Weak Glute Medius Muscles and a Chain Reaction.

A weak Glute Medius muscle will cause all sorts of problems. Here is why –

Where is the Gluteus Medius Muscle? The muscle an upper anterior buttock muscle that originates from the section of the pelvic bone known as the ilium. It inserts from there onto the femur at the greater trochanter. In less technical terms, you can find the muscle if you place your hands on the outsides of your hips, and then slide your hand down until you get to the area where your upper leg extends out from your side.

What does it do? The glute medius is there to abduct your leg. If you pull your leg away in a sideways motion you are using your gluteus medius muscle. However, in running terms, the main purpose of the muscle is to stabilize your pelvis when your one leg is off the ground. As you can see in the photo below, weakness of the right gluteus medius will cause the left hip to drop when standing on the right limb. When the muscle fails in its duty during a run or walk you get what is called a Trendelenburg Gait. From the moment you started crawling, your instinct was to keep your head in an upright position. A falling hip will necessitate that you take action to stabilize the head. This means that your lower back muscles such as your Quadratus Lumborum will attempt to stabilise what is going wrong beneath them. Other runners in an attempt to keep the pelvis neutral will adduct and internally rotate the weight bearing leg.
Without it you couldn’t walk. 80% of walking is on one leg. Running is 100%. This muscle is the driver of single leg stance.

How to test if the muscle is weak. I use a functional test to see what is happening with the muscle. I do this as part of a runner’s leg assessment. I film the runner and then via our assessment software measure pelvic drop. Watching the kinematics of the pelvis and lower body closely can be very beneficial. There are other tests that are used if necessary but describing these is unnecessary for the purpose of this article.

A Chain Reaction – Injuries that can develop from a weak Glut Medius. Iliotibial Band Syndrome. Iliotibial band syndrome is considered by most to be an overuse injury, commonly seen in runners and cyclists. The iliotibial band is a thick fascia that crosses the hip joint and inserts on the patella and tibia. The common theory has been that this band becomes inflamed from the friction of rolling over the lateral femoral epicondyle. There are at least five causes of ITB syndrome. Weak glute medius muscles will certainly bring on the condition. The strength of the muscle needs to be assessed. As the hip drops, the band is stretched over the trochanter of the femur. The band then gets tensioned over the upper trochanter causing it to tighten over the lateral femoral epicondyle on the knee. The result is that a weakened hip flexor can cause issues on the outside of the knee. This is one of those great examples of what is called a kinetic chain. In other words, you often need to look for the cause of an injury away from the actual injury site. Care must be taken to avoid your legs from crossing the midline when you run. One of the purposes of the ITB is to abduct the thigh (move it away from the body’s midline). The more your leg crosses the midline, or moves toward your centre line, the more the band and glute medius muscle will be stressed.

Medial Knee Pain, As the upper leg falls in, or adducts, strain is placed on the medial collateral knee ligaments. In non- technical terms, this means that you can experience pain on the inner knee area.

Lower Back Pain. As the lower back muscles compensate to get your head aligned properly, your quadratus lumborum muscles can tense up, develop trigger points, and ultimately cause major back pain. Proper stretching and trigger point release of both the quadratus lumborum and glut medius muscles might be needed. The pairing of the hip adductors on the same side and the opposite side quadratus lumborum forms the lateral subsystem of stability

Shin splints and Plantar Fasciitis. Weak glute medius muscles can cause the leg to rotate inwards which can place strain on the foot and shin causing either shin splints or even plantar fasciitis.

Trigger Points Trigger points or muscle knots very often form in this area and should be massaged out. Areas to have massages include both the Gluteus Medius muscles and lower back muscles. I have helped a number of runners in this regard with both sport massage and trigger point release therapy. http://sbrsport.me/2012/09/22/what-is-a-trigger-point/

Some exercises you can do. Hip Hike – Stand on a step with one leg held free over the edge. Keep your shoulders level and drop and raise your free leg. You can increase the difficulty of the exercise by adding ankle weights. Forward Straight Leg Raise – Lie down on your side with your bottom leg (the one on the floor) bent, and your top leg extended out at a 90 degree angle to the rest of the body. Keep a slight bend in the top knee. Now raise the top leg from the floor to about twelve inches off the floor. Try and keep your heel higher than the toe on this top leg in order to maximally recruit the gluteus medius. Again, you can add ankle weights to increase the difficulty. We test for Glut Medius weakness during our runner’s leg assessment. You can read more about the assessment on – http://sbrsport.me/2012/09/15/runners-leg-assessment/

I have found the following to be effective in dealing with the issue.

