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The ilium is the largest of the three bones that make up the pelvis. It is the uppermost bone of the hip and is essential for locomotion as it supports the spine when the body is upright. The iliac crest is the most prominent part of the ilium and is the site where many important muscles attach. These muscles include the gluteus maximus, gluteus medius, gluteus minimus, and iliacus muscles. The psoas muscle, which is a core muscle that helps move the hips and upper legs, also attaches to the ilium. Inflammation or injury to any of the tendons and muscles that attach to the ilium can cause pain and discomfort.
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What You'll Learn
Gluteus maximus
The gluteus maximus is the outermost muscle of the buttocks, forming the prominence of the gluteal region. It is the largest and heaviest muscle in the human body. It is enveloped by a thin fascia that separates it from the adjacent subcutaneous tissue. The gluteus maximus is a tensor of the fascia lata, and by its connection with the iliotibial band, it steadies the femur on the articular surfaces of the tibia during standing. The muscle's main functions are the extension, valgisation, and external rotation of the knee and thigh at the hip joint. It also assists in abduction and adduction of the thigh. The gluteus maximus is involved in several sports, from running to weightlifting, and is considered a symbol of health and strength.
The gluteus maximus originates from several sites, including the posterior gluteal line of the outer upper ilium, a bone of the pelvis, as well as above it to the iliac crest and slightly below it. It also originates from the lower part of the sacrum and the side of the coccyx, the aponeurosis of the erector spinae (lumbodorsal fascia), the sacrotuberous ligament, and the fascia covering the gluteus medius (gluteal aponeurosis). The muscle fibres take an inferolateral course, converging towards the femur. The most superficial three-quarters of the muscle form a tendinous lamina that inserts between the two layers of the fascia lata, contributing to the formation of the iliotibial tract.
The gluteus maximus is associated with three bursae: the trochanteric, ischial, and gluteofemoral bursae. The trochanteric bursa separates the gluteus maximus from the greater trochanter, the ischial bursa separates it from the ischial tuberosity, and the gluteofemoral bursa separates the iliotibial tract from the vastus lateralis. These bursae help facilitate smooth movement and reduce friction between the gluteus maximus and surrounding structures.
The gluteus maximus is innervated by the inferior gluteal nerve (L5-S2), which originates from the ventral rami of L5, S1, and S2. The nerve emerges from the inferior border of the piriformis muscle. The gluteus maximus receives its vascular supply from the muscular branches of the inferior gluteal, superior gluteal, and internal iliac arteries. These vessels enter the muscle at its centre, providing essential oxygenated blood for its function and growth.
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Gluteus medius
The gluteus medius is a large fan-shaped muscle located on the lateral aspect of the upper buttock, below the iliac crest. It is one of the three gluteal muscles, alongside the gluteus maximus and gluteus minimus. The gluteus medius is a primary hip abductor, responsible for moving the hip joint and maintaining the stability of the pelvis, especially during locomotion.
The muscle fibres of the gluteus medius take distinct courses based on their position. The fibres of the posterior portion pass forwards and downwards, while the fibres of the anterior portion pass backwards and downwards. The gluteus medius is supplied by the superior gluteal nerve and the superior gluteal artery, which is the largest branch of the internal iliac artery.
The gluteus medius plays a crucial role in gait and locomotion. When a limb is lifted off the ground, the gluteus medius works to prevent the pelvis on that side from dropping, allowing the other limb to swing forward for the next step. This muscle also supports the pelvis during walking, running, or when standing on one leg by producing hip rotation, with assistance from the gluteus minimus and tensor fascia lata.
Weakness or dysfunction of the gluteus medius can lead to gait disturbances and lower-limb musculoskeletal issues. Sitting with crossed legs for extended periods can potentially weaken the gluteus medius by elongating the muscle beyond its resting length. This can result in reciprocal inhibition, causing the body to rely on other muscles for stability and leading to tightness and overactivity in certain muscle groups.
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Gluteus minimus
The gluteus minimus is the smallest of the three gluteal muscles. It is fan-shaped and performs hip abduction, providing hip stabilization and movement away from the body. It acts in synergy with the gluteus medius to abduct and internally rotate the thigh, and contributes to the stabilisation of the hip and pelvis. The gluteus minimus also externally rotates the thigh when the hip is extended. Its anterior segment reduces the stresses on the hip anterosuperior structures, while its posterior segment stabilises the head of the femur.
Weakness in the gluteus minimus results in a trendelenburg gait, where the pelvic drops on the unsupported side. Lateral step-down tests are used to assess the quality of movement around the lower kinetic chain. Gluteus minimus tendinopathy often results in Greater Trochanteric Pain Syndrome (GTPS). The muscle has multiple trigger points referring strong pain in the lumbar spine and ends at the ankle, following a similar pain pathway to the sciatic nerve.
The gluteus minimus is composed of two distinct segments (anterior and posterior) with two different roles. The anterior fibres also flex the hip, and by drawing the greater trochanter forward, rotate the thigh inward, in which action they are assisted by the tensor fasciae latae. The gluteus minimus is similar to the gluteus medius in function, structure, nerve and blood supply.
