Weak Gluteus Medius: A Key Contributing Factor to Low Back Pain

By Ginny Ngo, PT, DPT
Low back pain is a bummer! And without the right treatment, it can add up and become expensive! The patients that enter my treatment room describe all of the things that they have tried to ease their low back pain: heat/cold pack, stretches, foam rolling, spinal decompression contraptions, inversion tables, TENS, massages, theraguns, new chairs, new beds, medication, back supports, surgery, and more. 

While many of these options are helpful on the road to recovery and can help regulate painful symptoms, most of them do not address the movement problem that led to the symptoms in the first place.

These movement impairments occur in activities that you perform every day such as washing dishes, unloading the dishwasher, bending forward to lift objects, walking, standing, sitting, or driving (1). Overtime, performing the same movements over and over again or sustaining postures with improper form add up and eventually aggravate surrounding tissues and cause pain (1). 

Studies show that weakness and poor recruitment of your gluteus medius muscles contribute to increased pressures on the spine and decreased spinal stability (2). In a systematic review analyzing the relationship between gluteus medius recruitment in those with and without low back pain, “those with low back pain had significantly greater gluteus medius muscle fatigability after 30 minutes of standing compared to those without low back pain (2).” In other words, fatigue of the gluteus medius shifts the workload towards your spine and lower back muscles to compensate for lack of strength and endurance (2). 

The gluteus medius is an important muscle for lateral stability of the spine and pelvis.

It is located where your butt dimples are. While most of the activities we perform every day are primarily in front of our bodies, lateral stability is essential for transferring body weight from one leg to the other as we walk or maintaining leveled hips when we squat and bend forward. Insufficient gluteus medius recruitment leads to increased recruitment of your low back muscles to compensate for the lateral stability your body needs to perform your daily activities. This consequently leads to low back pain and intervertebral disc compression (2). 

Now this isn't to say that strengthening your gluteus medius muscles will solve all of your problems, but it will definitely help. Be sure to have a movement expert take a look at your posture and form with functional movements.
References:

1. Sahrmann S, Azevedo DC, Dillen LV. Diagnosis and treatment of movement system impairment syndromes. Braz J Phys Ther. 2017;21(6):391-399. doi:10.1016/j.bjpt.2017.08.001

2. Sadler S, Cassidy S, Peterson B, Spink M, Chuter V. Gluteus medius muscle function in people with and without low back pain: a systematic review. BMC Musculoskelet Disord. 2019;20(1):463. Published 2019 Oct 22. doi:10.1186/s12891-019-2833-4
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November 2022: Strengthen Your Gluteus Medius
Proper hip hinge mechanics is key to getting your core and gluteus medius activated. Here are 3 of Ginny's favorite exercises to help strengthen your gluteus medius and improve low back pain.
Double Leg Hip Hinge

🔹 Place a form pole parallel to your spine so that it rests on your sacrum, mid-back, and the back of your head. There should be a grape sized space between the form pole and the small of your back.

🔹 Stand a little wider than hip width distance with a soft bend in your knees. Feet are parallel or toes slightly pointed out. Draw your low belly in to stabilize your core.

🔹 Begin to hinge at your hips while maintaining proper contact with the form pole. As you hinge your hip, allow your weight to naturally shift towards your heels while maintaining full foot contact with the ground. Drive into your mid-foot to stand and feel your weight naturally shift back into your midfoot.

🔹 Perform 1x8.
Split Stance Hip Hinge

🔹 Begin in a split stance. Most of your weight is in your front leg with little to no weight in the back leg. Maintain a soft bend in your front knee the entire time. Hips are squared and the front knee is pointed forwards rather than medially.

🔹 Start to hinge at your hip while keeping them squared to the front. Drive into your front midfoot to stand. If you are performing this correctly, you should feel the lateral hip of your front leg firing. 

🔹 Perform 2x10 on each side.
Elevated Split Squat With Hip Hinge 

🔹 Elevate your back leg on a 6 to 8 inch surface.

🔹 Perform your hip hinge and add a bend in your front knee. Your front knee should still be stacked over your ankle for more emphasis on your glutes rather than your quads. Ensure that your knee is not caving inwards.

🔹 Perform 2x10 on each side.
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