Ep 310 - Untangling the Glute Max: “The Rebel MT” with Allison Denney

0:00:00.0 Speaker 1: This episode is brought to you by Rebel Massage deep tissue body butter. Crafted, because oil is too slick and lotion absorbs too fast, these organic professional grade body work butters give you the grip you've been looking for. The best techniques in the world can get lost without the right product to support them. Try the, "Get a grip version," for a more specific focused work, or the, "Total meltdown version," for that grip with a little extra glide, made by a massage therapist for massage therapists, head over to rebelmassage.com to get your grip today. 

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0:00:48.5 Speaker 2: Society plays funny tricks on us, of course, I'm speaking of the society in which I live. I can not elaborate on societies of which I'm not immersed in because... Well, the immersing does the teaching, and therefore I have not learned. But this current society of arguably large power in the western hemisphere has tossed me around a bit, and in my attempt to make heads or tails of it all, I have worked myself into quite a few tizzies. From birth, we are raised by our parents, or parent or some version of parental figures who do the nurturing, but we are also nurtured by society, and as time ticks on the societal hold grabs us at younger and younger ages. The opinions and judgments and expectations of who we should be, creeps into our tiny, little, spongy brains, while the hard wiring is still sought who we become wired to be, has a lot of cooks in the kitchen, too many, I would postulate. Who we listen to then often becomes a matter of which voice is loudest, a highly impressionable skin bag of neurons and hormones will most definitely be attracted to the biggest attention grabber. 

0:01:50.5 S2: I should correct myself and say that I don't actually think that society consciously plays tricks, as it were. Attributing an individualized characteristic to a society, just contributes to the power that it's collective conscious already has. No need to do that, because it already has enough power, and this is why it's tricky. But I do think that society communicates largely through the internet, and the internet tells us many, many things. How we should look, how we should feel, who we should love or hate, and even when to be real. We have such an unquestioned trust in the worldwide web that we Google things like, "Why am I depressed?" Or "Why are people mean?" Or "What is pain?", expecting that the answer we find will solve all of our problems. We, no longer dig deep to find our own answers, we have come very close to losing that skill altogether. The trickiest part is once we have realized how tangle up we really are, how do we untangle ourselves?  

0:02:46.7 S2: Uh, if there was only a red pill that would open our eyes to the Matrix. Or should I ask, if there was only someone who could manipulate our thought patterns and retrain us to break free? I mean, there is therapy, I'm a huge fan, but it's not a pill. It takes a lot of work. Okay, so what if there was also a therapy where we could manipulate a muscle that has fallen into a similar toxic belief pattern? Like, what if a muscle buys into the hype that it is the worst or the weakest or the most bad ass of them all? Or even, what if the muscle doesn't understand its own pain? Wait a minute. Okay, so obviously this is what we do, we calm muscles down that are too tense and engage muscles that are too lax, we even explore the big pain question mark as it relates to muscles. But think about it like this, what if a muscle like, the glute max, for example, actually believes itself to be too weak or believes itself to be stronger than all of the other muscles? Or believes that it is in pain when it's functioning well, or the opposite, that it's fine when it really isn't?  

0:03:51.5 S2: Unveiling that mask would take a lot of work. But hey, we've got a lot of time. The glute max is actually the perfect example for this anthropomorphized thought experiment, it symbolizes some pretty intense inner feelings. How we feel about our butts is inextricably intertwined with how we feel about ourselves, it is displayed in every advertisement for what we should wear, what we should eat and drink, and definitely what workout equipment we should buy, so that people will like our butts even more. And figuring out how we really feel about our own butts would take a lot of introspection. But before we dive into how we might address this complicated crux, let us first look at its anatomy. 

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0:04:36.0 S2: Where the glute max originates at the sacrum is quite literally at the center of our physical selves. Okay, yes, so it might be situated a tad posterior, but our sacrums are the pivot point from which everything else moves, it is the base of the spine and the connection for the hips and legs that hold us up. It is the house of the Cuada Equina, which if you think about it, is the roots of our central nervous system and an essential region for communication. And our sacral chakra, if we wanna veer outside the Western box a bit, is centered around personal identity and emotional needs and desires. So yeah, the center of ourselves. I raise this point first, because it's important to note that when the glute max contracts, it is not only creating movement of the coxal joint, but it can also influence the sacrum's relationship to the ilium and the spine. But obviously peer is being that if there is hyper or hypo tenacity in this large muscle mass, the foundation of our elemental structure can shift away from a healthy function, more on this in a bit. 

0:05:36.6 S2: Technically speaking, the origin of the glute max listed from inferior to superior is the coxis, the lateral edge of the sacrum and the posterior iliac crest. It also includes a few ligaments, which in my mind always indicates the possibility for more complications, the sacrotuberous ligament, which binds the sacrum to the ischial tuberosity, and the sacroiliac ligament, which bridges the sacrum to the posterior ilium. If you look at these on an anatomy map, they look like the end result of, if Spiderman taught Batman how to spin a web. Together they act to create stability along the sacroiliac joint, but the glute max latches on to all of this. It is the most superficial muscle in relation to a lot of deeper muscles and structures, so I always picture it grabbing on to whatever it can to lock itself in place. From here, the glute max drops obliquely and laterally to insert itself onto the IT band for the most part, which is a whole cool thing in and of itself, this massive muscle lends itself to a massive tendon that travels from just below the greater trochanter all the way down to the lateral knee. 

