I like big butts and I cannot lie, a common ground both I and 1990’s American rapper Sir-Mix-a-Lot clearly share. But what interests me with the human derriére is far more than its aesthetically pleasing values. The role the gluteal muscles play in our everyday and sporting lives has become more and more evident as research emerges (you other brothers can’t deny! – last reference to Baby Got Back I promise). Many injuries can be attributed to instability or misfiring of the gluteal muscles around the hip. From ongoing ankle sprains, shin splints, knee pain, groin strains, hamstring tightness, low back pain, even elbow or shoulder pain. Depending on the pain provocation movement pattern involved if glutes are not providing a stable base that desired movement can be like trying to shoot a canon from a canoe. A perfect example is a tennis serve. While the racket hitting the ball is the desired end result the force generated starts from the leg. Energy can get lost and dissipated meaning inefficiency and increased workload elsewhere, usually the site of injury somewhere else along the kinetic chain. In the case of the tennis serve usually the shoulder or elbow.
I like to think of gluteus medius (glute med from now on) as stabilisers on a child’s bike – they provide stability. Take them away and the journey becomes more rocky and daunting for the child on board and with that comes an increased risk of falling and ultimately injury. Electromyography studies give us information on the activity levels of muscles during different exercises. Reinman et al (2012) took a battery of exercises commonly given out with the aim of improving glute strength. Their findings were interesting and somewhat surprising. So which exercises rank best and why should you be doing them? Here’s my favourite 5.
Please note this is not a complete rehabilitation plan for any specific condition but merely an idea of some of the ways to to engage glute medius.
- Side Lying hip abduction: There are arguments regarding its functional application. After all who spends their time lying on their side throughout the day? But what cannot be argued is the amount of voluntary muscle recruitment of glute med with this exercise. When compared with other exercises this scores highly time and time again while also eliminating activity in other surrounding muscles like front of the thigh.
- Side Bridge/Plank with hip abduction: This hits the glutes in 2 ways. It firstly requires a static contraction of the lower most leg but also a concentric and eccentric contraction of the upper most as the leg raise is performed. From Reinman et al’s (2012) study this actually scored highest for maximal isometric voluntary contraction of gluteus medius
- Single Leg Wall Press/Squat: Much more functional than the side lying exercises this works well for anyone planning on not spending all day lying on their side. While up on your feet the leg closest to the wall is pushed against the wall. Keeping the pelvis level and body symmetrical this kicks off an equal and opposite contraction of the muscles of the outermost standing leg. This is great for endurance runners struggling to maintain form. It can also be progressed to a single leg squat great for runners. This is my favourite exercise but important that form is maintained otherwise all sorts of trick and compensatory movements are possible.
- Single Leg Bridge: Progress from a double leg bridge (once comfortable) to make it more challenging. This requires good control around pelvis using both the trunk and opposite hip muscles to work together to maintain a stable position.
- Band walks/squats: Mini bands are a really useful, inexpensive tool to have in your kit. They add resistance to whatever the desired movement pattern is. Side walks (or crab walks) with the band wrapped around the lower thigh targets the lateral hip area. Add a sustained squat into the mix while performing the same exercise hits glute medius more, especially when the band is then transferred to provide resistance across the mid to forefoot.
While this highlights the importance of glutes there may be other muscle imbalances and limitations with movement that need addressing. Also some exercsies may bemore suited than others. With all these exercises control and form is key. The repetition of a correct movement pattern is required to make that movement second nature.
For a full assessment or for more information on any of the issues addressed throughout this article please contact the clinic via email at firstname.lastname@example.org, Twitter @mccabephysio, Facebook at McCabe Physiotherapy or visit http://www.mccabephysiotherapy.com
Rob McCabe MISCP
MSc (pre reg) Physiotherapy, BSc Sport Science and Health, MSc Sports Physiotherapy, PG Dip Orthopaedic Medicine
Orchard House, Moorefield Rd, Newbridge, Co. Kildare
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