Glutes, The Powerful Stabiliser Part I

Desk jobs, cars, lifts; the adversary to stronger gluteal muscles.

The gluteals act as the powerhouse of the body, providing a base of stability from which power is generated and transferred. Underlying that, the gluteals also play a large role in optimising lower limb function to assist in preventing injuries. Over several posts, I will discuss the roles of the glutes, their effect on lower limb biomechanics, reasons for why they need to be strengthened and exercises to help wake up your booty.

Part I will outline the function of glutes, their influence on biomechanics and their role in preventing overload injuries.

The Gluteal Complex is comprised of gluteus maximus, gluteus medius and gluteus minimis, all which work in unison. Working alone, gluteus maximus acts to create powerful hip extension and hip external rotation. During walking, glute max will help with extension of the hip, deceleration of the swing leg and assist in maintaining an upright trunk. On the other hand, glute medius and minimus have similar actions. Its most important action is to abduct (bring leg to side away from midline) the thigh. It also is able to internally and externally rotate the hip, due to 2 different muscle fibres, anterior and posterior. Functionally, they prevent hip adduction (leg towards midline) and knee valgus, which will be discussed further down. In saying that, the most important function of the gluteals is as a whole. The complex provides stability to the hips, pelvis and trunk and allows for optimal and sound movement. Any disruption to the gluteal stability will result in biomechanical faults and injuries further down the line.

GLUTE!

#1 Gluteal Strength to reduce the susceptibility of overloading injuries

Gluteus medius and minimus are the principle muscles, which provide hip stability to optimise lower limb biomechanics. It is believed that weakness, primarily in these 2 muscles leads to internal rotation of the hip, adduction of the femur and valgus collapse at the knee, particularly in single legged positions, as shown below.

MAX 2                                                                    Dynamic Knee Valgus                                                                    

One of the most commonly caused overload injuries from reduced gluteal strength is Patella femoral pain syndrome (PFPS). It is primarily caused by excessive joint compressive and kneecap mal-tracking from prolonged suboptimal (valgus collapse) loading whilst running.

“ A study by Loyd et al. in 2003 measured the gluteal strength of 15 subjects with patellafemoral pain. On average, all 15 subjects demonstrated a 26% reduction in hip abduction strength and 36% reduction in hip external rotation strength when compared to their control group of subjects without patella femoral pain”

Iliotibial band syndrome (ITBS) is also another common knee injury caused by poor glute medius and minimus function. It is thought that the internal rotation and adduction of the femur results in a valgus position of the knee, leading to lengthening of the iliotibial band during prolonged running, causing it to tighten and irritate.

“A 2014 study by Noehren et al. examined the knee adduction and hip internal rotation angles of 17 ITBS subjects and compared them to subjects with no ITB pain. The study showed that there was a 20%  increase in knee adduction and a 14% increase in hip internal rotation which was attributed to glute deficits”

MAX3

A study regarding the effectiveness of hip and gluteal strengthening on knee joint pain (in particular PFPS), was performed by Ferber et al. in 2011. Following a 3-week hip abduction strengthening program the group with noticeable PFPS pain had a 32.69% improvement in isometric muscle strength and a 43.10% reduction in pain scores.

Part II, Performance Power of the Glutes

By William Chin

References:

  • Ferber R, Kendall KD, Farr L (2011) Changes in Knee Biomechanics After a Hip-Abductor Strengthening Protocol for Runners with Patellofemoral Pain Sydnrome. Journal of Athletic Training 46(2): 142-149
  • Fredericson M, Cookingham C, Chaudhari AM, Dowdell BC, Oestreicher N, Sahrmann SA (2000) Hip Abductor Weakness in Distance Runners with Iliotibial Band Syndrom. Clinical Journal of Sports Medicine 10: 169-175
  • Ireland ML, Wilson JD, Ballantyne BT, Davis IM (2003) Hip Strength in Femails With and Without Patellofemoral Pain. Journal of Orthopaedic & Sports Physical Therapy 33(11): 671-676
  • Noehren B, Schmitz A, Hempel R,Westlake C, Black W (2014) Assessment of Strength, Flexibility, and Running Mechanics in Men With Iliotibial Band Syndrome. Journal of Orthopaedic & Sports Physical Therapy 44(3): 217-222      
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5 thoughts on “Glutes, The Powerful Stabiliser Part I

  1. Good point Will! Such a common pathology (if you can call it that) every second patient who walks through my doors has weak glutes. Whats your favourite glut strengthening exercise? I have always been a fan of clamshells, but talking to my colleagues, clamshells may be targeting the deep external rotators rather than glut med. What do you think?

    1. That’s a really good question. Eileen, I think the position of the clamshell exercise (hip flexed), limits the ability of glute med to function. Specifically, it inhibits the function of the posterior component of the muscle (which is the main external rotator). I haven’t read to much into why, but i’d say its due to overactive hip flexors, which is present in most people. So performing this exercise will stimulate the glute max and the deep external rotators instead of the intended glute med.
      I had a read of an article (Boren et al, 2011) and it assessed the % of maximal voluntary contraction strength of glute med when performing certain exercises. Clamshells (with feet fixed), only activated glut med at 47.4% of its maximal contraction potential, and when you compare that to single leg squats (82.26%), its peanuts.
      I think you’ve started something here Eileen … so i might write a post specifically on the best exercises for activating glute med specifically.

      1. You both make excellent points. However, I think what also needs to be taken into consideration is the client’s competency and tolerance with an exercise. A clamshell, for example, is a well supported movement and once mastered, it isn’t too difficult. On the other hand, I have tried many a time to get a client to complete a single leg squat only for them to butcher the movement completely whilst also complaining of pain.

        I believe it will be important to find a middle ground with glute med exercises. The clamshell does not quite replicate the function of this muscle accurately, while the single leg squat is too difficult for most in my opinion.

        I look forward to your post on exercises for glute med Will and would be interested to hear both of your thoughts on what I have discussed above.

  2. Yeah, Ill definitely have to write a post on it.
    I’ve had the same issue as you Andrew, where clients struggle to grasp the concept of the single leg squat. Usually it is caused by gluteal amnesia, where they struggle to actually activate the muscle functionally.
    But what I’ve found with exercise prescription is that the exercise should activate the muscle in its functional state. For example, if a weakness in the eccentric control of glute med is evident in running, then exercises for strengthening should focus on the eccentric control. And this could be in the form of 1:2 ratio exercises where the eccentric component is biased twice as much, either through time under tension/speed/load etc..

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