Repeat
measures were conducted by the rst and fth authors.
Specimens were prevented from drying during
dissection using a water-based wetting solution. Mean
fascicle orientation and length were measured for each
attachment, then its volume measured.

Attachments and Fascicle Orientation

A fascicle was dened as a bundle of muscle bres
with a discrete medial attachment (Bogduk et al.,
1998), surrounded by perimysium. Fascicles attaching
to brous tissue (including the TLF and ESA) were
veried by their ability to visibly transmit tension to
these tissues using gentle manual tension. Deeper
bony attachments were identied by blunt dissection
and their attachments documented as they were
detached from bone. For each attachment, the orientation of (three) fascicles from its upper, lower, and
mid-region were documented using a clear plastic
hinged protractor goniometer (GON040, Physio-med
Services Ltd, Derbyshire, England, accuracy: 61 ) and
averaged. The vertical axis was aligned with the spinous process tips below, and the oblique axis in parallel with the mid-region of the fascicle, between its
attachment points. These angles are reported as
acute from the horizontal axis for force resolution.

Length and Volume Measures

Attachments containing fascicles of similar length
were removed from between their myotendinous junctions and laid straight (but not stretched) to record their
length, using a metal metric ruler (accuracy 61 mm).
The volume of each attachment was then measured by
observing water displacement (accuracy 65 mL) when
it was immersed in a 500 mL volumetric cylinder.

Force Resolution and Estimates

The PCSA of each attachment was then calculated
(dividing attachment volume by mean fascicle length)

Gluteus Maximus

Statistical Analysis and Repeatability

Fig. 1.
Force resolution of GMax attachments.
F 5 maximum muscular force, Fx 5 compressive (transverse) component of force, Fy 5 shear (vertical) component of force.

Paired t-tests were performed for differences in

angle, length and volume values between sides and in
the absence of differences, left and right results were
pooled. Measures of PCSA and Fx values were analyzed
graphically for any trends associated with sex and age.
Three separate measures of fascicle length and attachment volume were documented bilaterally on two
specimens to evaluate measurement consistency. Prior
to repeat measures of volume, additional moisture was
removed from the muscle using paper towel.

RESULTS
Attachments and Fascicle Orientation

and the maximum possible force it could generate

determined by applying a specic tension (stress)
value. A force coefcient of 49 N/cm2 (Bogduk et al.,
1992) was used to enable comparison of results with
those reported for latissimus dorsi (Bogduk et al.,
1998).
Trignometric vector analysis was used to resolve
the force into vertical (shear; Fy) and transverse
(compression; Fx) components in the coronal plane
(Fig. 1) to determine the effects of each attachment
at the SIJ and lumbar spine. The horizontal force vectors for fascicles were summed to determine the maximum compressive force (sum Fx) of the attachment
at the SIJ. The extensor moment of GMax on lumbar
segments was calculated by multiplying its Fy vector
by a moment arm of 7 cm (Tracy et al., 1989).

In all specimens, fascicles of GMax originated from

(in order, from superolateral to inferomedial and supercial to deep) the GMed fascia, ilium, TLF, and
ESA, dorsal sacroiliac ligaments, sacrum, sacrotuberous ligament, and coccyx (Fig. 2). The attachment of
GMax to the TLF was located between the lower border of the PSIS and a point just lateral (12 cm) to
the spinous process of S3, from an oblique (superolateral) line of origin. Proximally, attaching bres of the
TLF projected across the midline between the L3S3
spinous processes. Fascicles of GMax arising from the
ESA passed deep to the lateral border of the TLF.
Mean fascicle orientation ranged from 32 (in upper to
mid attachments) to 45 (lower attachments; Table 1
and Fig. 2). Most fascicles of GMax inserted distally
into the iliotibial band at its aponeurotic origin over

Fig. 2.
Fascicle angles of GMax attachments (white arrows5 mean values).
GMed 5 Gluteus medius, TLF 5 Posterior layer of lumbar fascia (also to underlying
erector spinae aponeurosis, ESA), LDSIL 5 Long dorsal sacroiliac ligament, STL 5 Sacrotuberous ligament).

Barker et al.

