Gluteals, Piriformis, TFL

Overview of Gluteal Muscles

• Discussed muscles: Gluteals, Piriformis, Tensor Fasciae Latae (TFL)

• Focus on bony landmarks as reference points for acupuncture and palpation techniques.

Bony Landmarks & Acupuncture Points

• Gluteal Fold: Key area for finding acupuncture points; vary with individual size.

• Popliteal Fossa: Important structure, be prepared for examination questions.

• Posterior Superior Iliac Spine (PSIS) and Iliac Crest: Previously covered landmarks.

• Gluteal Cleft: Refers to tissue cleft of the buttocks, not coccygeal or sacral regions.

• Linea Aspera: Both medial and lateral lips identify attachment points for muscles.

  • Obturator Foramen: Key identification point for associated muscles.

• Greater Trochanter: Significant landmark for attachment of lateral hip rotators.

Muscle Origins and Attachments

• Gluteus Maximus: Originates from PSIS, Iliac Crest, Sacrum, and Coccyx; inserts at Gluteal Tuberosity and IT band.

  • Main function is to extend the hip and act as a strong lateral rotator.

• Gluteus Medius: Situated beneath Gluteus Maximus; important for hip abduction.

  • Anterior fibers flex and internally rotate hip; posterior fibers extend and externally rotate hip.

• Gluteus Minimus: Positioned lower than Medius; primarily involved in hip abduction, internal rotation, and slight hip flexion.

Palpation Techniques

• Greater Trochanter: Best palpated with a broad hand to ensure proper location; use internal and external rotation of the leg to assist.

• Piriformis: Locate between PSIS and Sacral Hiatus; insertion on greater trochanter.

Anatomy of the TFL and IT Band

• TFL assists in tensioning the IT band; primarily functions in hip flexion, abduction, and medial rotation.

• IT Band: Thickening of fascia lata; runs laterally down the leg and can be palpated along the lateral femur.

Piriformis and Lateral Rotators

• Piriformis: Abducts and laterally rotates the hip; originates from the sacrum and inserts on greater trochanter.

• Lateral rotators: Include other muscles like Obturator Internus, Superior and Inferior Gemellus, Quadratus Femoris.

Actions of Gluteal Muscles

• Gluteus Maximus: Hip extension, lateral rotation, and adduction based on the position of the hip.

• Gluteus Medius and Minimus: Hip abduction, with varying degrees of internal and external rotation depending on which fibers contract.

Ligament Overview

• Sacrotuberous Ligament: Key for hip stability; important for identifying associated structures like the sacrospinous ligament.

• Iliolumbar Ligaments: Stabilize the SI joint; relevant in assessing lower back pain.

Clinical Considerations

• Beware of tenders points in the gluteal region; importance in identifying specific acupuncture and trigger points.

• Greater Trochanteric Pain Syndrome: A common issue not solely attributed to bursitis; encompasses tendon inflammation and mechanics.

Summary of Techniques

• Employ structurally sound techniques for needling and palpation.

• Be cautious with depth and pressure in sensitive areas to avoid over-palpation injuries.

Closing Remarks

• Encouraged students to think critically about the content and engagement in upcoming classes.