The gluteus minimus is an important muscle that attaches to the ilium, the largest and uppermost bone of the hip and pelvis. The ilium forms the right and left sacroiliac joints with the sacrum, and the sacroiliac ligaments attach the ilium to the sacrum. The ilium is a weight-bearing part of the skeleton, supporting the spine when the body is upright and enabling locomotion.
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Rectus femoris
The rectus femoris is a muscle in the human body that is part of the quadriceps group. It is located in the superior, anterior middle compartment of the thigh and is the only muscle in the quadriceps group that crosses the hip. The word rectus is derived from the Latin word for "straight", which is why the rectus femoris is named as such—it runs straight down the thigh.
The rectus femoris is a two-way acting muscle as it crosses over the hip and knee joints. It functions to extend the knee and also assists the iliopsoas in hip flexion. It is thus also a hip flexor. The rectus femoris is a direct antagonist to the hamstrings, at the hip and at the knee. The muscle is the anterior thigh compartment's most superficial and nearly vertically oriented muscle. It is also known as the "kicking muscle" for its involvement in activities involving forceful knee extension.
The rectus femoris is prone to injury since it crosses both the knee and the hip. Rectus femoris strain, referred to as hip flexor strain, is an injury commonly at the tendon that attaches to the patella or in the muscle itself. The injury is usually a partial tear, but could be a full tear. The injury is caused by a forceful movement related to sprinting, jumping, or kicking and is common in sports like football or soccer. Symptoms include a sudden sharp pain at the front of the hip or in the groin, swelling and bruising, and an inability to contract the rectus femoris with a full tear.
The muscle tissue of the rectus femoris arises from the myotomic portions of somites, which arise from the mesoderm. The femoral artery supplies blood to the quadriceps muscle via the lateral femoral circumflex branch. The muscle's venous drainage is via the femoral vein and its branches. Lymphatic vessels of the anterior thigh drain into the superficial inguinal nodes.
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Iliacus
The iliacus is a flat, triangular muscle that fills the iliac fossa, the curved surface of the largest pelvic bone. It forms the lateral portion of the iliopsoas, which is the chief flexor of the hip joint. The iliopsoas is formed by the combination of the iliacus and the psoas major muscles. The iliopsoas is responsible for hip flexion and is involved in trunk flexion, such as bending the trunk forward when performing a sit-up or bending down. The iliacus muscle is also continuously active during walking, and it helps to maintain proper body posture.
The iliacus muscle has a vast origin, with the majority of it arising from the superior two-thirds of the iliac fossa. The rest of the iliacus muscle arises from several other origin points, including the inner lip of the iliac crest, the lateral aspect of the sacrum, and the anterior sacroiliac and iliolumbar ligaments. The muscle fibres converge distally towards the hip, contributing to the triangular shape of the muscle. At the level of the hip joint, the iliacus muscle fibres blend with those of the psoas major muscle, forming a common tendon for the iliopsoas.
The iliacus muscle is innervated by the femoral nerve (L2-L4) and is mainly supplied by the iliolumbar artery. It also receives blood from the deep circumflex iliac, obturator, and femoral arteries. The anterior surface of the pelvic part of the iliacus muscle is covered with the iliac fascia, which separates it from the peritoneum. This surface of the iliacus is also crossed by the lateral femoral cutaneous nerve, the cecum on the right side, and the iliac part of the descending colon on the left side. The medial margin of the iliacus muscle is in relation to the femoral nerve and the lateral margin of the psoas major muscle.
The iliacus muscle can be prone to shortening, especially in individuals with sedentary jobs or those who engage in excessive exercise without adequate stretching. As the iliacus muscle shortens, it can cause dysfunction and injuries in the hip and pelvic regions. This can manifest as trigger points, tight areas, or knots in the muscle that are painful, tender, and stiff. Additionally, a shortened iliacus can lead to iliacus ischemia, a condition characterised by reduced blood flow to the muscle. Imbalances in the length of the iliacus muscle on either side of the hip can affect a person's gait, resulting in walking with imbalanced hips.
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Frequently asked questions
The ilium is the largest of the three bones that make up the pelvis or hip bone. It is an essential part of the pelvic girdle.
Many muscles are attached to the ilium, including the gluteus maximus, medius, and minimus, the tensor fascia latae, internal and external obliques, latissimus dorsi, and rectus femoris.
The muscles attached to the ilium are important for hip movement and stability. For example, the gluteus maximus extends and laterally rotates the hip joint.
The iliac crest is the most prominent part of the ilium, forming the curved top border of the bone. It is the site where many important muscles attach.
The psoas muscle is a long, ribbon-shaped core muscle that starts in the lower back and runs through the pelvis to the top of the femur. It is one of the muscles that help move the hips and upper legs and stabilize posture. The psoas muscle, along with the iliacus muscle, forms the iliopsoas muscle group.
