1 of 20

Gluteus Medius

Ryan Gilmore

2 of 20

Anatomy Review

  • Origin: Lateral ilium between posterior and anterior gluteal lines
  • Insertion: Lateral aspect of Greater trochanter
  • Innervation: Superior Gluteal Nerve (L4-S1)
  • Action: Pelvic Stabilization, Hip abduction, and assist other hip movements
  • 3 Heads similar to deltoids

3 of 20

Literature Review

4 of 20

Exercises With Highest Gluteus Medius Activity

Overall:

hip hitch/pelvic drop exercise

Additional Anterior:

The dip test

Isometric standing hip abduction (Also Posterior)

Additional Middle

single leg bridge

side-lying hip abduction with hip internal rotation

lateral step-up

standing hip abduction on stance or swing leg with added resistance

resisted side-step

5 of 20

Low Back Pain

Systematic review of 24 articles involved 1088 participants with LBP and 998 without LBP

The gluteus medius muscle LBP group:

reduced strength

more trigger points

Inconclusive results:

The level of activity

Fatigability

time to activate

time to peak activation

cross sectional area

muscle thickness

Meta-analysis was not performed due to the heterogeneity

6 of 20

Hip Osteoarthritis CPG

Manual Therapy (A):

​

Soft tissue mobilization of areas of soft tissue restriction, such as iliacus, hip ERs, posterior gluteus medius, quadratus femoris, and gluteus maximus

​

7 of 20

Patellofemoral Pain CPG

A high-quality RCT assessed an 8-week

Hip-targeted exercises compared with knee-targeted exercises

Superior outcomes for pain and function in hip-targeted exercises group

Weight-bearing exercises resulted in high levels of gluteal activity.

​

Dry Needling of GM and QL

When combined with exercise, had superior beneficial effects compared to exercise alone

8 of 20

Dry Needling RCT

Main outcome measures: recorded at baseline and at 4 and 6 weeks after the start of treatment

pain intensity

function (Kujala score, modified star excursion balance test, step-down test)

QL and GM pressure pain threshold (PPT)

Results:

Both groups showed significant improvements in pain, function, and PPT at weeks 4 and 6 compared to baseline

Between-groups comparisons showed significantly greater improvements in pain, function, and PPT in the Ex+DN group

​

​

9 of 20

Lateral Ankle Ligament Sprain CPG

Pt’s with chronic ankle instability have abnormalities in the knee and hip

Reduced knee adduction

Decreased gluteus med activity

Altered hip-ankle coordination.

​

​

Studies investigating jumping have found

less hip flexion and hip abduction at initial contact

with decreased gluteus medius activity

reduced jump height and flight distance

​

10 of 20

Plantar Fasciitis CPG

Overuse injuries to LE can lead to strength deficits in hip musculature

​

A 6-week training program to strengthen the hip abductors and external rotators resulted in improved lower extremity joint load response during running.

11 of 20

Postpartum CPG

Persistent asymmetry of the pubic symphysis can cause leg length discrepancy or positional impairment

​

Correction followed by stabilization exercises to reduce stress (abdominal, pelvic floor, adductor, and gluteal musculature)

​

Impaired muscle performance can lead to force closure across joint

​

Assess force closure through movement testing

​

12 of 20

Hip Dysplasia

Patients with developmental dysplasia of hip and hip arthroplasties

Gluteus medius had substantial loss of cross sectional area, radiological density, and length in people with developmental dysplasia of the hip

​

13 of 20

Foot Type

Assessed healthy adults foot type and associated muscle activity during gait

Pes Cavus foot type had higher levels of gluteus medius muscle activity compared to neutral and Pes Planus

Orthoses had no impact on glute medius activation over 4 weeks

​

14 of 20

Pneumonia

Testing of muscular function found altered muscles in

Gluteus Maximus and medius both found to be altered

Other muscles: The erector muscle of the spine, musculus quadriceps femoris, iliopsoas muscle, rectus abdominis muscle and oblique abdominal muscle, deep cervical flexor muscles, pectoralis major and pectoralis minor muscles on the side of the affected lung.