TABLE 1. Architecture of Gluteus Maximus Attachments

Mean (range)
Gluteus maximus attachment

Angle ( )

Length (cm)

GMed fascia
37 (2456)
Ilium
34 (2042)
TLF/ESA*
32 (2540)
LDSIL*
35 (2645)
Sacrum*
38 (2660)
STL*
36 (2750)
Coccyx*
45 (3260)
Total (range)
*Total of attachments crossing SIJ (lower 5)

11.1
13.7
15.2
15.2
16.8
15.5
18.3

(815)
(1017)
(1220)
(920)
(1223)
(1119)
(1322)

Volume (mL)
30 (1352)
67 (31128)
34 (1673)
36 (2056)
113 (48221)
62 (19118)
47 (2575)
389 (290519)
292 (216391)

Percentage of
total volume
8
17
9
9
29
16
12
100%

n5 11 sides. GMed 5 Gluteus medius, TLF 5 Posterior layer of lumbar fascia, ESA 5 Erector spinae aponeurosis,
LDSIL 5 Long dorsal sacroiliac ligament, STL 5 Sacrotuberous ligament).

the greater trochanter, while its most inferior fascicles

(approximately one-third) inserted into the gluteal
tuberosity.

Length and Volume Measures

Fascicle volumes are reported in millilitres (mL)
due to the technique of measurement (water displacement). Mean (pooled left and right) length and volume
measures for each attachment are presented in Table
1. Fascicle lengths were greatest for sacral and coccygeal attachments of GMax and least for fascicles
arising from the GMed fascia. The mean volume of
sacral attachments was also greatest (113 mL) followed by iliac, STL and coccygeal attachments, with
remaining attachments (to dorsal sacroiliac ligaments,
TLF 1 ESA, GMed fascia) being almost equal in volume
(3036 mL). The average total volume of GMax for
the six cadavers (pooled for sides) was 389 mL
(290519 mL; Figs. 3 and 4).

Force Estimates

crossed the SIJ. The average maximum force predicted

to be generated by GMaxs total attachments crossing
each SIJ (excluding iliac and GMed fascia attachments)
was 891 N (range 6611210). Of this muscular force,
70% (702 N: range 520955) could act perpendicular
to the plane of the SIJ (Table 2, Fig. 5). Sacral attachments made the greatest (35.5%) contribution to SIJ
compression, followed by the STL (23.5%) with
remaining (TLF and ESA, LDSIL, coccygeal) attachments each contributing 1314% (Table 2, Fig. 5). Fascicles attaching to the TLF or ESA were calculated to
produce a maximum sagittal shear (Fy) force of 59 N
(26136), translating to an extensor moment of 4 Nm
(29.5) across lower lumbar (L3L5) segments.

Repeatability
ICCs for repeated measures were high for data on
GMax fascicle length (ICC 5 0.98) and attachment volume (ICC 5 0.94)

DISCUSSION
2

The mean total PCSA of GMax was 26 cm (range

1636), of which 70% (18.2/25.9 cm2Table 2)

The large PCSA of GMax crossing the SIJ indicates

that it may contribute to force closure at the SIJ

Fig. 3.
Mean total volumes of GMax. (n 5 six cadavers). Data for latter ve cadavers is pooled for sides.

Fig. 4.
Average PCSA of GMax attachments.
(n 5 six cadavers, 11 sides). Error bars indicate standard
deviation. GMe fascia 5 Gluteus medius, TLF/ESA 5 TLF/
Erector spinae aponeurosis, ESA), LDSIL 5 Long dorsal
sacroiliac ligament, STL 5 Sacrotuberous ligament).

Gluteus Maximus

TABLE 2. Force Capacity of Gluteus Maximus Attachments

Mean (range)
Gluteus maximus
attachment
GMed fascia
Ilium
TLF/ESA*
LDSIL*
Sacrum*
STL*
Coccyx*
Total mean (range)
Total * crossing
SIJ (lower 5*)
Percentage crossing
SIJ (5 Total */Total)

PCSA (cm2)

Force (N)

Fx (N)

2.7 (25)
5.0 (210)
2.3 (16)
2.4 (24)
6.6 (313)
4.2 (19)
2.7 (15)
25.9 (1636)
18.2 (13.525)

132 (98245)
244 (98490)
114 (49294)
116 (98196)
322 (147637)
207 (49441)
132 (49245)
1,267 (7841,764)
891 (6611,210)

104 (77193)
202 (81404)
98 (43294)
95 (79158)
249 (113490)
165 (39354)
95 (35176)
1,008 (6251,406)
702 (520955)

70%

70%

70%

n 5 11 sides. GMed 5 Gluteus medius, TLF 5 Thoracolumbar fascia,

LDSIL 5 Long dorsal sacroiliac ligament, STL 5 Sacrotuberous ligament).

