Physiotherapy for The Gluteus Medius
The Gluteus Medius muscle is one of the key muscles when it comes to injury prevention and plays an important role in core stability. Weakness in the glute med has been shown to contribute to lower back strains as well as hip, knee and ankle injuries.
What does the Glute Med do?
The Glute Med muscle is located over the side of the hip. It is one of the main muscles that allows you to move your leg out to the side (abduction) and also to turn your leg out (external rotation). But its injury prevention powers lies in its ability to keep your pelvis level and stop your leg from turning in when you walk, run or jump.
Why is this important? Because it puts extra strain on your muscles, ligaments and joints if your pelvis drops or your leg turns in excessively when you move. Some of the injuries that are associated with poor hip and pelvis stability are in the picture below.
How to strengthen the Glute Med
You should always master the low load exercises first and then move on to the more challenging ones. You may find that one leg is stronger than the other when you do these exercises and you should train it according to what the weakest leg can do. That way it will maintain the strength in the strong one while the other leg is allowed to catch up.
You will notice that I tend to prefer single leg exercises. This is to ensure that both your legs get worked properly.
I have chosen the exercises below, because they have all been shown to strongly activate the gluteus medius muscle and the level 3 exercises also work the muscle in its functional position (as you would use it when walking, running, jumping).
NB: These exercises may not be right for you at this specific time. You should consult your healthcare provider or physiotherapist before starting any of these.
Glute Med Training: Level 1
Purpose: This exercise serves 2 purposes:
1. To teach you how to effectively turn your hip out – you’ll need this for the next level exercises.
2. Besides strengthening the glute med, it also strengthens the other muscles, e.g. piriformis and glute max, which are important for hip stability.
Starting position: Lie on your side with your hips bent to about 60 degrees and your knees at a 90 degree angle.
Movement: Tighten your stomach muscles to help stabilize your trunk during the movement. Keep your feet touching but lift your top knee up and back, so that your legs separate and open like a clam. Hold the position for 2 seconds and then SLOWLY take your leg back down.
Check that: Your pelvis or hips does not roll back as you lift your leg.
Aim: Build up to doing 3 sets of 15 repetitions. Rest 1 minute between sets.
Side leg lift
Purpose: To activate and strengthen the glute med muscle.
Starting position: Lie on your side with the leg at the bottom bent up and the leg at the top straight. It works really well if you can lie with your back against a wall so that you keep your heel in contract with the wall as you lift it up and down. That way you ensure that you don’t roll backward and that your leg does not drift forward.
Movement: Tighten up your pelvic floor and lower stomach muscles. Turn your foot so that the toes point to the ceiling and slowly lift your leg up and out to the side as far as you can BUT make sure that your leg does not drift forward. It has to stay against the wall or in a straight line.
Check that: Your pelvis or hips does not roll back as you lift your leg. Your head, back and heel should stay in contact with the wall behind you. If you’re not using a wall and can see your whole foot as you do the movement, you’ve likely allowed your leg to drift forward – correct it by taking the leg back.
Aim: Build up to doing 3 sets of 15 repetitions. Rest 1 minute between sets.
Glute Med Training: Level 2
Side walk with band
Purpose: To teach you how to position your knee over your foot in a more functional position while you strengthen the glute med.
Starting position: Tie an elastic band around your legs – I prefer it just above my knees. Now place your feet hip distance apart and separate your knees against the band’s resistance so that your knees are aligned with the middle of your foot. Then squat down to about 45 degrees knee flexion.
Movement: Walk sideways but make sure that your knees always stay aligned with the middle of your feet.
Check that: Your knees should never turn in and always be pointing in line with the middle of your feet.
Aim: Build up to giving a total of 45 steps into each direction. How many you do in one go will depend on the space you have available.
Purpose: To strengthen the glute med. This is not a functional exercise but is much harder than the side leg lift and will give you better strength gains.
Starting position: Lie on your side with your knees bent back so that your shoulders, hips and knees are in a straight line. (You can do this with the legs straight if you are strong enough) Support yourself on your forearm.
Movement: First contract your pelvic floor and lower abdominal muscles. Then lift your hip off the floor so that your body forms a straight line. Hold the position
Check that: You do not rotate your body forwards or backwards.
Aim: Build up to being able to hold the position for 40 sec and do 3 repetitions. Rest 1 minute between reps.
Glute Med Training: Level 3
Single leg squat with support
Purpose: I love this exercise as it not only teaches you how to control your body in a functional position (improves position sense), but also strengthens your glute med, glute max, quads and hamstrings.
Starting position: Balance on one leg and have the other leg resting on a chair behind you. It’s best to do this in front of a mirror at first so that you can make sure that you are doing it right. Your pelvis should be level and your knee should be pointing in line with the middle of your foot.
Movement: SLOWLY push your bottom out to the back and bend your knee so that you squat down. Your pelvis must remain level throughout the movement and your knee must stay in line with the middle of your foot. Stop at the bottom and check your alignment. If you find that your knee has turned in or pelvis has dropped, correct it first before you come back up.
Check that: Your pelvis stays level. Your knee does not move in but stays over the middle of your foot. You knee does not cross over the front of your toes. If this happens, it’s a sign that you are not pushing your bottom out far enough to the back.
Aim: Build up to 3 sets of 15 slow repetitions. Rest 1 minute between sets. Aim to squat to at least 60 degrees or more knee flexion. You may have to spend a lot of time on this exercise before you move onto the next one.
Single leg sit-stand-sit
Purpose: This exercise is a step up from the one above and the unstable position makes all your muscles and control systems work a lot harder. It’s a great exercise to strengthen your glute med, glute max, quads and position sense.
Starting position: Choose a chair that you can manage to get up from using only one leg. Your aim should be to use a chair that places your knee in 90 degrees flexion, but if this is too hard use a higher surface. I usually place some pillows on the chair to make it easier. Sit on the edge of the chair with your one leg on the floor and the other one in the air. Your hands can either be in your sides or out in front of you.
Movement: Slowly stand up from sitting, using only one leg. Make sure that your pelvis stays level and your knee moves in line with the middle of your foot. Then slowly sit down again.
Check that: Your pelvis and knee stays aligned. If you find that you “plonk” down instead of slowly lowering yourself down, you may have to use a higher chair to start with.
Aim: Test how many your can do with good form from 90 degrees knee flexion. Your aim should be to get to 22 with no wobbling and keeping your pelvis and knee aligned. I can only manage 8 and with rather poor form, so I should work on the Single Leg Squat With Support exercise BEFORE doing these. Retest this every 4 weeks to check on your progress.
Start strengthening it by doing sets of 8 reps until fatigue. Rest at least 1 to 2 minutes between sets.
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