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Gluteal progression for back, hip and knee health

3/20/2013

23 Comments

 
Picture
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.  ​​
Gluteal strength assessment: step down from a stool
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

Single leg standing balance
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.
Single leg balance with vertical leg
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!
Single leg balance with opposite knee flexion
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.
Standing hip abduction to strengthen gluteus medius
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.
Side step with monster band for gluteal strengthening
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.
Hip strengthening with resistant band
Make sure not to bend your knees. Most people cheat by bending the knee because the glutes are weak. Don't do it!
Monster walk with band glut med strength
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!
Standing balance with hip extension
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.
Hip strengthening: standing arabesque
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.
23 Comments
Annette link
3/20/2013 11:14:45 am

This is a fabulous post. The pictures are so helpful - I can't wait to try all of this! Thanks!!!

Reply
Susan
3/20/2013 12:32:01 pm

Annette,
This was part of my Restorative Exercise™ class last week. I loved it so much I wanted to share! Hope you like it! Susan

Reply
Alexa
3/20/2013 01:16:08 pm

Ditto what Annette said! It's such a great sequence and I walk with greater ease afterwards. Thank you!

Reply
Christine Shuttleworth
3/20/2013 05:10:42 pm

Great blog. Thank you. Will share.

Reply
Helen
3/23/2013 01:03:58 pm

Great blog. My glutes need strengthening and so it is hard to do the 2nd one unless I hold on. Does this still help my glutes?

Reply
Susan
3/23/2013 01:37:20 pm

Helen,
I am glad you like the blog. Yes, hold onto something. You want to make sure that you can keep your form. You are still strengthening! Have fun, Susan

Reply
Tracy Sher link
4/5/2013 02:03:57 pm

Great post, Susan! I'm sure I'll share this :)

Reply
Susan
4/7/2013 01:43:22 am

Thanks Tracy! I would love to have you share! Susan

Reply
Tracy Sher link
4/7/2013 01:57:41 am

Susan- I just shared this article on FB on the Pelvic Guru page. :)
www.facebook.com/pelvicguru

Reply
Susan
4/11/2013 10:45:49 am

Tracy,
Thanks for sharing! I love your work! Susan

Reply
Ida
4/8/2013 03:32:41 am

What's the repetition for each exercise & how many time a day is recommended? Thanks

Reply
Susan
4/8/2013 04:26:00 am

Ida,
I recommend perform each position for a minute. Repeat 1-2 times in a day. Thanks for your response, Susan

Reply
Ashley
4/11/2013 04:17:48 am

One thing I've noticed, is that when I bend to get something off the floor - my knees turn OUT. What does this mean? I'm so confused as to what I need to be stretching/strengthening with this particular symptom. Can you advise me?

Reply
Susan
4/11/2013 10:45:09 am

Ashley,
More than likely your psoas muscles are tight. Check out this post:
http://www.alignintegrationandmovement.com/1/post/2012/05/a-song-to-my-psoas-please-release-me-let-me-go.html

Hope this helps, Susan

Reply
Denise
4/11/2013 08:49:12 am

I'm so glad you posted this!! I need this so much! Thank you so much for all of your help:)

Reply
Susan
4/11/2013 10:46:27 am

Thanks Denise, I am glad that you like it! Susan

Reply
Kari
6/29/2013 12:08:30 am

Probably a dumb question, but when you use the term "progression," do you mean to do all the exercises in a row or do you start with one until you're seeing improvement and then move on to the next one? Thanks for your very informative posts!

Reply
Susan
7/1/2013 11:01:49 am

Kari,
Not a dumb question at all. For this post this was a sequence that I went through in my exercise class. So these can be done one after the other!

Reply
Michelle
8/15/2014 04:21:01 am

Found you on Pinterest - so glad I did!!

Reply
Susan
8/15/2014 04:54:16 am

Michelle,
Thank you for following! Susan

Reply
Sharon link
9/26/2014 05:47:13 am

I just had my hip replaced and my physical therapist has me doing all of these exercises.

Reply
Susan
9/26/2014 08:19:35 am

Glad to know that we are the same page! Susan

Reply
David W. Miller MD link
1/5/2021 12:01:33 am

Nice blog thanks for sharing, that was a fascinating and informative article.Weak glutes are often a major cause of knee pain and back pain. I would love to appreciate the pictures you have added in your blog, they are so helpful and these steps are easy to practice to strengthen the glutes. Strong Gluteal muscles help in hip extension as well as stabilization of the joint.

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