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Written by: Blake Scott, MPhty, BA (Kin, Hons), Registered Physiotherapist (Note: no longer at GRSM)
The Glute muscle group is a very popular group of muscles in the rehab world, especially the Glute Medius muscle!
Often the “Little Brother” of the Gluteus Maximus (Glute Max), the Gluteus Medius (Glute Med) plays an important role in maintaining a level pelvic alignment (preventing abnormal or excessive unilateral hip drop during single leg activity) and proper hip/knee/ankle alignment in single leg activity (walking, running, hopping). The Glute Max is more of a powerful global muscle responsible mainly for hip extension (think sprinting, running, stairs etc.).
There are many pathologies associated with the inability to maintain a proper alignment with the pelvis and femur including Patella Femoral Pain Syndrome (PFPS), Medial Tibial Stress Syndrome (shin splints), low back pain, and increased risk of ACL injury to name a few.
A study using EMG analysis (monitoring muscle activation with electrodes) was performed in 2011 by Borgen et al.1 to determine which exercises commonly performed in the clinical setting best activate the Glute Med and Glute Max.
The results of this study can help rehab professionals to develop a tailored, gradual graded strengthening program to specifically target poor muscle strength/activation, especially in the early phases of rehab.
The results of this study compared each exercise’s Glute Med/Max muscle contraction as a percentage of the individuals maximal voluntary muscle contraction (MVIC).
The study results are shown in the chart below:
As you can see the side plank abduction with the dominant leg (DL) down has the highest percentage of MVIC of the Glute Med making this an excellent rehab exercise if an individual struggles with maintaining a level pelvis and/or femoral knee alignment with single leg activity.
Although this is a great study for identifying exercises that target Glute Med activation, it does have some limitations in that it does not include exercises that require external equipment (therabands, weights) and is mainly relevant for early phase rehab only.
Below are video examples of the top Glute Med exercises identified by this study:
1. Side Plank with Static Hip Abduction
Aim for 30-60 second holds, 3-5 repetitions each side
2. Single Leg Squat
Keep a close eye on hip/knee/ankle alignment. Ideally you are trying to maintain a level pelvis with the middle of your knee tracking over your 2nd toe. 5-8 reps, 3-4 sets
3. The Banded Clam Shell
Looks easy but if you add a mini band and prolonged holds, it is a great way to feel a burn in the Glute Med! Hold 10-15 seconds for 10 reps
4. Front Plank with Hip Extension
This is a great challenge for the core as well! Try to avoid any excessive side to side movement through your hips as you lift your leg up towards the ceiling. 5 second holds, 5-8 reps, 3-4 sets
5. Lateral Step-Up/Down
Similar to single leg squats, keep a keen eye on hip/knee/ankle alignment of your stance leg. 5-8 reps, 3-4 sets
References:
Boren, Kristen et al. “Electromyographic analysis of gluteus medius and gluteus maximus during rehabilitation exercises.” /International journal of sports physical therapy/ vol. 6,3 (2011): 206-23.
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This patient came in with a painful and disturbing clunking sensation while reaching overhead. With his consistency you can see his progress through his injury rehabilitation.
Many people don’t realize that they can come in BEFORE they have pain. You don’t have to wait until the pain effects your quality of life to come to physio.
