Unsung Hero of the Musculoskeletal System: Gluteus Medius
by Joe Giandonato, MBA, MS, CSCS
Let’s face it, there are a number of muscles that don’t get the press they deserve. A majority of our body’s 600 plus muscles (actually 656) never receive any attention, until an issue which hinders strength and or performance manifests itself.
Devoting too much time on the showy muscles and devouring the big three without any concerted assistance and supplementary work will eventually compromise your ability to train and acquaint you with your local physical therapist.
While the stars of our musculoskeletal anatomy (i.e. the pecs, deltoids, and gluteus maximus) are routinely featured in mainstream press, many forget the vital role supporting muscle groups play in facilitating the proper function of the “stars of the body”.
Unsung Hero: Gluteus Medius
The gluteus medius gets no love. It’s shadowed by its neighbor, the glute max anatomically and in the press. As such, it receives little or no attention within a strength training program. Integral in providing hip stability, the gluteus medius is capable of generating more hip abduction force than any other muscle of the lumbopelvic hip complex due to having the greatest abduction moment arm at the greater trochanter. When it becomes inhibited from disuse or trauma, the tensor fascia latae, piriformis, and sartorius then inherit the role of abducting the hips, eventually leading to knee and/or lower back pain, since they cannot summate the amount of abduction force the gluteus medius is capable of generating.
Orginating from the external surface of the ilium, between the superior and middle gluteal lines and the iliac crest, the gluteus medius attaches to the lateral portion of the greater trochanter of the femur. Its primary role involves stabilizing the hips, particularly during a single legged stance, which occurs during the support phase of gait. A weakened or inhibited gluteus medius muscle triggers a viscious cascade of compensatory patterns throughout the kinetic chain.
When the gluteus medius cannot provide runners stability in the frontal plane through abduction torque on the stance leg, the hips and torso may lean toward the side of the swinging leg, thus exhibiting a pattern known as Trendelenburg Gait. When the hips drop during gait, the IT band becomes stretched over the greater trochanter of the femur and pulls on the lateral epicondyle of the knee, altering the tracking of the knee and potentially igniting patellofemoral pain. Gluteus medius dysfunction may also lead to medial tibial stress syndrome (shin splints) and foot pain.
Gluteus medius weakness is also implicated in back and hip pain. When the gluteus medius is not firing properly, it cannot generate the necessary internal torque to meet the external torque created by bodyweight and external load, resulting in aberrant lumbopelvic movement patterns that place a number of structures at risk of injury. A lack of hip control forces the quadratus lumborum, a key lumbar stabilizer, to work overtime as it attempts to secure the hip position during movement.
Assessing and Progressing
Corrective strategies geared toward optimizing function of the gluteus medius should entail a thorough assessment which influences the design and implementation of programming and exercises. Since the cardinal role of the gluteus medius is stabilizing the hips, you may have your client or athlete assume a single legged stance and gauge static stability and muscular endurance. Further, you may have your client or athlete perform a step up or step down, while you look for a hip and/or trunk shift. In conjunction with the field tests, you may also want to see if they have any sacroiliac joint issues, stemming from injury or laxity. An unstable SI joint essentially nullifies the function of the gluteus medius. Also, it would be prudent to collect anthropometric and goniometric measurements to determine if your client or athlete has a leg length discrepancy, which may be structural or adaptive.
Once it is determined that your client or athlete is presenting weakness of the gluteus medius, programming considerations should include self myofascial release for the muscles of the lumbopelvic hip complex, particularly the piriformis, quadratus lumborum, IT band, and adductor complex, which may be overactive.
Exercises should be prescribed and progressed based on the abilities of your client or athlete, utilizing the 4X4 Matrix, which commences with non-weight bearing activities that provide no resistance and ends with standing exercises encompassing external load.
Beginner
Supine Hip Abduction with Core Brace
Lie on ground, relax head, shoulders, and arms on the ground and straighten legs
Flatten lumbar curve by bracing core
Plant heels of feet into ground and slowly slide them away from each other
Hold for a three second count
Return to starting position
Repeat movements for specified reps
Intermediate
Lateral Leg Raise with Bent Knee
• Assume quadruped position, place hands and knees at an equal distance from one another
• Flatten lumbar curve by bracing core
• Elevate one knee off ground and drive it up to hip height
• Hold for a two second count
• Return to starting position
• Repeat movement for specified reps
Intermediate
Banded Side Lying Clamshell
• Wrap resistance band around legs and position slightly over the knees
• Lie on side with head supported with flexed hips and knees
• Position heel of top foot on top of toe of bottom foot
• Keep core tight
• Drive knee out and exhale
• Hold for a two second count
• Return to starting position
• Repeat movement for specified reps
Intermediate
Spread Eagle Sit Up
• Firmly plant hips on ground with legs spread as wide as possible
• Grasp a small weighted object – a plate, kettlebell, or dumbbell
• Lie back while keeping core tight and heels planted on the ground
• Drive back up by using abs and obliques to pull yourself up and exhale
• Hold briefly at the top
• Slowly return to starting position
• Repeat movement for specified reps
Advanced
Lateral Squat
• Position feet as if you are about to squat
• Move hips back and shift weight to heels while moving laterally
• Plant drag leg into ground and keep core tight
• Drive back up by using bent leg and exhale
• Slowly return to starting position
• Repeat movement for specified reps
• Can be performed with band, dumbbell, kettlebell, plate, or barbell