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Soft Tissue Release (STR) treatments for the gluteus maximus and the deep lateral rotators

This is an excerpt from Soft Tissue Release, 4th Edition by Mary Sanderson.

With the subject in a prone position, apply pressure at points off the gluteal attachments by locking in and moving away from the iliac crest and away from the sacrum while the subject attempts to flex the hip by pushing the knee into the table (fig. 3.5). Given that the lock is precise, a small stretch will be felt. To obtain a more significant stretch in the muscle as a whole, treat the muscle in a side-lying position, in which full flexion can be obtained by the subject actively flexing the hip.

Alternatively, with the subject in a prone position and the knee flexed to 90 degrees, gently rotate the leg medially and laterally (see fig. 3.6). This will in itself indicate restriction in the hip and/or pelvis. Lock in appropriately, broad surface first, away from the sacrum, then away from the iliac crest, each time applying the pressure, then medially rotating the leg and releasing the pressure to return the leg to the starting point. Systematically cover the whole of the gluteus maximus area. Active STR is beneficial particularly if there is a reduced range of movement, in which case the subject only moves through a range that is comfortable.

Once the muscle is released, progress to the deep lateral rotators. Angle your elbow or a knuckle slowly, maintaining relaxation through the gluteal muscles towards the piriformis, which can be located halfway between the sacrum and the greater trochanter (fig. 3.7a). Apply the lock and medially rotate the hip.

The quadratus femoris can be reached by gliding away from the ischial tuberosity to the back of the greater trochanter. The other rotators can also be approached by locking inferior to the piriformis, although they may be difficult to differentiate. Having attained any one of these deep pressures, hold the pressure as the hip is medially rotated, then promptly release the pressure. In side-lying the subject can lift their ankle to produce medial rotation of the hip (fig. 3.7b).

Medial Rotation of the Hip

Major Muscles: Anterior fibres of the gluteus medius, gluteus minimus and TFL, pectineus, adductor longus, adductor brevis, adductor magnus and piriformis (at a range of more than 90 degrees).

Medial Rotators – Treatment

The gluteus medius and minimus can be treated as one, the minimus lying directly under the medius. Apply pressure in the gluteus medius (anterior fibres), away from the iliac crest, and laterally rotate the leg; apply a deeper pressure to target the gluteus minimus and again laterally rotate the leg.

Another useful manoeuvre is with the subject supine. Link into the medius with the fingers of one hand reinforced with the other hand and slowly pull the fibres transversely very slightly. Lock the subject’s opposing hip with your knee to stabilise the pelvis while the subject actively rotates the leg, medially if the posterior fibres are locked and laterally if the anterior fibres are locked. It is also possible to work the TFL effectively here using the same method.

Lumbosacral Junction and Sacroiliac Joint Area – Treatment

This joint area is included here with the hips, because of the impact restrictions can have on the lumbopelvic motion and hip movement. It is also a key area to address when treating the back.

Place the subject in a side-lying position and, using a knuckle to apply an MFR lock away from the PSIS, instruct the subject to minimally flex the hip; alternatively, ask the subject to posteriorly tilt the pelvis. Progress to the ‘V’, between the PSIS and the lumbosacral joint, and apply an MFR lock, again guiding the subject into hip flexion or a posterior tilt of the pelvis (fig. 3.8).

More Excerpts From Soft Tissue Release, 4th Edition

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