  1. The runner’s leg assessment with the suggested strengthening exercises, shoe advice etc.

  2. Getting the lower back massaged out. Tight muscles in this area will inhibit recovery.

  3. Kinesiology tape can be placed in such a way as to stimulate glute medius activation.

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Regards.
Mike Roscoe.
Kinesiologist.

Mike Roscoe

About sbrsport

SBR Sport specialises in Swimming, Biking and Running. On the medical side we are able to do intensive bike setups, leg assessments and soft tissue release. Follow us on twitter - www.twitter.com/swimbikerunshop and/or facebook - www.facebook.com/sbrsport.
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27 Responses to Weak Glute Medius Muscles and a Chain Reaction.

  1. Alex nielsen says:

    Kendall’s research into gluteus medius weakness illustrates general weakness in healthy and LBP populations in their right gluteus medius whereas all populations have a strong left gluteus medius. Have you found this unilateral discrepancy in your own experience?

    This study is found in Muscles, Testing and function by Kendall p.8

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  4. Jane says:

    I havr had years of problems on my right. I walk a lot. I have been told that I have weak glute meds. This article has explained the problems I have experienced in my QL. Thanks for the explanation ithas added some perspective and understanding.

  5. Dan McCluskey says:

    Great Article. Crank you🏃🏻🌀🏊🏻🚴🏼👍👍

  6. Linda Hobaty says:

    Thank you! I’m printing this
    A weakness here is also the reason you may have difficulty rolling over in bed. It is causing me issues. My PT have me a clam exercise and. Couple others I don’tt do oh. There you go! I probably won’t get better because I dint do all the at home work. I guess I hate it worse than not being able yo roll over. PleAse excuse me. I’m very depressed.thank you for more ideas.

  7. Jen says:

    I tore my glute med on the right side clean off the hip joint. Is there anything I can do to stabilize? I’m a half-marathon runner but can only do about half that length before my hips and low back start really hurting, now I know why!

    • sbrsport says:

      Hi Jen. You need to do everything you can to strengthen the area and then get the scar tissue myofascially release. I am not sure where you live but would love to help if possible.
      Regards.
      Mike.

  8. Nancy says:

    I have had similar issues due to foot drop (L5 disk herniation)

    Running becomes very painful and not pleasurable when it flares up.

    In all honestly, i was blaming my sneakers for my painful, uncomfortable runs. But, after doing my physical therapy exercises (similar to the hip raises you demonstrated, to name one) just one time, I had a much stronger run!

    I thought that by squatting heavy, I’d fix the problem. But, apparently, my physical therapy exercises need to be reincorporated back into my routine.

    Great article. Thank you.

  9. Bella says:

    Which country do you practice ?

  10. Christel says:

    Could this also be a reason if a man has problems with his hips? Like cramps?

  11. sbrsport says:

    Hi Christel – it is possible. An overworked muscle will be more prone to cramping.

  12. Carol says:

    If your flute medius is weak on the left side, would that cause medial knee pain on the right or left side?

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  14. Andre van Drongelen says:

    I have had ongoing back problems after a hip operation 7 months ago and illiosoas lengthening my left glute med is Said to be strong by my physio (it can do 100 reps of a clamshell with a blue band ) but when it does a hip hitch to lift pelvis to the side it feels painful and weak. Could I be firing the wrong muscles doing clamshells? Any other thoughts to why it’s weak to hip hitch but not clamshell ? Thanks

    • sbrsport says:

      Haha Elle. Absolutely.

    • sbrsport says:

      Hi Andre – I would keep up with the hip hikes. Also, I have a blog on mountain climbers. I would do them unless otherwise indicated.

  15. Jacob says:

    Hey mate,

    in regards to weak glute med causing the internal rotation and the knee alignment to be off; would the load bearing region in the knee be the lateral femoral epicondyle causing excessive wear or is that inflammation purely the IT band rubbing due to over use?

    Thanks!

    • sbrsport says:

      Hi Jacob,
      I would put that down to an overuse issue. The weakened glute medius will tension the Illiotibial band by the hip itself and thus place pressure on the lateral epicondyle.
      Hope that helps,
      Regards,
      Mike.

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