Re-activating and strengthening the gluteal muscles

Introduction

The gluteus maximus is the strongest and biggest muscle of the body. The gluteus maximus is not only a hip extensor but also plays an important role in pelvic and spinal stabilisation [1, 2, 3, 4, 5]. The gluteal muscles (gluteus maximus, gluteus medius and gluteus minimus) stabilise the hip by counteracting gravity’s hip adduction torque and maintain proper leg alignment by eccentrically controlling adduction and internal rotation of the thigh [6, 7].

The gluteus maximus allows us to maintain an upright position needed for bipedalism. Through evolution the gluteus maximus enlarged in humans as a means to stabilise the trunk while standing and counteract the high impact forces that tend to flex the trunk anteriorly during running and sprinting. Consequently the glute muscles gradually lose tone during our chair-laden lifestyle [8, 9]. The terms ‘gluteal amnesia’ and ‘sleeping giant’ probably sound familiar. These terms refer to inhibition and delayed activation of the gluteal muscles, which in time leads to weakness of these muscles. Gluteal inhibition negatively affects performance and lower body strength and is a root cause for many injuries and chronic pain [10, 11, 12, 13, 14, 15, 16, 17, 18, 19]. Low back pain and lower body injuries result in delayed and reduced glute activation with concurrent hamstring and low back compensation [20, 21, 22, 23, 24].

Note the big gluteal muscles of the Bushmen
Note the big gluteal muscles of the Bushmen

Because of our lifestyle, the glutes are almost always asleep and they are not targeted in most strength programs. What is the last time your glutes felt really sore after a workout? Many athletes and lifters don’t know how to turn on the glutes, because the compensation pattern to get around using the glutes are so engraved.

This article focuses on exercises that address the major functions of the glutes and result in the greatest level of glute activation. These exercises will help to switch your glutes back on and re-establish correct muscle recruitment patterns. Re-activating your glutes will positively affect every compound lower body lift, improve your core stability, prevent lower-body injuries and enhance sport performance.

The gluteus maximus and lower back stability

Activating and strengthening the glutes needs to form an important part of your core routine.

Co-contraction of the gluteus maximus with the psoas major (part of iliopsoas muscle) contributes to lumbo-sacral stabilisation [25, 26]. The gluteus maximus provides stability to the sacroiliac joint (SI joint) by bracing and compression [4, 5]. Excess movement at the SI joint would compromise the L5-S1 intervertebral joints and disc and could lead to SI joint dysfunction and low back pain.

The gluteus maximus also provides lower back stability through its connection with the erector spinae and thoraco-lumbar fascia [27, 28]. Some of its fibres are continuous with the fibres of the erector spinae. A contraction of the gluteus maximus will generate tension in the erector spinae muscle on the same side, providing stiffness to the spinal column [27, 28].

Gluteus maximus contraction also exerts a pull on the lower end of the thoraco-lumbar fascia, which is a thick layer of ligamentous connective tissue. Tightening of this fascia stabilises the vertebras. People with low back pain often have weak and deconditioned glutes [29].

Inhibition of the gluteal muscles

Low back pain has been associated with inhibition of the gluteus maximus [20, 21, 30]. The activation of the gluteus maximus during hip extension is delayed in people with a history of low back pain compared to people with no back pain. In people with low back pain hip extension is initiated by the hamstrings and erector spinae instead of the gluteus maximus [20, 30, 31]. Even after the episode of low back pain has resolved, the altered firing patterns in the gluteus maximus remain [32].

Janda described a similar pattern of delayed activation of the gluteus medius during hip abduction in patients with low back pain [31].

People suffering from ankle sprain injuries also have been shown to have reduced activation levels of the gluteus maximus [22].

The gluteus maximus plays an important role in maintaining an upright standing position [8, 9]. Lengthened gluteal muscles as a result of our sitting lifestyle leads to a decreased stabilizing function in the gluteus maximus [33].

Inhibition and delayed activation of the gluteus maximus compromises pelvic stability [34]. This can result in compensation by the lower back and more altered muscular firing patterns and function. In the case of low back pain, ankle and probably all lower body injuries, rehabilitation needs to focus on re-activating the gluteal muscles.

Weak or inhibited gluteal muscles contribute to injury

Weak or delayed activation of the gluteus maximus and gluteus medius is a root cause for many injuries and chronic pain.

