Have you been experiencing hip or knee pain due to osteoarthritis or a history of injuries? If so, you’re not alone. In fact, hip and knee pain and stiffness are extremely common, and while there can be many different causes to courses of treatment, one of the most reliable structures to target is the gluteus medius muscle. This muscle starts on the side of your butt and crosses over the side of your hip joint. Its main action is hip abduction, which is kicking your leg out to the side, but functionally, it has many more roles that can be considered just as important, if not more important. We will break everything down below.
The most general and simple way to describe what the gluteus medius does is that it is the main muscle responsible for kicking the leg out to the side. However, as we mentioned previously, this is just one of the many functional roles it has.
Stabilizing the Hip Joint – Trandelenburg’s Sign
Gluteus medius crosses over the hip joint, so in addition to helping move that joint, it can also help stabilize the joint as well. This is particularly the case during walking or climbing/descending stairs. For example, let’s say you are taking a step and are just making contact with the ground on your right foot. If your gluteus medius on that right side is weak, your pelvis will actually drop on the left side.
How does this make any sense? This can be really difficult to picture, but it does make sense theoretically and also holds true realistically. If you think of the gluteus medius muscles as being a rope that crosses over the side of your hip joint, this “rope” will help keep the hip joint from separating. If this muscle is weak, it is less capable of holding the joint in that stable position, so the muscle stretches a bit and allows the pelvis to drop. This drop is referred to as Trandelenburg’s sign. We understand this is incredibly difficult to understand in writing, so I have included a crudely drawn picture in hopes that this can help provide a simple visualization.
Reduces Hip Pain
Hip pain is a very common complaint across the population, but especially for those with overuse injuries, as well as aging populations. It’s a very common site for osteoarthritis, which is a degenerative joint disease that wears down the cushioned surfaces of the joints. So how does strengthening this muscle actually help decrease pain, especially if exercise often brings the pain on?
By strengthening muscles around a painful joint, we can actually take some of the stress off that joint. In a sense, the surrounding structures will be strong enough to handle some of the load placed on that area, and will also help provide proper alignment of the joint. These two factors ultimately lead to reduced stress in the joint, which will help with pain in the long run.
Additionally, moving the joint is essential for providing the joint with proper lubrication and nutrition. So while it may be a little uncomfortable at the time, the overall effects will lead to a healthier and less painful joint, which will further assist you in staying active.
Reduces Knee Pain
The gluteus medius muscle isn’t only important at the hip joint, which is the the only joint it crosses, but it actually can be a huge factor in knee pain and knee injury prevention as well. For example, young female soccer players are at a way higher risk of ACL tears than any of their soccer peers. Part of this is because of a higher Q-angle, which is basically the angle of the knee when you are looking at it straight on. Females have a wider pelvis, so the femur (thigh) has to come down at a greater angle to the knee. Add in the other factor of being an adolescent with lower muscle strength than an adult, and we have a recipe for collapse, or more accurately, a much higher risk of knee injuries.
Strengthening this muscle may not seem like it will have a big effect, but it’s one of the best ways to reduce the risk of injury in soccer and any sport that involves running and especially cutting. It’s sets a foundation of strength and proper alignment by which other structures lower down can follow.
How to Isolate and Exercise the Gluteus Medius Muscle
Hip Abduction in Side Lying
Hip abduction in side lying is one of the most simple and effective gluteus medius exercises. You can do the standard version of it, or you can make it easier or harder depending on your needs. The picture at the top of this page is an example of this exercise, and we have also included a video below courtesy of Bespoke Physical Therapy. Here are some key points to remember:
Try and “stack” your hips when you are getting into this position. That is, your right hip should be in line with your left hip, and not on an angle that opens you up more to the ceiling or makes you angle down towards the bed. Another way to think of this is to try and be as much on your side as possible. Then, once you feel like you’re in a good position, you can bend the bottom leg for more stability as necessary.