0:06:39.9 S2: The IT band is so fascinating, in fact that I did an entire episode on it, which I will include a link to in the show notes. But the glute max's most inferior fibers, dip deep and attach to the gluteal tuberosity of the femur. This little bump on the posterior and lateral aspect of the upper leg bone can be palpated on some people and is an important component when considering how to work this area. And this is the perfect segue into what the glute max does, remembering that the insertion points of a muscle are the bones that move when a muscle contracts, one can see how the glute max is gonna move the coxal joint or the hip. When all the fibers contract together, they will pull a leg back into extension, like you're getting ready to kick a soccer ball, rotate the hip out laterally, like you're trying to show someone a bruise on the inside of your ankle and abduct the hip, like you're attempting to climb over a fence or onto a horse. 

0:07:31.9 S2: When the lower fibers contract individually, not that this is an easy thing to make happen, they actually pull the leg back into adduction, like you're trying your hardest to stay on that horse, again, more on this in a bit. You also might remember though, that some muscles have actions that don't follow the bones of insertion, moving role. The glute max isn't one of them, but anatomy is a slippery slope. As I mentioned earlier, there are some cool ligaments securing the sacrum and the ilium into place, the glute max, having its fingers tightly gripped under this whole area is not, not going to have an effect. Reflecting on my previous comment about what happens with hyper or hypo-tenacity in a muscle, the glute max expresses this perfectly. With all of the reasons that a muscle can become too tense or lack necessary tone, or a muscle on the left side of the body can have more or less strength and its counterpart on the right or vice versa, when this happens with the glute max, it is clearly going to have an influence on how we feel about ourselves, not only because an off-kilter sacrum can cause a downward spiral of dysfunction that twists into many different directions, but also because if our butts feel funny, at least according to how society tells us they should feel, then we feel funny. 

0:08:43.6 S2: Bringing balance back to our butts, how we feel about ourselves, and these prominent muscles seated at the base of who we are, involves a lot of time, patience, and as I mentioned at the beginning of this episode, introspection. And just to bring this all full circle, scroll through my previous episodes to gain some insight about the identity crisis of the glute max's most intimate neighbor, the glute medius. I'm just saying the glute max's impact is greater than we realize. How your client feels their glutes should be operating may just be a socially influenced thought and not one that they have come to on their own. Even the expression of pain is defined at least partially by the interpretation of the brain, from a signal that it has received. And how a brain interprets a signal has become clouded by the internet. So as I walk you through a few techniques that will help you work in this area with more confidence, I urge you to guide your client to be introspective about their own experiences as you begin your session. 

0:09:40.3 S2: With your client prone, ask them to let go of their ankles, their knee caps and their belly buttons as you begin sinking in with gentle and slow compressions into the glute max. Start on one side. I would suggest the side that is not problematic, so that you can get a sense of what your client considers normal, move around the entirety of the glute max with your compressions, getting a sense of where you feel tension or laxity and listening to your client's feedback about possible pain or relief as you work. Repeat this work again on the same side, only this time with some engagement from your client towards the lower fibers, as I alluded to earlier, remember that they pull a leg into adduction. So asking your client to squeeze their legs together will help isolate this section of the muscle. You might consider using soft finger pads here to palpate the gluteal tuberosity, holding your pressure into this area as your client relaxes from pressing their legs together will even enhance your palpation skills and give you both more information about how this pointed area feels. 

0:10:42.2 S2: For the belly of the muscle, sink in again and ask your client to lift that same leg up off the table into slight hyper-extension, again, hold the compression as they relax, trying to gather even more information. And at the top of the glutes, ask your client to ever so gently lift their torso up off the table as you hold your pressure. If this is too difficult for them, even imagining the action, but not actually doing it can create a surprising response. Again, remain consistent with your hold into the fibers as they relax back down. Now, repeat all of this on the other side, you may find that what they're telling you is dysfunctional is actually indeed dysfunctional, or you might find tension or weakness where they did not, take your time and be methodical. Let your clients know that you might even use an entire session to gather information before proceeding with the plan. 

0:11:33.3 S2: Your willingness to dig deep and not make any assumptions about what you think you know will set the tone for them to do the same. It is not an easy task finding one's own balance as opposed to copying someone else's efforts, but the glutes are a good start. Take a deep breath, know your anatomy, listen to the tissues and take your time. Soon enough, those glutes will start feeling pretty good about themselves, even if they don't fit the mold. 

0:12:00.8 S2: And here we are, the end of the episode, thank you to the extraordinary crew over at ABMP for helping me get my words into your ears. And if you wanna get any of your words into my ears or more accurately into my brain via my eyeballs from a computer screen, drop me a line at rebelMT@abmp.com. That's R-E-B-E-L-M-T@abmp.com. I always wanna hear your questions, comments, suggestions or salutations. Also, if you're interested in checking out anything else I'm doing, head over to rebelmassage.com where you will find all sorts of fun things to click on, like homemade organic products for your practice, cool links to continuing education classes, thoughts I have typed up and posted here and there, and other Rebel Massage dabblings. 

0:12:51.9 Speaker 3: Members are loving ABMP Five-Minute Muscles and ABMP Pocket Pathology, two quick reference web apps included with ABMP membership. ABMP Five-Minute Muscles delivers muscle-specific palpation and technique videos plus origins, insertions and actions for the 83 muscles most commonly addressed by body workers. ABMP Pocket Pathology created in conjunction with Ruth Werner puts key information for nearly 200 common pathologies at your fingertips and provides the knowledge you need to help you make informed treatment decisions. Start learning today, ABMP members log in at abmp.com and look for the links in the featured benefits section of your Member home page. Not a member? Learn about these exciting member benefits at abmp.com/more