  1. Hamstring strains: Due to delayed gluteus maximus activity, the hamstring muscles become dominant during hip extension, which can cause hamstring strains [10]. A lot of athletes that pulled a hamstring keep suffering re-injuries despite their focus and efforts to strengthen the hamstrings. They are reinforcing a compensation pattern instead of reactivating their inhibited glutes. Shirley Sahrmann said, "Any time you see an injured muscle, look for a weak synergist.” A synergist is a muscle that performs the same joint motion.
  2. Low back pain: Gluteus maximus activation plays an important role in stabilising the pelvis during the task of lifting [2, 3]. Delayed gluteus maximus activation also causes excessive compensation of the back extensors [30].
  3. Anterior knee pain: The excessive internal rotation of the femur as a result of glute weakness increases the pressure on the patellar cartilage [11, 12, 13].
  4. Anterior hip pain: Decreased force production from the gluteus maximus during hip extension is associated with increased anterior translation of the femur in the acetabulum. The increased femoral anterior glide could lead to increased force and wear and tear on the anterior hip joint structures [10, 14]
  5. Lower-body malalignment: Weak glutes results in increased internal rotation of the femur, knee valgus and foot pronation [35].
  6. Gluteal weakness also has been associated with anterior cruciate ligament (ACL) sprains [15, 16, 17], chronic ankle instability [18], and iliotibial friction syndrome [19].

Exercises to re-activate the gluteal muscles

Re-activating the gluteal muscles will re-establish correct muscle recruitment patterns and enhance strength and performance.

The gluteus maximus is the strongest muscle of the body and has a multi-tasking function [36]. This muscle is able to combine a local stabiliser, global stabiliser and global mobiliser role.

Local stabiliser

Global stabiliser

Global mobiliser

Segmental stabilisation

Eccentric lengthening or isometric holding to control range of motion

Produce high force or power

  • Force closure of the sacroiliac joint
  • Control and centralise the femur in the hip socket (acetabulum)
  • Co-contraction with psoas major provides pelvic stability.
  • Segmental stabilisation of the vertebras: 1. directly by tensing the thoraco-lumbar fascia 2.indirectly by triggering the deep lumbar multifidus
  • Sagittal plane stabilisation of the trunk during walking, running and standing
  • Control of trunk rotation during gait through the connection with contra-lateral latissimus dorsi (Posterior oblique system)
  • Frontal plane stabilisation of the pelvis during single-leg stance (resisting gravity’s hip adduction torque)
  • Control of the stance leg in the frontal (preventing adduction of the thigh) and transverse plane (preventing internal rotation of the thigh)
  • Hip extension
  • External rotation
  • Superior fibres: hip abduction
  • Lower fibres: hip adduction

The gluteus maximus is especially active during stair climbing, running and activities that involve stabilising the trunk against flexion [9, 37, 38, 39]. An exercise that combines these movements would trigger a strong contraction of the gluteus maximus and addresses both the stabilising and movement role. Single-leg stance exercises require the gluteus medius, minimus and upper part of the gluteus maximus to resist gravity’s hip adduction torque.

Sprinting highly activates the glutes. Gluteus maximus strength is related to maximal sprint speed.
Sprinting highly activates the glutes. Gluteus maximus strength is related to maximal sprint speed.[44]

In the resisted slide-board back lunge the pull of the cable creates a hip flexion force against which the gluteus maximus has to stabilise. The movement also mimics the hip action of running and stair climbing. Like in running, the body has to be pulled over the foot by a powerful hip extension. The single-leg stance emphasizes the gluteus medius, the gluteus minimus and the upper fibres of the gluteus maximus.

As an advanced progression the exercise can be combined with a shoulder press. This compound exercise emphasizes the stabilising role of the gluteus maximus even more. Pressing dumbbells overhead requires anti-flexion stability from the core. The co-contraction of the gluteus maximus, psoas major and deeper trunk muscles stabilises the spine, so forces can be effectively transferred from the lower to the upper body.

Other exercises that elicit a high gluteus maximus and medius activity are the single-leg squat and the single-leg Romanian deadlift [6, 40, 41]. These single-leg exercises require concentric or eccentric hip extension throughout a large range of motion, frontal plane pelvic stability, together with a control of the stance leg in the frontal and transverse plane, which results in a high neural drive to the gluteus maximus, medius and other muscles of the lateral system.

