Top 10 exercises to strengthen Gluteus Medius muscle – A strong stabilizer of femur and pelvis during weight-bearing activities.

Gluteus Medius (GM) is one of the strongest lower extremity muscles ¹. It primarily abducts the hip, providing frontal plane stability for the pelvis during standing, walking, running and other advanced weight bearing or non-weight bearing functional activities 2. Gluteus Medius weakness or dysfunction is linked to lower back injuries, abnormalities in the gait cycle, and numerous lower extremity injuries like Trendelenburg gait, patellofemoral pain syndrome, iliotibial band friction syndrome, anterior crucial ligament injuries, and chronic ankle instability ⁷. A weak or fatigued GM muscle results in excessive pelvic rotation and femoral internal rotation, consequently leading to pain or injury ^3,4. Examples of poor lower extremity control are; Dynamic knee valgus, which results from coupled hip internal rotation and adduction ⁵. Trendelenburg gait, which results due to contralateral pelvic drop due to poor activation of Gluteus Medius muscle to produce a sufficient internal hip abduction moment to balance the external hip adduction moment that occurs during single leg stance ⁶. Therefore, proper conditioning or strengthening exercises are important to address many lower extremity injuries, gait abnormalities, and lower back injuries. This article focuses on 10 exercises that are researched to be the most effective exercises to activate or strengthen the Gluteus Medius muscle.

Anatomy of Gluteus Medius muscle

Gluteus Medius is a broad, thick radiating muscle on the outer surface of the pelvis, which has anterior, middle and posterior fibres, which accounts for the 60% of hip abductor muscle cross section area. These fibres are curved and fan-shaped which tapers to a strong tendon inserting on the lateral surface of the greater trochanter of the femur. GM fibres originate from the outer surface of the ilium between the middle and posterior gluteal lines. The GM being primarily a hip abductor, the anterior fibres assist to hip flexion and internal rotation, and the posterior fibres assist to hip extension and external rotation.

Gluteus medius strengthening exercises

Here are the top ten exercises with the highest activation of Gluteus Medius from high to low.

1.Side plank with Abduction, training leg down:

• Patient in a side-lying position with the training leg down.
• Shoulders, hips, knees, and ankles in a straight line bilaterally, and then rise to plank position with hips lifted off ground to achieve neutral alignment of trunk, hips, and knees.
• Use elbow and feet to lift the whole body off the ground to maintain plank position.
• To progress and to work upper leg at the same time lift upper leg into abduction. Can be repeated without holding to work concentrically while can be held in abduction for isometric contractions.
• Boren ⁸ et al., 2011 conducted EMG study on 5 different GM strengthening exercises and Maximal voluntary muscle contraction (MVIC) was established for each muscle group in order to express such exercise as a percentage of MVIC. Side plank with abduction, training leg down exercise showed the highest EMG value of 103% MVIC. Followed by 89% MVIC, when the same exercise is performed with training leg on top.
• This is an advanced level exercise to activate Gluteus Medius and is thus very challenging. It would not be appropriate for beginners and during the initial phase of rehabilitation. To perform this exercise strong core musculature is required due to the amount of core stabilization required.

2. Single limb squat

• Patient stands on training leg, slowly lowering the buttocks to touch a chair behind and then extends back to standing while non weight bearing leg is extended forward.
• This exercise can be done by using a stepper. Patient stands on the side edge of a stepper on a training leg, drop down the free leg to touch the floor with the heel. Patient bends on knee on the stance leg when free legs goes down and extends back in standing.
• This exercise can be progressed by increasing the stepper height and can be regressed by using a chair to sit back and then get up from the chair.
• Maintain good upper/lower back posture, engage core muscle, maintain hip abduction, external rotation and avoid knee valgus.  
• This is an advanced level exercise which basically activates all the lower limbs muscles and demands high degree of coordination, balance and stability.
• Boren et. al., have reported 82% MVIC while Distefano et al., 2009, have reported 64% MVIC.

