The gluteal muscles are a group of three muscles that make up the buttocks. These consist of the gluteus maximus, gluteus medius and gluteus minimus. The three muscles originate from the ilium and sacrum and insert on the femur. Along with many other smaller, supporting muscles – act as a base of support for the pelvis and hips. The muscles functions include extensions, abduction, external rotation and internal rotation of the hip joint. 

  • Gluteus maximus 

This is the largest of the gluteals, it attaches to the side of the sacrum and femur. It is responsible for extending and externally rotating the hip joint. The maximus creates forward thrust as you walk, run and rise from a sitting position. 

  • Gluteus medius 

This muscle sits partway under the gluteus maximus and connects the ilium (hip bone) to the side of the upper femur. It helps externally rotate the leg when its extended backwards and internally rotates the hip when the leg is flexed forwards. Together with the gluteus minimus, this muscle abducts the hip. 

  • Gluteus minimus 

A smaller muscle located under the gluteus medius, the minimus helps abduct, flex and internally rotate the hip. This muscle is used when making circular movements with the thigh. 

Underneath these three main gluteal muscles are what are commonly referred to as the ‘deep six’ or ‘lateral rotator group’ all of which externally rotate the femur in the hip joint. These muscles include: 

● Obturator internus 

● Quadratus Femoris 

● Gemellus Inferior 

● Obturator Externus 

● Gemellus Superior 

● Piriformis 

Nerves of the gluteal region 

There are a number of significant nerves that either directly innervated the buttocks or pass through the gluteal area to innervate more inferior regions such as the perineum and thigh. 

These nerves can be categorised into superficial (clunial nerves) that provide sensation to the skin of the buttock area, and the seven deep gluteal nerves either directly innervate the gluteal structures or continue through to other areas. These seven deep nerves are known as: 

● Superior gluteal nerve 

● Inferior gluteal nerve 

● Sciatic nerve 

● Nerve to quadratus femoris 

● Posterior cutaneous nerve of the thigh 

● Nerve to obturator internus 

● Pudendal nerve 

  • The clunial nerves  

The most superficial nerves of the gluteal region are the inferior, middle and superior clunial nerves. The provide sensation within the borders of the iliac crest. 

  • Deep gluteal nerves 

The seven deep gluteal nerves all originate via the lumbosacral plexus or sacral plexus, all exit the pelvic region through the greater sciatic foramen with the exception of the superior gluteal nerve, all travel through the infrapiriform foramen to innervate gluteal regions or other inferior structures. 

  • Sciatic neve 

The sciatic nerve does not supply any of the gluteal region, however due to its relationship with the piriformis and individual variability in its course, it is an important structure of the gluteal region. Any damage caused to the sciatic nerve can lead to life changing and long-term health risks to the client. 

Blood vessels of the gluteal region 

The major arteries that supply the gluteal region are the superior gluteal artery and the inferior gluteal artery. The superior gluteal artery divides through the suprapiriform foramen into a superficial branch that supplies the gluteus maximus and an inferior branch that supplies the gluteus minimus, medius and the tensor fasciae latae. 

The inferior gluteal artery also originates via the iliac arteries and descends through the infrapiriform foramen travelling deep into the gluteus maximus, turator internus, quadratus femoris and proximal fibres of the hamstrings. 

Veins of the gluteal region 

The superior and inferior gluteal veins arise from the internal iliac veins and travel alongside the superior gluteal artery and inferior artery through the suprapiriform foramen and infrapiriform foramen to drain blood from the gluteal region. As a safety mechanism the gluteal veins also connect with the femoral veins to provide an alternative pathway for blood to return if the femoral vein becomes occluded.