In the single-leg squat & pull and the single-leg Romanian deadlift & pull the hand opposite to the stance leg is loaded. The added rotary force stimulates the external rotator capability of the gluteus maximus and medius and gives these exercises a multi-planar character. The glutes need to stabilise the hip in the frontal (resisting gravity’s hip adduction torque) and transverse plane (preventing internal rotation of the thigh) and generate movement in the sagittal plane (concentric/eccentric hip extension). These exercises train the cross-body connection (posterior oblique system), that transmits forces from the ground through the leg and hip, across the SI-joint via the thoracodorsal fascia, into the opposite lattisimus dorsi.

A great warm-up exercise that addresses all major functions of the gluteal muscles is the superband X walk. This exercise combines hip extension and hip abduction and requires stabilisation of the lumbar-pelvic region, which are all major functions of the glutes. This exercises also trains the cross-body connection.

High activation levels of the gluteus medius, upper part of the gluteus maximus and lateral system muscles have been observed during the side bridge and the side bridge with abduction exercises [42, 43].

The slide-board lateral slide combines a powerful hip extension and abduction and really activates the gluteus maximus, medius and minimus. Skating develops and shapes the hips and glutes best.

These exercises can be used in the warm-up to activate and wake up the glutes, before heading over to the squat rack. It is also possible to integrate them as part of your workout.

Due to our lifestyle, low back pain or other injuries our glutes may be inhibited and do not fire when they are supposed to. Because of compensatory patterns it may be difficult to target and strengthen the glutes with bilateral leg exercises like squats. Exercises that require single-leg balance, stability of the lumbo-pelvic region, hip extension or eccentric control of hip flexion, which are all major functions of the gluteus maximus result in the greatest level of glute activation. These exercises will help to switch your glutes back on and re-establish correct movement patterns. Re-activating your glutes will positively affect every compound lower body lift and enhance sport performance.