(Snijders et al., 1993a, b; Vleeming et al., 1995), with

14% of this force attributable to its attachment to the
TLF and ESA. Via the TLF, this attachment may also
generate a small extensor moment on lower lumbar
segments. These ndings, together with EMG ndings
indicating GMax is co-activated together with attached
(LD) and the underlying paraspinal muscles during
activities such as swimming, walking and running
(Lyons et al., 1983; Montgomery et al., 1994; Hashimoto et al., 2000; Mooney et al., 2001), support proposals that transverse tension in the TLF may
distribute loads between the limbs and trunk and contribute to stability at the SIJ as well as the hydraulic
amplier effect. Tension on the TLF may also, to a
small extent, assist extension at lower lumbar
segments.

Attachments
In this study, GMax had a consistent and substantial (10%) proximal attachment to the TLF and ESA
between the PSIS and S3, attaching via the TLF up to
the L3 vertebra. Although generally acknowledged in
anatomical texts (Williams et al., 1995; Sinnatamby,
1999), the fascial attachment has not previously been

Fig. 5.
Comparative (%) contribution of GMs
attachments for horizontal force generation at the SIJ.
(n 5 six cadavers, 11 sides).

ESA 5 Erector

Percentage contribution
to SIJ compression

14.0
13.5
35.5
23.5
13.5
100%

spinae

aponeurosis,

quantied. Fascicles attaching to the TLF are located

in the region in which EMG activity of GMax is typically
recorded (Noe et al., 1992; Mooney et al., 2001;
Souza et al., 2001; Hungerford et al., 2003) and their
level corresponds with that at which pelvic belts are
placed (Vleeming et al., 1992) to brace the SIJ for
relief of pregnancy-related pelvic girdle pain (Mens
et al., 1996, 2006).
Distal attachments were as described in both current and traditional anatomy texts (Poirier, 1901;
Frohse and Frankel, 1913; Testut and Latarjet, 1948;
Williams et al., 1995).

Fascicle Volume, Angle, and Length

Measures
The average total volume (389 mL) of GMax translates to 412 g [since density of muscle is 1.06 g/cm3;
(Mendez and Keys, 1960)] and was within the range
of previous reports of its weight from dissection studies of elderly cadavers (range 140590 g; Frohse and
Frankel, 1913; Ito, 1996). Total PCSA (26 cm2) was
also within the range cited by previous studies [2072
cm2 (Friederich and Brand, 1990; Klein Horsman
et al., 2007; Ward et al., 2009)] The wide range in
volume and PCSA measures (of both individual attachments and total muscles) is also consistent with previous reports (Delp et al., 2001) and descriptions of
substantial variation in GMaxs architecture between
individuals (Nemeth and Ohlsen, 1985; Duda et al.,
1996).
The major factor inuencing volume measures, and
subsequent force estimates, is likely to be muscle atrophy associated with age and disuse. This may
reduce estimates by up to 50% (Bogduk et al., 1998).
Other factors that may have inuenced these measures are individual variation within this relatively small
sample size and the use of gross attachments rather
than fascicular measures of volume. The sample size
was limited by specimen availability and is consistent
with that of other dissection studies (Bogduk et al.,

Barker et al.

1998). Measuring entire attachment volumes can

include small amounts of connective and neurovascular tissue, although this effect would be minor (compared with theoppositeeffect of ageing). It may
also overlook minor differences in fascicle length,
slightly reducing PCSA data accuracy. Other studies
estimating muscle forcegenerating potential have
used gross measures of muscle mass with fascicle
length (Delp et al., 2001).
To the authors knowledge, there is no existing data
with which to compare ndings on fascicle orientation
of GMax. The more horizontally oriented upper fascicles have increased capacity for compressive force
generation at the SIJ and the lower fascicles to generate hip extensor moment. There was no marked
change in orientation between supercial and deep
fascicles (e.g. from the STL). Average GMax fascicle
lengths (range 1118 cm) correspond well with early
descriptions of 11.5 cm for upper fascicles and 17.5
cm for lower fascicles (Frohse and Frankel, 1913).
Other studies have similarly noted low variation
between specimens in fascicle length measures (Delp
et al., 2001). Fixation and storage in supine can
increase the horizontal orientation of fascicles, due to
attening of GMax, and could lead to increased compressive force estimates. This problem was overcome
by approximating the angle between fascicle attachments during measurements.

