The Gluteus Medius

It’s All In The Hips: The Importance Of The Gluteus Medius.

The Gluteus Medius is one of the most important muscles in the hips, but more often than not, one of the most neglected when it comes to exercising and training.  If you’ve had a recent increase in back and/or lower body pain, whether you’re a weekend warrior, a novice exerciser, or even an avid exerciser, it’s quite possible weakness in the hips specifically the gluteus medius muscle could be the source of your symptoms .  

“I’m trying to get in shape, but I keep getting injured, what do I do?”

With the recent increase in participation in exercises including HIIT or high intensity training, crossfit, powerlifting, and obstacle course training, there has been an increase in the number of back and lower body injuries. A common mistake is the muscles that stabilize the body go untrained resulting in overactive mover muscles and weak stabilizer muscles. This imbalance creates faulty movement patterns which can eventually lead to poor performance and injury.

The gluteus medius is the main muscle involved in stabilizing your hips, as well as rotating them inside and out. Adequate strength, activation, and endurance of this muscle are essential for optimizing walking, running, and sprinting.

Where is the Gluteus Medius and What Does It Do?

The Gluteus Medius is one of the three muscles that make up the gluteal muscles (gluts, hips, butt, etc). It’s located on the side of your hip and attaches from the top of the pelvis to the top of your thigh bone. Situated underneath the Gluteus Maximus, the gluteus Medius works in conjunction with the Gluteus Minimus to support the hips. The Gluteus Medius absorbs forces during landing phase of gait/running, assists in propelling the leg forward, and stabilizes the pelvis and trunk during walking and running.  The Glut Med also assists with hip abduction or moving for leg away from your body to the side.

My Hips don’t work?

There are 2 contributing factors that can lead to Gluteus Medius dysfunction. The first being the muscle is too weak. The other being the muscle is fatigued or overworked.

Gluteus Medius Weakness

A weak glut muscle can increase stress on other muscles and its surrounding structures. Weakness with this particular muscle may cause your thigh to angle inwards and rotate abnormally during walking, running, and jumping. Due to this compensation, excessive stress is placed through your knee and ankle and may place you at an alarming risk for injury if weakness of the gluteus medius persists.

Gluteus medius weakness/decreased endurance/overtraining may indirectly contribute and be associated with the following conditions:

• Gluteal Tendinopathy

• Gluteal Muscle Strain or Tear

• Patellofemoral Joint Pain Syndrome / Anterior Knee Pain

• ITB Friction Syndrome

• Achilles Tendinopathy

• Hamstring Injuries

• Hip and Knee Osteoarthritis

• Piriformis Syndrome

• Trochanteric Bursitis

Benefits of Physical Therapy

If you are having lower extremity pain or back pain visit your physical therapist for a evaluation. Your PT will perform a muscle screening, assess what is causing your symptoms and either create a treatment plan or refer you to the appropriate medical professional. The goal of physical therapy is to get you back to your normal, pain-free activity level as quickly and safely as possible. Some sample exercise your therapist may recommend include:

Exercises to Strengthen the Gluteus Medius

Before initiating any exercise program it is advised to check with your physical therapist or physician. Correct rehabilitation of an injury is key to a successful return to optimal level of functioning as well as minimizing the risks for re-injury.

Side-lying Hip Abduction

While lying on your side, slowly raise up your top leg to the side. Keep your knee straight and maintain your toes pointed forward the entire time. Keep your leg in-line with your body. The bottom leg can be bent to stabilize your body.

Single-leg Bridges

Lay on your back with your hands by your sides, your knees bent and feet flat on the floor. Make sure your feet are under your knees. Tighten your abdominal and buttock muscles. Raise your hips up to create a straight line from your knees to shoulders. Squeeze your core and try to pull your belly button back toward your spine. Slowly raise and extend one leg while keeping your pelvis raised and level. If your hips sag or drop, place the leg back on the floor and do a double leg bridge until you become stronger.

