When I asked clients for blog topics they’d like to read about, one exclaimed “weak glutes”.
“Help,” she said. “I’m in pain and I’m told I have weak glutes. Can you do anything to help ?” And thus ensued a little conversation about how weak glutes are likely caused by tight somewhere else.
I think she may have been hoping for a magic pill, a short answer, but nothing in the body is that simple…
In this blog, I’ll cover what those glutes are and what they do, followed by some simple assessments to understand glute weakness… in the next, we’ll cover why that glute or those glutes may be weak, and how Bowen can (and you) can help !
what are the symptoms of having weak glutes ?
As you read on, you’ll find that gluteus muscles do many different things. As such, the range of symptoms felt could be a pretty long list. They can become “weak” due a number of causes, or be the cause of other muscles not working in synch.
Most commonly, pain is experienced in the lower part of the body.
Lower or mid-back pain is a common symptom. The sacral area (especially around sacroiliac joints) can experience soreness or tightness. Pain around the sitbones and extending down the back of the leg can also originate from the glutes. Sciatica or piriformis syndrome can also be seen.
With weak glutes come pelvic instability and postural problems.
Lack of pelvic stability can result in difficulty walking, especially up stairs. Poor firing patterns can also result in hip pain, lower back tightness, and knee pain from iliotibial band syndrome.
These symptoms that may be felt are not unique to gluteus muscle – they are simply one group of muscles out of balance with others.
what are glutes and what do they do ?
The glutes are a set of three muscles – gluteus maximus, medius and minimus. Located in the buttocks, they’re key to so many everyday movements – like standing up and walking.
Each of the gluteal muscles have different functions, some in opposition to each other. Weakness in one glute can be different to weakness in another glute.
As the name would suggest, gluteus maximus is the largest of the gluteal muscles. This muscle lies more superficial (near the skin) than the other gluteal muscles, with muscle fibres that run diagonally across the buttock. It originates as a long line along the coccyx, sacrum, and part of the iliac crest. The upper fibres insert on the iliotibial band, while the lower fibres insert on the rear of the femur (thigh bone).
The main action of the gluteus maximus is to extend the hip joint (leg moving backwards), and lateral rotation of the hip (thigh rotating outward at the hip joint). Upper fibres abduct the hip (leg going out the side), while lower fibres adduct the hip (help bring it in from the side).
Gluteus maximus is not very active when walking, but is activated when doing powerful lower limb motions like going up steps, climbing or running. Working together with hamstrings, the gluteus maximus is key to standing up from bent over position.
The gluteus maximus is important for maintaining an upright posture, keeping the pelvis balanced on the femurs. It’s attachment to the iliotibial band means it gives support to the lateral side of the knee. It’s action to laterally rotate the hip/femur means that a well-functioning glute max is also key to foot arch.
The gluteus medius is located more laterally on the hip. It’s also mostly superficial, with the exception of the posterior portion that tucks behind the maximus. This muscle originates on the ilium, just below the iliac crest – that’s the curved part of the pelvis bone you feel at your back. It inserts on the femur, the thighbone – on the lateral aspect of the greater trochanter (the part of the thighbone you feel sticking out at your hip).
In terms of movement, the gluteus medius is the main muscle involved in abducting the hip (moving the leg out sideways). The posterior fibres also help to extend and laterally rotate the hip, while the anterior fibres help to flex and medially rotate the hip.
The gluteus medius supports the pelvis during walking and running. When one leg is taken off the ground to step, the gluteus medius works to maintain stability through the weight-bearing leg. This prevents the pelvis from dropping to allow the leg to swing forward in the step.
Gluteus medius is key to frontal plane stability of the pelvis. It forms a lateral fascia sling with the same side tensor fasia latae and opposite side quadratus lumborum to give that stability.
The gluteus minimus lies deepest, beneath the gluteus medius. It attaches to the gluteal surface of the ilium (like the medius), but inserts on the anterior (front) aspect of the femur.
The primary role of gluteus minimus is internal rotation of the hip, with support from gluteus medius and tensor fascia latae. The minimus also helps to abduct the hip (leg out to the side). With the insertion on the anterior aspect of the femur, it also helps medially rotate (turn in) the hip.
Working with the gluteus medius, the minimus acts to give stability to the hip and pelvis when the opposite leg is off the ground.
So, which glute may be the problem ?
Well, it could be any of them, and possibly all of them to an extent… it could be one-sided or both… and it’s worth noting here that the glutes are probably not the only problem (but we’ll deal with that later)…
There are a few assessments that can be done to understand which are weak. Knowing the movements and key functions of each glute (detailed above), these assessments should make a whole lot of sense.
Here’s a few that may help:
Recall that the primary function of the big gluteus maximus is hip extension. A weak gluteus maximus will likely not be strong on extension, and have an altered firing pattern with other muscles compensating.
With the client lying prone and knee bent, have them raise their leg off the table. Apply a little resistance against the lower part of the posterior thigh. If the leg can’t push back strongly, then the gluteus maximus is likely weak.
To assess the firing pattern, palpate the erector spinae with one hand, resting the thumb and index finger on opposite sides. Use fingers on the other hand to rest on the belly of the gluteus maximus and hamstring. When the client raises their leg at least 15degrees off the table, feel the order of muscles firing – the gluteus should fire first, hamstring later, with opposite erector spinae firing before the same side erector spinae. If the gluteus maximus doesn’t fire first, then that muscle would be weak or inhibited.
The gluteus medius muscle (with the glute minimus) is key to hip abduction, so this movement will help ascertain how strong or weak those glute muscles are.
For this one, the client is lying on their side, bottom leg bent to support, top leg straight. Ability to raise the leg to the side (perhaps with some resistance) will indicate strength of the gluteus medius and minimus.
Placing one hand on the quadratus lumborum, and the other on the tensor fascia latae and gluteus medius can assess the firing pattern. The normal firing pattern should be gluteus medius first, then tensor fascia latae, and lastly quadratus lumborum. An altered firing pattern would indicate weak gluteus and overactive other muscles.
This is a fairly quick and easy test to give an indication of possible weakness in gluteus medius and minimus. Recall that these muscles are key to pelvis stability when one leg is off the ground (eg walking).
The client is instructed to stand on one leg for about 30 seconds (holding something lightly if balance is an issue, but not leaning to the side). If the pelvis raises a little or stays level, then the gluteals are strong and stabilising the pelvis. If the pelvis drops on the lifted leg side, then it’s likely that the gluteus medius (and minimus) is weak.
Sometimes this can be more obvious when walking, if other muscles have taken over when doing the test. One hip may drop or kicking out to the side due to that weak glute not providing stability.
In the next instalment, I’ll explore further possible causes of weak glutes, and how Bowen Therapy (and some exercises) can help bring balance back to the body – and reduce pain !