Are you aware that things like knee pain, back pain after squats, and problems (like losing your balance!) when standing on one foot could all have the same cause?
Gluteus medius can be the source of these problems and strengthening your gluteus medius can have huge benefits for your body and improve your mobility.
The 3 muscles that make up your gluteals or bottom muscles are gluteus maximus, gluteus medius and gluteus minimus. The trio are an important part of our overall function and well being. Together they provide movement and stability at the hip joint as well as supporting the lumbar spine and pelvis when we walk, stand up from a chair, climb stairs, cycle or run. Gluteal strength and stability are determinants for balance in all populations. They are also important in contributing to good knee and trunk control during any “dynamic” task.
Gluteus maximus is the most superficial muscle of the group, responsible for the main bulk of your bottom. It is a large powerful muscle that externally rotates and extends the hip (ie turns the leg outwards and lifts the leg behind you). Exercises like simple bridging and squats work your glut max.
Gluteus medius and gluteus minimus are deeper muscles. They originate from the top of the pelvis (the iliac crest) across the hip joint to the top of the thigh bone (femur). Both muscles generally perform the same action- hip abduction and internal rotation (ie lifting the leg out to the side and turning the leg inwards).
Gluteus medius is the much larger of these deeper muscles. As you can see from the picture below, when the fan shaped muscle fibres contract (or shorten in the direction of the arrows), the gluteus medius muscle will pull your leg outward into abduction.
Now, when your leg is on the ground, as it is during single leg activities like walking, your gluteus medius muscle contracts to stabilise the pelvis on the hip. This prevents your hip from hiking upward. This is known as a Trendelenburg gait or hip drop. It is described by the dropping of the opposite side of your hip, rather than the hip hiking on the standing leg. See the diagram below for a good representation of this.
If you think about it, as we spend a lot more time walking than we do lifting our leg out to the side, the primary function of the gluteus medius is to stabilise our hips. That is to maintain and keep them level or in a “neutral pelvis” position.
When you walk, for example, your gluteus medius keeps your pelvis steady so that the hip of your leg that is swinging off the ground doesn’t sag. This is crucial. If that hip were allowed to drop, your moving foot would also drop, hitting the ground. This is instead of swinging over it and allowing you to move forward.
So the gluteus medius becomes especially important when you’re balancing on one leg. Good examples are when you are setting up to kick in sports like soccer and for martial arts and yoga. Similarly, if you are a runner or play team sports, the demands on your gluteus medius when running, cutting, and jumping are much greater.
The Trendelenburg test (as shown in the diagram above) identifies weaknesses in your gluteus medius and other hip muscles. It does this by examining your body position when you stand on one leg. Usually, standing on one leg will mean strong contractions in the muscles of your gluteus medius and other hip abductors on the standing leg, which work to keep your entire pelvis stable. But when these muscles are weak, they’re unable to keep things steady and the hip of your lifted leg will drop noticeably – either backwards or down- so you will wobble and overbalance.
Weak glutes that fail to keep your body stable when moving can cause recruitment of other muscles to do the job. For example the muscles of your low back, hamstrings or your ITB. If your low back muscles, especially your quadratus lumborum, attempt to take on more and more of a job they aren’t designed to do, these muscles can tighten and contract painfully or spasm from being overworked. This often means your back starts to hurt, usually on the side with the weaker gluteus medius.
Other leg abductors, like your tensor fascia latae (TFL) can also become overworked if your gluteus medius is weak, leading to lateral hip pain, knee pain and ITB troubles.
The big take home message though is that a weak gluteus medius doesn’t only affect your butt- it can show up throughout your body. I see it often when people are exercising. Lets take two common exercises as an example- lunges and squats.
A weak gluteus medius can contribute to knees rolling in towards each other during both squats and lunges. It can also result in leaning forward more than necessary to balance. This can potentially put your back in jeopardy and aggravate knee pain. You might also be able to notice an asymmetrical weight shift. (See Samantha in the photo below- the arrow makes it more obvious). Here gluteus medius isn’t working properly to balance her pelvis as she lowers into her lunge or split squat.
So the effort that you put into performing these exercises may be wasted if you’re doing them with improper or poor form. You aren’t really getting stronger in a helpful way and you’re increasing your risk of injury. Potentially reinforcing problematic positions and chronic weaknesses.
So how do you fix this? – gluteus medius exercises
We know that gluteus medius lifts your leg outward, away from your body (abduction). It also maintains your hips in a neutral position when your foot is planted on the ground. Thus, your gluteus medius can be trained through any variation of these 2 motions.
We also know that research suggests that most individuals glutes contract harder during body weight gluteal activation exercises. So the BEST exercises for gluteus medius activation (in terms of how much of your gluteus medius is activated) are, in order,
The list goes on with around 20 other exercises- but many of these are hard, high level exercises for the average person.
You can start your gluteus medius training with simple clam exercises and bridging variations. These are safe and achievable for all ages and levels of fitness. * It is worth noting that the traditional clams exercise may not be the best exercise for the gluteus medius (if you consider the above list). But it has been shown to be the best exercise for most people to preferentially activate their gluteus max and gluteus medius while minimising the activation of their Tensor Fascia Latae or TFL. I also find that it is the easiest exercise for most people to start with and get successful activation of their gluteus medius.
We can progress clams and bridges with resistance bands and add in complexity by doing single heel lifts and single leg bridges, or add in a roller as demonstrated below (bridging on a roller)
In standing, using a small or large ball or roller at the hip (glutes with a roller) ticks the box in terms of a single leg activity and is a fabulous exercise that can also be modified easily to suit all exercisers.
When these exercises are producing good gluteus medius contractions we can add in single leg standing activities with bands, with or without chair support as shown in the photo below.
You can then progress to more dynamic (or moving activities) that start to simulate how we move in real life. This is where squats and split squats or lunges come in (now with correct gluteus medius activation of course!). Your planks and side planks could also be included. It is worth noting that a well rounded strengthening programme would also include exercises that targeted gluteus maximus as well as your core.
Our gluteals are capable of being the strongest muscles in our body. If properly trained they can bolster athletic performance, basic balance and reduce our risk of developing hip, back and knee pain. If you think your gluteals should be assessed or would like to know more about exercises to strengthen them, please get in touch.