Force Estimates
It is arguably more appropriate to use the upper
limit of the range of GMax force estimates for application to a young healthy population. This provides
potential forces of 955 N compression at the SIJ
(Table 2), 14% (133 N) of which may occur via its TLF
attachment, and 9.5 Nm of lumbar extension
(moment), 4 Nm of which may occur via GMaxs TLF
attachment, during maximal contraction of GMax.
Although daily activities tend to recruit GMax at less
than 40% of its maximal activity (Nemeth et al.,
1984), moderate contraction of GMax (and other adjacent muscles) may still be effective in closure of the
SIJ (Wingerden et al., 2004). Biomechanical studies in
embalmed cadavers (Vleeming et al., 1992), healthy
subjects (Damen et al., 2002) and patients with pregnancy-related pelvic pain (Mens et al., 2006) indicate
that application of 50 N compression via a pelvic belt
across the SIJ (high position; just below the ASIS) at
the level of GMaxs TLF and sacral attachments, inuenced SIJ motion effectively. Biomechanical models
(Pel et al., 2008) support this proposal, suggesting
pelvic belts may unload other pelvic muscles and
ligaments.
Data on GMaxs PCSA and force estimates may be
compared with those reported for latissimus dorsi
(LD) from a similar elderly sample (Bogduk et al.,
1998). The mean total PCSA of GMax crossing the SIJ
is over four times larger than that noted for LD (mean
26: 6 cm2) and the PCSA of GMax crossing the lower
lumbar spine twice as large as that noted for LD (2.3:
1.1 cm2). Because of GMaxs more horizontal fascicle
orientation, its maximum predicted compressive

capacity at the SIJ (955 N) in the current study is

almost 32 times that predicted for LD (30 N) at the
SIJ (Bogduk et al., 1998). This would cause substantial (equivalent of almost 100 kg) compression.
GMaxs predicted maximal extensor moment of the
lumbar spine (9.5 Nm) is however only 1.5 times the
maximum extensor moment (6 Nm) predicted for LD
at the lumbar spine. This would produce less than 5%
of the moment required for a moderate heavy lift
(Bogduk et al., 1998), highlighting the need for concurrent erector spinae contraction. Colour DIV ndings
also suggest that submaximal voluntary contraction of
GMax makes a greater (two to three times) contribution to SIJ stability than does contraction of LD (Wingerden et al., 2004) (although muscle cocontraction in
vivo makes quantitative comparisons difcult).
Calculation of forces at the SIJ and lumbar spine
performed here assume that GMaxs attachments to
the ESA and TLF acted as xed attachments in the
coronal plane, although in reality these muscles are
curved across the paraspinal muscles and display
some movement across the midline (Vleeming et al.,
1995). In addition GMs compressive force may be
somewhat attenuated where its attachments are facial
(e.g., to the TLF and iliotibial band). These factors
might slightly reduce the capacity of these attachments for effective force generation, yet since the
study aim was to determine maximum force capacity,
the linear vector was considered acceptable. Finally,
the specic tension value of 49 N/cm2 chosen to enable comparison of the current results with those of
Bogduk et al. (1998) is toward the upper extreme of
those cited in the literature for vertebrate muscles
(2035 N/cm2) (Pierrynowski, 1995). This might have
led to overestimation of GMaxs capacity for force generation, yet would again be predicted to be more than
corrected for by the use of atrophied elderly
specimens.
Substantiation of GMaxs force-generating capacity
at the SIJ is consistent with observations of its reex
activation during electrical stimulation of the joint,
suggesting that GMax has a regulatory function
(Indahl et al., 1999). EMG studies indicate that
GMaxs force generating capacity may be recruited
during activities when the SIJ is subject to shear, such
as during the stance phase of gait (Lyons et al., 1983;
Hashimoto et al., 2000) and running (Montgomery
et al., 1994; Vakos et al., 1994; Jonhagen et al.,
1996). Biomechanical models predict that it has the
greatest potential of all lower limb muscles to contribute to support in gait (Anderson and Pandy, 2003)
and GMs unique origin from the TLF in humans
(Stern, 1972) supports the proposed contribution of
this attachment to sacroiliac and lumbar support.
The current study presents data that may be
applied to biomechanical models and integrated with
existing anatomical, EMG, and DIV results. The ndings emphasise the need to consider all muscle
attachments in control of the lumbopelvic region and
in therapeutic exercise approaches. GMax is predicted
to have considerable (>700 N) capacity for compressive force generation across the SIJ. Its bony and brous attachments may assist in effective load
transfer between the lower limbs and trunk.

Gluteus Maximus

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