When most of us think about our rear ends, we automatically think of our gluteus maximus muscle. This mighty muscle is large and extremely powerful, plus it is the most superficial and thus most visible muscle in that region of the posterior chain. However, just because it steals the spotlight doesn’t mean this muscle acts alone. The “glutes” consist of three muscles, each with a different yet important role to play in the activities of daily living. In addition to gluteus maximus, this muscle group also contains gluteus medius and gluteus minimus. In this post, I will highlight gluteus medius, because it is problematic for many of my clients (and for me, too!).
Gluteus medius comprises the middle layer of the glute muscles. It originates on the lateral posterior surface of the ilium, or hip bone, and attaches to the greater trochanter of the femur, or the bony protrusion at the outer top of the leg bone. (If you prefer a video, here is a video.)
Gluteus medius is a powerful abductor of the leg, meaning it is the muscle we use when raising our leg out to the side. Since it has both anterior and posterior fibers, it is also responsible for both internal and external rotation at the hip. However, this muscle’s most important role in the body is that of pelvic stabilizer. It provides stability to the pelvis while standing on one leg, for example. Considering that we stand on alternating legs every time we take a step to walk, it becomes clear how important this little muscle is! During the gait cycle, each leg takes a turn holding up our entire body weight as the other leg leaves the ground and swings forward.
If gluteus medius is weak, when we lift and swing the opposite leg forward, we can not hold the pelvis up. In that case, that opposite hip dips down rather than being maintained upright.
Normally in order to compensate for this weakness, we use our back muscles to shift the torso over the affected hip in order to create more stability through an altered center of gravity, which in time can lead to the dreaded low back pain. (A recent study found that pregnant women with weak gluteus medius muscles were 6-8 times more likely to have back pain than their “non-weak” counterparts.) This weight shift can also result in torsion forces in the knee, which can contribute to knee pain. Other muscles, such as the tensor fasciae latae, which attaches to the iliotibial band, may compensate for the lack of hip stability, which can lead to painful inflammation of the IT band.
My mentor, Ed Buresh, underscores the importance of the gluteus medius by highlighting its relationship to the psoas, a muscle which has definitely reached celebrity status. Just as the psoas provides stability to the spine, the gluteus medius provide stability to the hips. The two must work together. The psoas is often identified as a source of low back pain. However, one of the things I learned from Ed early on is that if we ignore the role of the gluteus medius in that scenario, we are missing half of the equation. In my experience, the psoas tends to be tight and the gluteus medius tends to be weak.
The best way to gently build up weak gluteus medius muscles is to start incorporating non-weight bearing exercises, like the clam shell (figure to the right),
and gradually move toward more advanced movements like pelvic lists.
Here is Katy Bowman explaining the pelvic list:
For some in between exercises, here is an excellent resource I found online:
The gluteus medius is often overlooked, although it is commonly one of the weakest muscles in the hip and thus directly involved in various soft tissue dysfunctions. Becoming aware of the health of this muscle is key to maintaining proper gait biomechanics. In my clinical experience, most of us could benefit from incorporating some strengthening of the lateral hip into our weekly movement program.
Yoganatomy (for my yoga people)
Physiotherapy Exercises (other good ideas from same resource in article)