PDF | Print | E-mail

A Literature Based Approach for Rehabilitation of the Gluteus Medius

 

backside

glute_mead_and_bursa

The Importance of Gluteus Medius Strength and Stabilization

  • Hip abductors play an important role in locomotion and load transfer through the hip and pelvis
  • Weakness of the gluteus medius decrease the force closure mechanism through the sacroiliac joints causing dysfunction to the deep core musculature of the low back (multifidus)
  • Hip abductor weakness leads to compensatory changes in the low back, hip, knee and ankles
  • Sacro-iliac joint dysfunction causes delay in activation of the internal oblique muscles, multifidus and gluteus maximus on side of dysfunction during stance phase of gait (foot on ground during walking)
  • Pelvic/Sacroiliac compression belt caused a significant decrease in quadratus lumborum activity and significant increase in gluteus medius and lumbar multifidus activity.

Translation - Weak gluteus medius muscles can lead to unstable sacro-iliac joints in the low back/tailbone region and will eventually lead to pain and dysfunction in the low back, hips and knees due to functional compensation. With proper neuromuscular retraining of the gluteus medius and stabilization of the SI joints, a balance of muscle and joint function can be restored.


Gluteus Medius Neuromuscular Re-education Rehab

  • Side lying hip abduction exercise (pictured first in row below) had significantly more EMG activity than clam exercises (second picture) done at 30 and 60 degrees of hip flexion. It was also greater than single legged squat, lateral band walk, single limb deadlift and lunges

Glut_Mead_rehab1 Side_Leg_Lift__Back_Pain

  • No difference in EMG activity of the gluteus medius in single leg squats on stable or unstable surface
  • Greatest gluteus medius EMG activity in single leg stance with an abduction and internal rotation force on the pelvis vs straight abduction force

side_abduction

  • In evaluating 5 unilateral weightbearing exercises, wall squat had the most significant EMG activity with (in descending order) front step up, lateral step up, retro step up and unilateral mini squat following
  • Overall the greatest gluteal EMG activity was during single legged squat and single legged deadlift. Transverse plane lunges showed the next highest gluteal activity

Translation - Specific and non-weight bearing neuromuscular training of the glut muscles will provide proper firing mechanisms for low back, hip and knee stabilization. Proprioception (balance) offers a lot of benefits but will not increase firing power of the gluteus medius. It is important to be evaluated by a properly trained physician or athletic training specialist to determine if loading should be directed at the abdominal or the low back during gluteus medius rehab training.


Referenced Case Studies:

Lee et al 1997; Hungerford et al 2003; Hungerford et al 2003; Pool-Goudwaard et al 1998; Bolgla and Uhl 2005; Cynn et al 2006; Eggen et al 2003; Janda 1996; Hungerford et al 2003; Krause et al 2009; Earl et al 2005; Ayotte et al 2007; Distefano et al 2009