Keep the moving leg as straight as possible!
When moving your leg, always remember to lead with your heel! If you start to open up your leg in a way where you start pointing your toes to the ceiling, then you won’t be targeting the gluteus medius nearly as well. By ensuring that you lead with your heel throughout the entire movement, you can have a high degree of confidence that you are working your gluteus medius muscle in isolation.
user-mdQuality is way more important than quantity, so don’t push for an extra few reps if you think it will come at the sacrifice of proper form.
If you want to make this exercise easier, you can do the exact same thing lying on your back in bed. This way, you can remove the resistance that is provided by gravity. In order to make sure your heel doesn’t get stuck on the bed as you kick your leg out to the side, try putting your foot in a plastic grocery bag. This will help it slide along the bed. In the instance that it is an appropriate level of difficulty, but you have pain when you lie on your side, you can also do this exercise in standing, just make sure to have something nearby in case you lose your balance.
If you want to make this exercise harder, there are a few things you can do. If you have mastered the technique and it feels really easy, then you can add an ankle weight for more resistance, requiring the gluteus medius muscle to work harder. If you are unsure if you are ready for this, try first increasing the number of repetitions, decreasing the rest breaks, or moving much slower throughout the entire movement.
Clamshell Exercise for Gluteus Medius
This one is a little more advanced, mainly because it takes a little more body awareness to make sure you are properly targeting the gluteus medius muscle. That said, with proper technique, this is one of the most popular exercises for strengthening the gluteus medius due to its effectiveness.
Realistically, this one can only be done in side lying, so you need to be comfortable in that position to begin with. In the video below (courtesy of GPS Human Performance), as well as many other tutorials of this exercise, you will notice the instructor using a band around their legs for resistance. A great way to find the best band is to book an appointment with a physioptherapist. This way, they can make sure that you do in fact need to be strengthening this muscle (although most people have weak gluteus medius muscles, even without pain or injury), they can instruct you on the best way for you to strengthen this muscle in a way that is practical for you, and then they can also provide bans or tubing that are the appropriate resistance for your needs.
However, you might not even need tubing to begin with. As I mentioned previously, most people have really weak gluteus medius muscles, and these types of isolation exercises can take a little while to master, and moreover, at the beginning stages, gravity may be more than enough resistance. Some people may still use a band in this case as a source of feedback, as they find it allows them to maintain proper positioning and technique, even if it’s not really adding any resistance.
The Monster Walk for Gluteus Medius Strengthening
This is another highly popular exercise for strengthening the gluteus medius muscle; however, you may see different variations all using this name. A couple different methods can work, including that shown in the video below. This exercise is more advanced, so it requires a little more awareness and overall strength and endurance. It’s also easy to perform incorrectly, so you definitely need to spend some time learning the proper technique first. Additionally, this is done under your own weight, so it’s suggested that you also have healthy-enough ankles, knees, hips, and lower back, as well as overall balance.
Notice in the video below that they emphasize not allowing your knees to collapse inwards. This is important because that’s exactly what we are tying to prevent! They explain this more thoroughly at 1:03, which also serves as a great visual showing the difference between a weak gluteus medius (knee collapsed inwards) and a strong gluteus medius (knees in line with hips). Otherwise, this video, courtesy of KOH Physical Therapy Lab, provides excellent instruction for this rather advanced exercise.
If you are aware that you have a weak gluteus medius, these exercises should serve as good starting points to getting you back on track with your activity with less pain. Not only is this a good way to help with hip and knee pain, but it’s also one of the best ways to reduce the risk of hip and knee injuries in sports that involve lots of running, especially with planting and cutting. However, if you are unsure what the source of your pain is and if you require exercise for treatment, we highly recommend you visit your doctor or physiotherapist to ensure that you have a proper treatment plan in place. Even if they diagnose you with what you already knew, these professionals will be able to cater the exercises to your specific needs and make sure you are doing everything properly.
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