Gluteal strengthening is a hot topic in the physiotherapy world. Clamshells, bird dog, bridging and side leg lifts seem to be fan-favourite rehabilitation exercises amongst therapists and clinics. Gluteus medius are one of the most influential muscles in the human body. They stabilize the pelvis, control rotation of the hip, and affect the alignment of the knee. Weakness in these muscles has been linked to several pathologies like patellafemoral pain syndrome, ACL injuries, knee osteoarthritis and lateral hip pain.
The main questions many people ask us are why their glutes have gotten weak in the first place? And what the best strengthening exercises are to do at home?
Gluteal muscles tend to become inactive for a few reasons. Many studies blame our sitting culture for glute deactivation. Like any other muscle, glutes need activation to maintain strength. Muscles placed in a stretched position, as they are when sitting, tend to become deactivated. Muscle memory is also an important factor in muscle activation. Over time, your brain can become used to activating certain muscles more than others or certain muscles in a particular order. If you tend to shift your weight and lean to one side while you stand, or you participate in a sport that uses one leg more than the other, your brain will get used to those movement patterns, and it will become habitual for you to use those muscle sequences in everyday life. This is what leads to muscle imbalances and can ultimately lead to a weak glute muscle.
The type of gluteus exercises you should perform for rehabilitation is a difficult question to answer because gluteal muscles tend to be fairly complex in terms of which exercises best activate them, what goals the individual is attempting to achieve, and what strength the individual is starting at. Choosing an exercise program must be tailored based on desired results, whether the aim is for strength, endurance, or progressive loading of the tendon1. This means that two individuals that require gluteus strengthening may be given two different exercises with differing parameters by which to complete these exercises. There are numerous positions and movements that can activate your gluteal muscles. Leave it to your trusted physiotherapist to help you find the best exercise for you.
A recent literature review determined the percentage of muscle contraction (MVIC) obtained during many different gluteus medius exercises. Certain conditions like tendinopathies, or some individuals who are extremely weak or post-surgical may require lower percentages of MVIC as a starting point for strengthening. Athletes or those seeking to increase power or strength may be requiring strengthening programs with higher gluteal muscle loading. Information from this study can be a starting point in determining the best exercise for your specific condition.
The aforementioned study arranges the results in stratified groups of low (0–20% MVIC), moderate (21–40% MVIC), high (41–60% MVIC) and very high (>61% MVIC) loading groups (1). Here is a look at a few of the exercises that were investigated in the study and what the percentage of muscle contraction was found to be:
1. Prone Hip Extension (moderate)
2. Quadruped Hip Extension (moderate)
3. Bird Dog (high)
4. Bridge 2 legs (low to moderate)
5. Bridge 1 leg (moderate to high)
6. Side Bridge with Hip Abduction (high to very high)
7. Single Leg Balance Unstable Surface (moderate)
8. Lateral Plane Band Walk (moderate to very high)
9. Lateral Step Up (moderate to very high)
This is just a very small sample of exercises that can be used to challenge the gluteus medius muscle group. As you can see, there are many exercise options to choose from and as such, we recommend working with a skilled physiotherapist to develop a program that is most desirable for you. There are many exercise variations, cues, feedback and compensation strategies that a trained physiotherapist would be able you with. They will also be able to work with you to release, stretch and mobilize any other areas of the body that may be limiting your gluteal function.
- Ebert JR, Edwards PK, Fick DP, Janes GC. A Systematic Review of Rehabilitation Exercises to Progressively Load Gluteus Medius. Journal of Sport Rehabilitation. 2016 DOI: http://dx.doi.org/10.1123/jsr.2016-0088