The Middle Child

You ever notice people walking, looking really fierce? Like they just own it! Hips kicking from one side to the other, like they are walking down the catwalk as if it were New York Fashion Week? But it’s not September or February (that’s when fashion week is, duh), and they aren’t on a catwalk, and they are talking to you about how bad their knees hurt and their IT bands are on fire. Well, maybe it is the Gluteus Medius.

The Gluteus Medius muscle is considered an abductor of the leg and stabilizer of the pelvis. This muscle starts at the side of the illium (or crest of the hip) and ends at the greater trochanter of the femur (bony part of the hip).

Image from Jae Kun Shim Ph.D. Alternate lower extremity resistance training to increase stability in young and elderly adults.

Image from Jae Kun Shim Ph.D. Alternate lower extremity resistance training to increase stability in young and elderly adults.

So why are we talking about the Gluteus Medius or, Glute Med, for short? The importance of this muscle is during the mid-stance phase of gait. Picture this: If you are standing and have your right foot out in front to continue walking, you will swing your left leg, which is behind your body, through to the front for it to now be in front of the right leg. The phase where your left leg is moving from the back to the front is when your right glute med will be doing its job to stabilize. The mechanics are when one foot is off the ground, the hip must stabilize to keep the hip from shifting out. So what happens if this doesn’t occur?

We can look at a Trendelenburg test. If you stand on one leg, similar to the mid-stance phase of gait, what happens to your hip?

Postive Trendelenburg test

Postive Trendelenburg test

Does the leg you are standing on create a “hip hike?” If so, this is positive for a weak glute med. And you are just standing at this point. What happens when you are going through active motion such as running or walking? This creates an imbalance all the way down. As the hip lifts, the knee will compensate by collapsing in (creating a valgus position), thus back to your friend complaining about their knee pain walking like Cara Delevingne over there.

Now, this does not mean we should forget about the Gluteus Maximus or Gluteus Minimus either. Both these muscles help the hip stabilize as well and are the muscles that move you through your gait phase and other motions such as squatting, jumping, and cutting. If there is an overall weakness, it must be corrected to avoid knee pain.

The second picture with the red arrow shows the medial collapse of the knee due to the hip not being stabilized.

The second picture with the red arrow shows the medial collapse of the knee due to the hip not being stabilized.

Chiropractic can work on any trigger points or muscle spasms that may be present first. This will break up any scar tissue, or lactic acid build up that has been formed from the muscle dysfunction. From there we move into activating the muscle, either by origin/insertion techniques – firing up the golgi tendon organs at the end of each muscle to help engage the muscle – or by strengthening exercises listed below.

Note that all exercises can be done with a band, but the last one specifically is always done with a band for resistance.

- Clam shell

o Begin side lying against a wall with back, buttocks and heels touching the wall. Support your head with a pillow or arm. Slowly abduct (open) the top leg separating the knees. Once you have reached the peak, slowly come back down. You should feel the outside of the hip engage, that’s the glute med!

- Abduction exercises

o Start side lying similar to clam shell exercises with legs straight. Keeping the toe pointed forward, slowly raise the leg up the wall until the muscle engages and hold for 1-2 seconds, thenreturn to the start position. Movements should be slow and controlled.

- Glute bridge

o Begin on your back with knees bent and feet flat on the floor. Start with an engaged core and squeeze your buttocks tight. Drive your feet into the floor, allowing your hips to come off the ground. The movement should be slow and controlled. Once at the top (making a bridge) with shoulder blades and heels pinned to the ground and back flat, hold for 3-5 seconds and slowly lower yourself to the start position. This will be your Gluteus Maximus... ARE YOU NOT ENTERTAINED?!

- Monster walk

o Start standing with legs shoulder width apart, with a resistance band under your feet, holding the band at hip level. Bend the knees in a slightly squatted position. With core engaged, start moving to the right – first the right leg, then the left leg. Allow your body to push back the resistance when abducting (leg moving away from midline) and then adducting (leg moving toward midline) the following leg. Once you have walked 10 steps, walk back the other way to work the left side. This will work all the Gluteus muscles and adductors of the hip.

Clam Shell Exercises for Gluteus Medius

Clam Shell Exercises for Gluteus Medius

Abduction (leg moves away from midline) exercises for Gluteus Medius

Abduction (leg moves away from midline) exercises for Gluteus Medius

Glute bridge exercise for Gluteus Maximus

Glute bridge exercise for Gluteus Maximus

Monster walk set up for Gluteus Medius and Adductors (muscles moving leg towards midline). Starting postion then side step maintaining straight back and slight bend in knees feeling glute muscles engage walking 10-15 steps each way.

Monster walk set up for Gluteus Medius and Adductors (muscles moving leg towards midline). Starting postion then side step maintaining straight back and slight bend in knees feeling glute muscles engage walking 10-15 steps each way.

Cooper, N.A., Scavo, K.M., Strickland, K.J., Tipayamongkol, N., Nicholson, J.D, Bewyer, D.C., & Sluka, K.A. (2015). Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. Eur Spine J. May 26. Epublish ahead of print

Morgan, W.E., & Javid, A. (2014). The gluteal-Knee connection. Dynamic Chiropractic, 32(15). 1-8. Retrieved from http://www.dynamicchiropractic.com/mpacms/dc/artic...

(2013). Gluteus medius & rotational stability of the hip. Fleet Feet Sports West Hartford. Retrieved from http://www.fleetfeethartford.com/sports-medicine/s...

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