Corrective Exercise Strategies for Improving Gluteus Medius

by Dr. Evan Osar

Evan OsarAs fitness professionals, there is hardly a day that goes by where we don’t see clients affected by gluteus medius weakness. With an increasing number of individuals walking, running, and/or participating triathlons, we are seeing the ramifications of poor gluteal function whether it be alterations in hip function, ramifications at the knee or further down the kinetic chain, or pain syndromes of the low back and pelvis. And while targeting the gluteus medius works for some, there are still many individuals that aren’t helped by these isolated exercises.  In this article, we will look at one reason why isolated hip abduction strengthening fails for some and introduce an exercise designed to incorporate the entire lateral stabilization chain to improve gluteal function so you can help your clients achieve their health and fitness goals.

Since it garners so much attention in training and rehabilitation settings, it is important to address the functional role of the gluteus medius before addressing the specific exercise aimed at improving its’ function. As mentioned above, stability of the hip and pelvis are of primary concern during walking and running. And there is no lack of exercises addressing the gluteus medius – the muscle most responsible (more appropriately, blamed) for hip and pelvis stability. Clam-shells, lying hip abduction, and lateral band walks are just three of the over dozen gluteus medius specific exercises. With all the strengthening exercises, why are so many clients still experiencing gluteus medius weakness? One of the biggest reasons has to do with the fact that none of these exercises adequately address how the trunk and spine relate to hip and pelvic stability. The gluteus medius is part of the lateral stabilization chain and to improve its’ function, you must address the entire lateral chain.

The lateral stabilization chain, comprised of the oblique abdominals, quadratus lumborum, latissimus dorsi, serratus anterior, lateral fibers of the gluteal complex, and vastus lateralis, connect the ipsilateral shoulder and hip complexes with the trunk and spine. While active in all movement, the lateral chain is most responsible for controlling frontal plane motion. The lack of frontal plane stability is most easily seen during single leg stance – the point of the gait cycle where the body weight is supported on one leg. A positive Trendelenburg’s (pelvic unleveling where the ilium on the side opposite the stance side drops significantly lower than the contralateral ilium) or a compensated Trendelenburg’s (lateral flexion of the trunk so that is aligned over the stance leg) are two common compensatory patterns for the lack frontal plane stability. Hip and knee dysfunction are common issues in patients/clients with a positive Trendelenburg’s while low back pain and sacroiliac joint dysfunction are more common in those with a compensated Trendelenburg’s pattern.

Exercises to Improve Gluteus Medius Function

One of the most important patterns for developing gluteus medius function in providing frontal plane stability is the modified side bridge. With all the gluteus medius exercises, what makes the modified side bridge so effective? A 2009 research report looked at several gluteal exercises and the effect on  gluteus medius function. Side lying hip abduction showed the most activity in activation as compared to two of most popular gluteus medius isolation exercises, the clam and lateral band walk. The modified side bridge pattern is essentially a closed chain version of the lying hip abduction. It is superior to the side lying hip abduction because it improves the stabilization function of the gluteus medius while it incorporates co-activation of its’ functional synergists.

This pattern is broken down into 4 phases and each level is designed to improve the components necessary to reach the next level. It is common for patients/clients to be progressed too quickly through the pattern without developing the prerequisite stability in the gleno-humeral, trunk, and pelvo-femoral regions. Stability in these regions are necessary prior to progressing to the level IV pattern since the advanced demands of this pattern can cause the client to break down and develop additional compensatory patterns if they lack the prerequisite stability.

Level 1

The client lies on his side with the ipsilateral shoulder and hip flexed to 90 degrees and 75 degrees respectively. His shoulder and hips are stacked and his spine is in neutral alignment. He contracts isometrically to push his left elbow and knee into the floor. This contraction activates the latissimus dorsi and serratus anterior of his support shoulder and the gluteal complex of his support hip. It also helps connect the shoulder and hip with the trunk and spine. He holds this contraction for 5 seconds and repeats for 10 repetitions. Throughout each of the progressions, his core should be activated and his spine should remain neutral.

Level 2

The client assumes the position and activation from level 1. He activates his shoulder stabilizers to push himself into an elbow-supported position. He holds this position for 2 seconds and then returns to the starting position. He repeats the pattern for 5-10 repetitions. This is also a great pattern for improving rotator cuff function since it combines glenohumeral rotation with scapulothoracic stability.

Level 3

The client assumes the position and activation from level 2. He then lifts himself up so that he is supported on both his elbow and knee. He holds for 2 seconds and returns to the starting position. He repeats for 5-10 repetitions for 2 sets.

Level 4

In the level 4 progression, the client assumes the position and activation from level 3. He lifts himself so that he is supported completely upon his support forearm and knee. He holds this position for 2 seconds while reaching out with his free arm and then returns to the starting position.  He repeats this exercise for 5-10 repetitions. He is supported on his knee rather than on his ankle and foot in level 3 and 4 progressions of the modified side bridge pattern since this enables activation of the hip complex rather than bypassing this region which occurs in the traditional side bridge patterns.

Regardless of the level your client has achieved, this pattern is a great way to activate the lateral chain prior to walking or running. In other words, even the level 1 pattern can be effective at activating the lateral chain for those clients that don’t have the shoulder, trunk, or hip stability required for the higher patterns.

Conclusion

Many of our clients present with hip and pelvic instability, which requires improved gluteal function. As we have discussed, the gluteus medius is one component of the lateral chain that is responsible for the stability required for efficient walking and running. If we help our clients improve their gluteal activation and integrate its’ function into that of the trunk and spine, they will demonstrate improved mechanics and confidence when performing activities that require single leg stability. With improved stability, we can empower our patients and clients to remain active while helping them to achieve their health and fitness goals whether they are simply to walk around the block or run a marathon.

References:

Lindsay J. DiStefano, J. Troy Blackburn, Stephen W. Marshall, Darin A. Padua. Gluteal Muscle Activation During Common Therapeutic Exercises. Journal of Orthopedic and Sports Physical Therapy 2009;39(7):532-540.

Osar, E. Corrective Exercise Solutions to Common Shoulder and Hip Dysfunction. 2012. Lotus Publishing; Chinchester, UK.

About Dr. Evan Osar

Audiences around the world have seen Dr. Evan Osar’s dynamic and original presentations.  His passion for improving human movement and helping health and fitness professionals think bigger about their roles can be seen and felt in every course he teaches.  His 20-year background in fitness and experience as a chiropractic physician and manual therapist provide a unique perspective on corrective exercise and fundamental training principles for the fitness professional that works with the pre and post-rehabilitation, pre and post-natal, baby boomer, and senior populations. Dr. Osar has become known for taking challenging information and putting it into useable information the health and fitness professional can apply immediately with their patients and clients. He is the creator of over a dozen resources including the highly acclaimed Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction. He is a regular presenter at ECA conventions and the developer of the Integrative Movement Specialist™ certification. For more information on products or courses, please visit www.fitnesseducationseminars.com.

3 thoughts on “Corrective Exercise Strategies for Improving Gluteus Medius

  1. Hi I am runner and have been using your corrective exercises for improving gluteus medius with much success. I am wondering how to get information on the next level 5? My goal is to do a single leg stance more easily.

    Thank you
    Donna Ferruzza

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>