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PLoS One. 2017 Jul 17;12(7):e0177008. doi: 10.1371/journal.pone.0177008. eCollection 2017.

Atrophy of gluteus maximus among women with a history of chronic low back pain.

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Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, United States of America.
Department of Biomedical Education and Anatomy, The Ohio State University, Columbus, Ohio, United States of America.



Although the relationship between low back pain (LBP) and the size of certain trunk muscles has been extensively studied, the relationship between gluteus maximus (GM) size and LBP has been only minimally examined. Determining whether such a relationship exists would help improve our understanding of the etiology of LBP, and possibly provide a rationale for the use of therapeutic exercise interventions targeting GM with LBP patients. The objective of this study was to compare gluteus maximus cross-sectional area in individuals with chronic LBP, and in a group of individuals without LBP. Our hypothesis was that individuals with LBP would have greater atrophy in their gluteus maximus muscles than our control group.


For this case-control study, we analyzed medical history and pelvic computed tomography (CT) scans for 36 female patients with a history of chronic LBP, and 32 female patients without a history of LBP. Muscle cross-sectional area of gluteus maximus was measured from axial CT scans using OsiriX MD software, then was normalized to patient height, and used to compare the two groups. The number of back pain-related medical visits was also correlated with gluteus maximus cross-sectional area.


Mean normalized cross-sectional area was significantly smaller in the LBP group than in the control group, with t = 2.439 and P<0.05. The number of back pain-related visits was found to be significantly correlated with normalized cross-sectional area, with r = -0.270 and P<0.05. The atrophy seen in the present research may reflect incidental disuse atrophy seen with LBP, which is present in many muscle groups after prolonged immobilization or with a sedentary lifestyle.


This research demonstrated a previously only minimally explored relationship between gluteus maximus cross-sectional area and LBP in women. Further research is indicated in individuals with varying age, sex, and LBP diagnoses.

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