Targeting these muscles showed far less alterations post study compared to control group

​

15 of 20

Twerking?

Bret Contreras, PhD AKA “Glute Guy” on Instagram

Took EMG data while twerking

Discovered no glute activation

All Erectors pulling on pelvis

16 of 20

Where Do We See It?

Lateral approach for total hip arthroplasty

Partial knee arthroplasty

Plantar Fasciitis

Low Back Pain

Greater Trochanteric Bursitis

IT Band Syndrome

FAI

OA throughout LE

17 of 20

Glute Med Tendinopathy (Dormant Butt Syndrome)

Prolonged sitting leading to tight hip flexor, muscle imbalance putting pressure on glute med, poor muscle control

Inflammation of Glute Med Tendon

Stiffness, Pain, and weakness

Can develop into Trochanteric Bursiti

18 of 20

How Do We Treat It?

  • Dosage: 1 x 10 x 5s hold
  • Progression
    • Banded Hook Lying Clamshell (Bridging with ISO hip abduction)
    • Side Lying Hip abduction (Banded)
    • Standing Hip abduction (Banded)
    • Banded Knee Sidewalking
    • Banded Ankle Sidewalking
    • Hip Hikes
    • Pistol squats, single leg bridges, side plank with hip abduction?

19 of 20

Questions?

20 of 20

Works Cited

Liu, R., Wen, X., Tong, Z. et al. Changes of gluteus medius muscle in the adult patients with unilateral developmental dysplasia of the hip. BMC Musculoskelet Disord 13, 101 (2012). https://doi.org/10.1186/1471-2474-13-101

Martin RL, Davenport TE, Fraser JJ, et al. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther. 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302

Martin RL, Davenport TE, Reischl SF, et al. Heel pain-plantar fasciitis: revision 2014. J Orthop Sports Phys Ther. 2014;44(11):A1-A33. doi:10.2519/jospt.2014.0303

Moore D, Semciw AI, Pizzari T. A SYSTEMATIC REVIEW AND META-ANALYSIS OF COMMON THERAPEUTIC EXERCISES THAT GENERATE HIGHEST MUSCLE ACTIVITY IN THE GLUTEUS MEDIUS AND GLUTEUS MINIMUS SEGMENTS. Int J Sports Phys Ther. 2020 Dec;15(6):856-881. doi: 10.26603/ijspt20200856. PMID: 33344003; PMCID: PMC7727410.

Sadler S, Cassidy S, Peterson B, Spink M, Chuter V. Gluteus medius muscle function in people with and without low back pain: a systematic review. BMC Musculoskelet Disord. 2019;20(1):463. Published 2019 Oct 22. doi:10.1186/s12891-019-2833-4

Sadler, S., Spink, M., de Jonge, X.J. et al. An exploratory study investigating the effect of foot type and foot orthoses on gluteus medius muscle activity. BMC Musculoskelet Disord 21, 655 (2020). https://doi.org/10.1186/s12891-020-03683-7

Somov DA, Makarova MR, Makarova IN. Vopr Kurortol Fizioter Lech Fiz Kult. 2015;92(3):7-10. doi:10.17116/kurort201537-10

Willy RW, Hoglund LT, Barton CJ, et al. Patellofemoral Pain. J Orthop Sports Phys Ther. 2019;49(9):CPG1-CPG95. doi:10.2519/jospt.2019.0302

Zarei H, Bervis S, Piroozi S, Motealleh A. Added Value of Gluteus Medius and Quadratus Lumborum Dry Needling in Improving Knee Pain and Function in Female Athletes With Patellofemoral Pain Syndrome: A Randomized Clinical Trial. Arch Phys Med Rehabil. 2020;101(2):265-274. doi:10.1016/j.apmr.2019.07.009

​