3. Single leg bridge

• Patient starts on supine with both feet flat on the table and the knees and hips flexed to accommodate the position of the feet.
• With training side’s foot on the floor, both hips are extended to lift off the table until the hips were in a neutral position and the knee of the training leg or weight bearing leg is flexed near 90 degree. The hip of the non-training leg was maintained in neutral and the knee was fully extended in line with the neutral hip in air.
• Phillipon ⁹ et al., 2011, study has reported 72.5% MVC for Gluteus Medius muscle during concentric phase of single leg bridge while 51% MVC during eccentric phase of the exercise.
• This exercise can be regressed by doing double leg bridge.

4. Side lying  hip abduction with hip internal rotation, hip external rotation, or against the wall

• Patient starts in sidelying on non-training side, the lower back, hips, knees and ankles in a neutral position.
• Patient then internally rotates the upper hip (training side) approximately to 15 degree. Maintaining hip internal rotation, patient abducts hip up to 30 degrees, and then return to starting position by lowering the leg to the starting position of both hips, legs and back in a neutral position in a single stack.

Sidelying hip abduction with external rotation

• Same as with internal rotation except the training side hip is externally rotated to approximately 15 degree and is maintained throughout the exercise.

Sidelying hip abduction against a wall

• Starts in a sidelying position with training side up. The lower back and hips are maintained in a neutral position and the backside of the body adh=jacent to a wall. Maintaining neutral lower back and hip positions, hip is abducted to 30 degree while the heel was conto=inously pressed in to the wall via hip extension and then returning to the starting position maintaining constant heel pressure against the wall throughout the exercise.
• Can be progressed using ankle weights or pressing against the physio ball while trying to maintain the neutral lower back and hip.
• Philippon et al., 2011 reported more than 50% MVC of Gluteus Medius muscle activation with all 3 forms of sidelying hip abduction exercise. However, the side lying hip abduction performed against the wall, and hip abduction with external rotation demonstrated moderate iliopsoas muscle activation (>20% MVC). Therefore, the exercise should be avoided when there is irritation of hip flexors or ilipsosas tendinitis is present.  

5. Single leg deadlift

• Patient stands on training leg with knee flexed to 30 degree while other non weight bearing legs knee is extended.
• Patient bends forward with hip flexion while maintaining knee flexion on a stance leg, full knee extension on free leg, and neutral back.
• Slight knee bending is required to allow easy trunk and hip flexion and to keep their knees over the toes.
• This exercise also works out other hip muscles while eccentrically loading the hamstring muscles on stance leg.
• Care should be taken to maintain the toes of free leg to point straight downwards on the floor to avoid excessive hip rotation.
• Single leg deadlift – 56% MVC⁸, 58% MVC⁷

CONTINUE READING ………

References

1. Ward SR, Eng CM, Smallwood LH, Lieber RL. Are current measurements of lower extremity Muscle architecture accurate? Clin Orthop Relat Res. 2009;467(4):1074-1082.
2. Earl JE. Gluteus medius activity during 3 variations of isometric single-leg stance. J Sport Rehabil 14:1–11, 2005.
3. Boling MC, Bolgla LA, Mattacola CG, Uhl TL, Hosey RG. Outcomes of a weight-bearing rehabilitation program for patients diagnosed with patellofemoral pain syndrome. Arch Phys Med Rehabil. 2006;87(11):1428-1435.
4. Nelson-Wong E, Gregory DE, Winter DA, Callaghan JP. Gluteus medius muscle activation patterns as a predictor of low back pain during standing. Clin Biomech (Bristol, Avon). 2008;23(5):545-553.
5. Griffin LY, Albohm MJ, Arendt EA, et al. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Am J Sports Med. 2006;34:1512-1532.
6. Earl J, Hertel J, and Denegar C. Patterns of dynamic malalignment, muscle activation, joint motion and patellofemoral pain syndrome. J Sport Rehabil 14:215–233, 2005.
7. Distefano L, Blackburn J, Marshall S, et al. Gluteal Activation During Common Therapeutic Exercises. J Orthop Sports Phys Ther. 2009; 39: 532-540.
8.  Boren K., Conrey C., Coguic J., et al. Electromyographic Analysis of gluteus medius and gluteus maximus during rehabilitation exercises. The International Journal of Sports Physical Therapy. 2011; 6(3): 206-223.
9. Phillipon M., Decker M., et al. Rehabilitation Exercise Progression for the Gluteus Medius Muscle with consideration for Ilipsoas Tendinitis. The American Journal od Sports Medicine. 2011; 39(8).