The gluteus maximus has a dual insertion — upper fibres into the iliotibial band and lower fibres directly onto the gluteal tuberosity of the femur. The IT band insertion allows the gluteus maximus to extend the knee indirectly by tightening the iliotibial band. Avulsion of the gluteus maximus origin from the sacrum or posterior ilium is rare but occurs in high-energy sports from explosive hip extension.
Hip extension force transmission; IT band tensioning during stance; proximal hamstring substitute in running
Gluteus maximus avulsion injuries produce buttock pain and hip extension weakness in sprinters and rugby players. MRI shows haematoma at the posterior iliac or sacral origin. Gluteus maximus strengthening through hip hinge movements (deadlifts, Romanian deadlifts, hip thrusts) is a primary exercise for posterior chain power development.
Rare high-energy posterior hip injury producing buttock pain and extension weakness managed conservatively for most partial avulsions.
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