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Glute Medius the one hip muscle that could be sabotaging your athletic performance and setting you up for injury.

janat00044 0184 copyThink your glutes are just for good looks? Think again. The gluteus medius is a powerhouse and it could be the hidden culprit preventing you from scoring that goal, pivoting to run down that ball in tennis or achieving just about any athletic goal. Even worse when this muscle isn’t working properly it can lead to TFL/hip flexor tightness, IT Band pain, Lateral meniscus issues, Bursitis, and even knee issues.

What's the Deal with the Gluteus Medius?

45922748244 3394dc4700 oThis muscle is crucial for stabilizing your hips, knees, and legs. It helps you move your leg out to the side (abduction), and stabilizes your hips when on one leg. The glute med assists in the inward and outward rotation of the leg. For hockey players, the Glute medius prevents the pelvis from tilting down on the opposite side when on one leg this assists the glute max to create that powerful push in your stride. You can apply this concept to any sport but I also think of tennis where all of the lateral movement makes these muscles’ functionality have key importance.  A functional glute medius keeps your whole lower body in alignment. 

When the glute med doesn’t fire or misfires the TFL (a muscle near the front of your hip) steps in to do the work, but the glute med is huge compared to the TFL and is most often the one causing trouble if it’s weak.

Anyone who has come in for treatment has no doubt heard me talk about the concept if one muscle does not do its job another muscle will try to pick up the slack. When your glute med is weak the TFL tries to do it all. An overworked TFL can lead to pain in the area of your hip flexors, IT Band issues and cause chaos in your knees.

My weak butt can cause knee problems?

iliotibial band itb anatomy diagramsA weak glute med (back and side of your hip) often results in an angry TFL (front of your hip). It is a secondary hip flexor, abductor, and internal rotator, the TFL exerts force on the hip directly and indirectly on the knee through its insertion into the IT Band (Cleland, 2005, p.250).

If your knee falls inward when you run, jump, or squat. Say hello to ACL tears, messed-up kneecaps, and an angry meniscus. Not the kind of training PRs (personal records) you’re after. Not to mention the dreaded and often complained about tight IT BANDS!  

I can’t tell you how many patients walk into the clinic blaming their IT Bands for everything. If you have a tight IT Band you need to work on getting the glute medius working properly, releasing stress on the TFL.

I won’t completely follow this train of thought because there is only so much room here.  But if you have a weak Glute medius and a tight TFL and go to lift your knee toward your chest (hip flexion) you are causing your psoas to work harder than it needs to. When we talk about psoas issues, I want you to think of lumbar spine pain.  We do not want that, enough said (for now).

Your Glutes Are Working, But Is Your TFL Stealing the Show?

So our goal for the following exercises is to get the the Glute med firiring properly and minimize use the TFL.

What level of rehab is your body ready for?

I take you back to basics in low-level rehab. I rebuild stability and eliminate your rigidity while gradually increasing your time under tension. Forcing those injured or weak muscles to handle the load properly, exposing and taking away any muscle guarding or “cheats”.

In mid-level rehab, I will put your body in a situation where there might be a little less time under tension (load) but I will start increasing your speed of movement.  

When you progress to a higher-level rehab you will be moving more and trying to get the nervous system to be in a position where it has to problem-solve so the muscle can go from tense to relaxed but still achieve a stable, smooth speed of movement.

My goal is to start taking away your hesitation to move in certain ways (some hesitations you don’t even know you have) so we can ultimately achieve Uninhibited Movement: Think less while moving with more confidence.

Low-level rehab examples:

Mid-level rehab examples:

Lateral step up, Foot clock frontal plane, Banded Moster walking, Dynamic clam, Med ball scoop toss

High-level rehab examples:

Trying advanced rehab exercises too early can do more harm than good. The high-level rehab we get into is about integrating your glute medius into safe, stable functional movement patterns. That way, you can achieve Uninhibited Movement.

"Radiopaedia - Drawing Iliotibial band - English labels" by Matt Skalski, license: CC BY-NC-ND
"Dundee - Drawing Abduction of the hip: muscles and tendons seen from posterior - English labels" by Shereen Kadir, © University of Dundee School of Medicine, license: CC BY-NC-ND
Marcaccio, Stephen & Babu, Jacob & Budacki, Ross & Tabaddor, Ramin & Shah, Kalpit. (2018). Diagnosis and Management of Hip Abductor Insufficiency. Rhode Island medical journal.