So….You’ve been told off by your physio/trainer/osteopath that you need to strengthen your glutes. What does glute weakness actually mean? What are the glutes? What is their function in our body? How can we assess if they are working properly? What can we do if we have pain, weakness or issues with our glutes? Here we will discuss all things glutes and give you plenty of great advice on how to have great functioning glutes in a matter of weeks and improve your current function.
Reading not your style? Have a look at these two short videos with Physiotherapist Ryan Dorahy on how to assess for glute weakness and exercises which improve glute strength.
Anatomy:
The gluteals (glutes) are collectively a group of three muscles (gluteus maximus, gluteus medius, and gluteus minimius) that are located in back and side of your hip joint. Gluteus medius is located on lateral aspect of the upper buttock, below the iliac crest (the bony top of your hip on the side) and inserts into the greater trochanter of the femur (the protruding bump at the top of your thigh bone). Gluteus maximus overlaps this muscle and is located at the back of your hip. Glute minimus sits underneath the two muscles as shown in the picture to the right. For the purpose of this blog, gluteus medius is the important muscle we will be discussing.
Gluteus Medius Function:
Gluteus medius acts to abduct (moving your whole leg sideways) and inwardly rotate the hip. Even more importantly, it stabilises the hip during single leg stance phase when walking, running and changing direction. When one leg is elevated from the ground, the hip naturally would drop due to a loss of support from the ground if not for the help of the gluteus medius. The gluteus medius contracts to elevate the hip off the ground and therefore allow the leg to swing forward to take the next step.
Causes of gluteus medius weakness or dysfunction:
The gluteus medius will not function correctly due to pain, poor mechanics or weakness. Below are some common pathologies of the gluteus medius:
Recent gluteus medius muscle tear/rupture: Generally seen in runners and athletes involved in high-impact sports. It usually occurs from a sudden burst of activity in combination with poor hip mobility. In some instances, it can also be seen in degenerative causes where chronic wear and tear of the muscle over time leads to tear/rupture.
Tendinopathy (glute medius tendon issue): Acute or degenerative damage to the gluteus medius tendon that inserts to your femur. You would generally find a slow onset of lateral hip pain and weakness associated with this form of dysfunction.
Neurological issue: The gluteus medius is controlled by the superior gluteal nerve (root L4, 5 and S1). Issues with this nerve can leave to the impaired innervation of the gluteus medius and therefore poor or no activation during normal activities.
Signs of glute weakness:
With glute weakness you may present with some or all of the following:
Postolateral hip pain: Pain at the back and side of your hip. This is usually apparent with exercise such as walking and running. However, may also be associated with sleeping at night if there happens to be a greater tronchanteric bursitis coexisting.
Onset of pain may be a slow and insidious onset or an acute sharp pain depending on the glute medius pathology. See CAUSES of GLUTE MEDIUS DYSFUNCTION for more information.
Trendelenburg sign: A visually apparent dropping pelvis on your elevated swinging leg in walking or running. This suggests an impaired glute medius activation as the muscle is unable to hold the opposite hip up. The final result of this is impaired walking and running mechanics and furthermore you will be overloading other muscles and structures around the hip to compensate which eventuates in further pain.
What to do for glute weakness?
Rest, ice and minimise inflammation.
If there is a pain associated with your glute medius, resting from exercises that irritate this pain is very beneficial in order to promote recovery. For example; if running is the main trigger for your pain, cease all running for a period of 1-2 weeks but still walking regularly if you are not in pain walking.
Icing the affected area. We suggest 20minutes on 30minutes off three times a day or an evening for a period of 48-72hours. Icing will help reduce your pain levels and also it slows down the rate of swelling helping to promote healing.
A course of anti-inflammatories may help to reduce some of the pain and inflammation associated a pathologic gluteus medius. Consult with your general practitioner before taking to ensure this is the right course of action for yourself.
Glute Rehabilitation with a Physiotherapist or Osteopath:
A registered physiotherapist or osteopath can work with you in order to reduce pain and improve your gluteal function. Generally the rehabilitation time can be anywhere from 6 to 12 weeks depending on the severity of the problem. Your physiotherapist will use a combination of manual and exercise based therapies in order to rehabilitate.
Rehabilitation work for your gluteus medius must start slow and controlled and aim to build not just strength but the control and coordination of the glutes and surrounding muscles in the hip and lower limb. Many people with poor gluteal activation will find that their body has created maladaptive techniques in order to function day to day.
You nay find the two videos at the top of this page useful if you believe you have glute weakness. The first takes you through how to assess if your gluteals are working correctly. The second demonstrates some great exercises to target and strengthen your gluteus medius.
Corticosteroid Injections and Surgery for Glute Medius:
In rare instances, conservative management may not improve you pain and function due to chronic inflammation and/or a more extensive injury. In these instances the below may be indicated:
Corticosteroid injection: A powerful steroidal anti-inflammatory drug. Generally indicated if the above conservative methods of treatment are not reducing the inflammation through the gluteus medius. It is most often administered with either gluteus medius tendinopathies and/or greater trochanteric bursitis. Traditional rehabilitation through manual therapy and exercise through a health professional are necessary after injection. However, you will need a period of rest after the injection is administered. Consult your general practitioner for more information.
Gluteus medius repair surgery is indicated when the muscle tear is extensive and will not repair conservatively. It is performed by a minimally invasive surgical approach; torn muscles tendons are reattached to the greater trochanter (femur/thight bone) and the inflamed bursa are removed if necessary.
By Sydney CBD Physiotherapist Ryan Dorahy
