Gluteal progression for back, hip and knee health

Photo by Gesina Kunkel 

Weak gluteal muscles can be blamed for many low back, hip and knee pain/injuries.  Without the muscular support, the back, hip and knee are subject to increased loads and excessive motion leading to friction and wear and tear. The 3 gluteal muscles: maximus, medius and minimus assist in controlling the trunk and the leg as it is loaded during foot contact to the ground as in walking, running, jumping, going up/down stairs, as well as moving from a sit to a stand or bending. 
When the gluteal muscles are weak, you will notice increased movement of the trunk toward the side of weakness, and the knee will cave in toward the midline.  Are your glutes weak or strong?

Gluteal assessment:  Step down from a stool. 

Start to observe what you do when you go up/down stairs: do you turn your foot out to give yourself more support, does your knee drift to the midline, do you shift your torso over to the planted leg to make it easier to step up? If yes, then your glutes are weak
What happens when you bend down to pick something off of the floor or transition to get in and out of a chair:  do your knees come together?  If yes, then your glutes are weak.  ​​

Stand on a stool. Slowly begin to lower one leg down, tap the floor with your heel and then return back up. Repeat 5 times. Notice if your standing knee collapses toward midline, or if your torso leans to the side. If either or both happens, you need to strengthen your glutes!

Strengthen your glutes: standing progression

1. Start by standing on your left leg. Keep your thighs parallel and bend your other knee so your foot can tap down on the floor like a kick stand if you need it to balance. Check yourself in the mirror. Make sure that your pelvis does not rotate. Keep your ASIS facing forward (that is what I am pointing to). Ideally you want to have your pelvis level. Check your waistband: if the right side is elevated then you are using your back muscles to compensate, if it has dropped, then you are not activating your left glute! Work toward standing for 1 minute. Switch sides.

From a side view, try to maintain vertical alignment: midpoint of shoulders and hips over ankle bone (I am not quite there, helps if you have a mirror to look into). Keep the standing leg straight, and your quads in front of the thigh relaxed!

2. Next progression begin to bend your knee as far as you can and then return to start position. Perform 10 reps and then on the last one, keep it bent as you balance for the final minute. Again, make sure that the pelvis doesn't rotate or drop.

3. Stand on your left leg. This time your pelvis will elevate because you won't be bending your right knee. Keep your leg straight as you move it out to the side and in. Work toward 1 minute and then switch sides.

4. Side step with a light resistance band (if you have had a hip replacement do this without the band). Make sure to keep feet straight ahead and plant your foot with the outside edge straight.

Make sure not to bend your knees. Most people cheat by bending the knee because the glutes are weak. Don't do it!

Make sure to land your foot with the outside edge straight, this position engages your glut med and min. Return to normal hip width distance. Make sure to relax your quads between steps!

5. Now for the glute max finale! Standing on your left leg, extend your rlght leg behind you. Begin to lower your torso as you hinge at your hips bringing your hips behind your ankle, and then return.

Make sure the movement is coming from your hips, not your spine! Pelvis should stay level. This is challenging, mostly from a balance perspective. If this is hard for you, then get into position and hold.

Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignintegrationandmovement.com.