Straight-leg Bridges with Ball

Begin lying flat on the ground with your legs extended out in front of you. Your feet will either be suspended in your suspension trainer straps or elevated, resting on your heels on a low bench. Place your arms on the ground by your sides to brace yourself. Squeeze your glutes and push your hips skyward through your heels, keeping your legs extended. Be sure to engage your core to help protect your lower back. Lower to your starting position and repeat

Clams

Lie on your side, with legs stacked and knees bent at a 45-degree angle. Rest your head on your lower arm, and use your top arm to steady your frame. Be sure that your hip bones are stacked on top of one another, as there is a tendency for the top hip to rock backward. Engage your abdominals by pulling your belly button in, as this will help to stabilize your spine and pelvis. Keeping your feet touching, raise your upper knee as high as you can without shifting your hips or pelvis. Don’t move your lower leg off the floor. Pause, and then return your upper leg to the starting position on the ground.

Wall Squat with Ball

Place the ball between the wall and your lower back, walking your feet out slightly. Lower your body toward the floor in a squat position as you continuously push back into the ball. Straighten your legs, keeping your weight over your heels to return to standing position.

Isometric Single-leg Wall Lean

Standing parallel to a wall, flex the hip closest to the wall to 90 degrees, with the knee bent. Press the foot of the stance leg into the floor while driving the bent leg into the wall. The gluteus medius of the standing leg will fire to stabilize the pelvis.

Crab Walk

Place a resistance band just below your knees. Begin standing with feet directly underneath your hips, and squat about halfway down. Take a step sideways to the right as far as you can. To fully activate the muscle, be sure to step onto your heel, rather than your toes. Actively resist the pull of the exercise band as you bring your left leg slowly toward your right, returning to the starting position. Step to the right 20-30 times, then reverse directions stepping to the left 20-30 times; you really want to feel the muscle burn. Repeat for three sets.

Monster Walk

Place the band around both legs. If you place higher up the leg, the move will be easier. If you place it around your ankles, or even your feet, the move will be more difficult. Step out wide so your feet are between hip-width and shoulder-width apart. You will then step forward and out to the side with one foot. Then step forward and out to the side with the other. You want to take “monster,” big steps, keeping your feet as wide apart as you can while moving forward. Then walk backwards in the same manner. You can do both a low monster walk (more of a squat) and a straighter leg monster walk. Try not to waddle or rotate your hips too much as you walk.

 

Incorporating trunk and back stabilizing exercises to this program can also reduce the distribution of load and reduce overcompensation of the gluteus medius.

So if you’re having pain or keep straining your lower body or back, remember it may all be in the hips.

References:

Barton, C.J., Lack, S., Hemmings, S., Tufail, S. & Morrissey, D. (2015). The Best Practice Guide to Conservative Management of Patellofemoral Pain: incorporating level 1 evidence with expert clinical reasoning. British Journal of Sports Medicine, 49, 923-934.

Kim, D., Unger, J., Lanovaz, J. & Oates, A. (2016). The relationship of anticipatory gluteus medius activity to pelvic and knee stability in the transition to single-leg stance. American Academy of Physical Medicine and Rehabilitation, 8, 138-144.

Semciw, A., Neate, R. & Pizzari, T. (2016). Running related gluteus medius function in health and injury: A systematic review with meta-analysis. Journal of Electromyography and Kinesiology, 30, 98-110.

Witvrouw, E. etal. Patellofemoral pain: consensus statement from the 3rd International Patellofemoral Pain Research Retreat held in Vancouver, September 2013. BJSM: 2014; 48: 411-414

 

Cooper, N.A. et al. (2016). Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. European Spine Journal, 25, 4, 1258–1265.

Macadam, P., Cronin, J., and Contreras, B. (2015). An examination of the gluteal muscle activity associated with dynamic hip abduction and hip external rotation exercise: A systematic review. International Journal of Sports Physical Therapy, 10, 5, 573–591.

Philippon, J. et al. (2011). Rehabilitation exercise progression for the gluteus medius muscle with consideration for iliopsoas tendinitis: An in vivo electromyography study. The American Journal of Sports Medicine, 39, 8, 1777–1786