The gluteus medius muscle is an important frontal plane stabilizer of the pelvis. Although its primary function is pelvic stabilization in single leg stance (closed-chain), many therapists and trainers continue to strengthen the gluteus medius in an open chain using hip abduction. The addition of an unstable surface such as a Thera-Band® Stability Trainer is thought to increase muscle activation due to the increased challenge of stabilizing the pelvis in the frontal plane while balancing on a labile surface.
Researchers found that single leg stance exercises produced significantly greater glute med EMG activity compared to bilateral stance. In addition, single leg squats produced significantly more EMG activity than single leg stance. While not statistically significant, performing single-leg exercises on a foam pad did produce more EMG activity of the gluteus medius than a stable surface.
The gluteus medius is normally associated with movement. Weak glut medius muscles have ‘ruined’ more running seasons than perhaps any other single cause of running-related injury.
Appropriate assessments, exercise and rehabilitation can restore proper glut medius function.
The gluteus medius muscle originates at the top of the ilium (hip bone of the pelvis) below the iliac crest, and runs to the top outside surface of the greater trochanter (outer side of the thigh bone). It is the major abductor of the thigh (lifts it away from the body to the side). The fibres at the front rotate the hip internally and the rear fibres rotate it externally.
During walking or running when the foot is on the ground the gluteus medius is a pelvic stabiliser. It helps to keep the hips parallel to the ground. If the gluteus medius is not functioning well enough to achieve this control, compensation will occur.
Weakness in gluteus medius will have implications all the way down the kinetic chain. For example:
- the femur (thigh bone) to shift inwards and internally rotate excessively
- the knee to fall into a knock-kneed position
- the lower leg to rotate internally relative to the foot
- weight to be excessively transferred to inner side of the foot.
As a result you are at increased risk of any condition relating to excessive and/or prolonged pronation of the foot, such as medial tibial stress syndrome or Achilles tendinitis.
What contributes to gluteus medius weakness:
- Medical – hip rotator tears and congenital dislocation of the hip
- Lifestyle – standing predominantly on one leg with the pelvis swayed sideways and hip joint adducted (the classic hip-hitch slouch, often used by mothers when they stand with a child in their arms)
- Simply sleeping on your side with the top leg flexed and adducted over the other leg: maintaining an elongated position for sustained periods can weaken the glute med.
My favorite exercises for the gluteus medius are side lying hip abduction, single leg squats, and lateral band walks.
Come in and I’ll teach you how to perform these maneuvers with perfection.
When I ask you to perform a squat, I get so much information about the way you move and walk. The info in the chart below explains some of that. The strength and function of the gluteal muscles is probably the most important active muscle in the achievement of efficient walking or running. One of our major treatment goals is to improve your gait.
The deep-lying glut med muscle is normally associated with movement, and it’s key role in running is to act as a stabilising force, to slow the downward drive of the pelvis on the opposite side during stance phase. I see all kinds of adaptations & compensations for weak gluteus medius muscles.
How clients cheat to compensate for weak buttocks
||Areas at risk of structural overload
|1. Excessive lateral pelvic tilt (Trendelenburg)
||Lumbar spine, sacroiliac joint (SIJ), greater trochanter bursa, insertion of muscle on greater trochanter, overactivity of piriformis and tensor fascia lata (TFL)
|2. Medial knee drift
||Lateral tibiofemoral compartment (via compression), patellofemoral joint, patella tendon and fat pad, pes anserinus, iliotibial band (ITB)
|3. Lateral knee drift
||Medial tibiofemoral compartment (via compression), ITB, posterolateral compartment, popliteus
|4. Same-sided shift of trunk (lateral flexion of trunk)
||Lumbar spine (increased disc and facet joint compression), SIJ (increased shear)
I gave you the “clam” maneuver to improve your glute medius:
Here it is: In side-lying, both hips are flexed to 30 degrees with knees bent and hips and feet stacked in line. You have to open the top knee while keeping heels together, and most importantly, holding the pelvis completely still (one on top of the other). Don’t let your pelvis rotate – if it does like when we were together in the office, it means you are not able to isolate the muscle and you are trying to recruit (‘cheate’) with the TFL muscle.