References

  1. [^] Lafond D, Normand MC and Gosselin G, Rapport force, Journal of Canadian Chiropractor Association 42(2), 90-100, 1998.
  2. [^ A B] Vakos JP, Nitz AJ, Threlkeld AJ, Shapiro R and Horn T (1994): Electromyographic activity of selected trunk and hip muscles during a squat lift. Spine 19(6), 687-695.
  3. [^ A B] Noe DA, Mostardi RA, Jackson, ME, Porterfield JA and Askew MJ (1992): Myoelectric activity and sequencing of selected trunk muscles during isokinetic lifting. Spine 17(2), 225-229.
  4. [^ A B] Vleeming A, Van Wingerden JP, Snijders CJ, Stoeckart R and Stijnen T (1989): Load application to the sacrotuberous ligament; influences on sacroiliac joint mechanics. Clinical Biomechanics, 4(4), 204-209.
  5. [^ A B] Snijders CJ, Vleeming A and Stoeckart R (1993): Transfer of lumbosacral load to iliac bones and legs. Clinical Biomechanics 8, 285-294.
  6. [^ A B] Distefano LJ, Blackburn JT, Marshall SW, Padua DA, Gluteal muscle activation during common therapeutic exercises. J Orthop Sports Phys Ther. Jul;39(7):532-40, 2009.
  7. [^] Moore KL, Dalley AF. Clinically Oriented Anatomy. Baltimore, MD: Lippincott Willliams & Wilkins; 1999.
  8. [^ A B] Jenkins D (1998): Hollinshead’s functional anatomy of the limbs and back. (7th ed) Philadelphia; London; Boston: WB Saunders.
  9. [^ A B C] Marzke MW, Longhill JM and Rasmussen SA (1988): Gluteus maximus muscle function and the origin of hominid bipedality. American Journal of Physical Anthropology 77, 519-528.
  10. [^ A B C] Shirley Sahrmann, Diagnosis and treatment of movement impairment syndromes, Mosby, 2002.
  11. [^ A B] Ireland M L, Willson JD, Ballantyne BT, et al. Hip strength in females with and without patellofemoral pain. J Ortho Sports Phys Ther. 2003;33:671–676.
  12. [^ A B] Powers CM, Flynn T. Research Forum. Presented at: Combined Sections Meeting of the American Physical Therapy Association; February 2003, Tampa.
  13. [^ A B] Tyler TF, Nicholas SJ, Mullaney MJ, McHugh MP. The role of hip muscle function in the treatment of patellofemoral pain syndrome. Am J Sports Med. 2006;34(4):630–636 .
  14. [^ A B] Cara L. Lewis, Shirley A. Sahrmann, Daniel W. Moran, Anterior hip joint force increases with hip extension, decreased gluteal force, or decreased iliopsoas force. Journal of Biomechanics, Volume 40, Issue 16, 2007, Pages 3725-3731
  15. [^ A B] Hewett TE, Myer GD, Ford KR. Anterior cruciate ligament injuries in female athletes: Part 1, mechanisms and risk factors. Am J Sports Med. 2006;34:299-311.
  16. [^ A B] Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33:492-501.
  17. [^ A B] Ireland ML. The female ACL: why is it more prone to injury? Orthop Clin North Am. 2002;33:637-651.
  18. [^ A B] Friel K, McLean N, Myers C, Caceres M. Ipsilateral hip abductor weakness after inversion ankle sprain. J Athl Train. 2006;41:74-78.
  19. [^ A B] Fredericson M, Cookingham CL, Chaudhari AM, Dowdell BC, Oestreicher N, Sahrmann SA. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med. 2000;10:169-175.
  20. [^ A B C] Leinonen V, Kankaapää M, Airaksinen O and Hanninen O (2000): Back and hip extensor activities during trunk flexion/extension: effects of low back pain and rehabilitation. Archives of Physical Medical Rehabilitation 81, 32-37.
  21. [^] Vogt L, Pfeifer K and Banzer W (2003): Neuromuscular control of walking with chronic low-back pain. Manual Therapy 8(1), 21-28.
  22. [^ A B C] Bullock-Saxton JE, Janda V and Bullock MI (1994): The influence of ankle sprain injury on muscle activation during hip extension. International Journal of Sports Medicine 15: 130-134.
  23. [^] Freeman MAR, Dean MRE and Hanham IWF (1965): The aetiology and prevention of functional instability of the foot. Journal of Bone Joint Surgery 47: 578-685.
  24. [^] Burger H, Valencic V, Marincek C and Kogovsek N (1996): Properties of musculus gluteus maximus in above-knee amputees. Clinical Biomechanics 11(1): 35-38.
  25. [^] Sean GT Gibbons and Mark J Comerford (2001) Strength versus stability: Part 1: Concept and terms. Orthopaedic Division Review. March / April: 21-27
  26. [^] Gibbons SGT 2005 Integrating the psoas major and deep sacral guteus maximus muscles into the lumbar cylinder model. Proceedings of: “The Spine”: World Congress on Manual Therapy. October 7th – 9th, 2005, Rome, Italy.
  27. [^ A B] Vleeming A, Pool-Goudzwaad AJ, Stoeckart R, et al: The posterior layer of the thoracolumbar fascia: its function in load transfer from spine to legs. Spine 20: 753-758, 1995.
  28. [^ A B] Snijders CJ, Vleeming A, Stoeckart R, et al. Biomechanics of the interface between the spine and pelvis in different postures. In: Vleeming A, Mooney V, Dorman T, et al. eds: Movement, Stability and Low Back Pain. Edinburgh, Churchill Livingstone, 103-113, 1997.
  29. [^] Kankaanpää M, Taimela S, Laaksonen D, Hanninen O and Airaksinen O (1998): Back and hip extensor fatigability in chronic low back pain patients and controls. Archives of 100 NZ Journal of Physiotherapy – November 2005. Vol. 33, 3 Physical Medical Rehabilitation 79, 412-417.
  30. [^ A B C] Nelson-Wong E, Alex B, Csepe D, Lancaster D, Callaghan JP. Altered muscle recruitment during extension from trunk flexion in low back pain developers. Clin Biomech 27(10):994-8, 2012.
  31. [^] Janda V (1985) Pain in the locomotor system - A broad approach. In Glasgow et al. (eds.) Aspects of Manipulative Therapy. Churchill Livingstone: 148-151
  32. [^] P. H. Ferreira, M. L. Ferreira, and P. W. Hodges, “Changes in recruitment of the abdominal muscles in people with low back pain: ultrasound measurement of muscle activity,” Spine, vol. 29, no. 22, pp. 2560–2566, 2004.
  33. [^] Richardson C and Sims K (1991) An inner range holding contraction as an objective measure of stabilizing function of an antigravity muscle. 11th International congress of the World Confederation of Physical Therapy, London.
  34. [^] Wilson, J. Ferris, E. Heckler, A. Maitland, L. Taylor, C. A structured review of the role of gluteus maximus in rehabilitation. New Zealand Journal of Physiotherapy, 2005, VOL 33; 3, pages 95-100, 2005.
  35. [^] Lephart SM, Ferris CM, Riemann BL, Myers JB, Fu FH. Gender differences in strength and lower extremity kinematics during landing. Clin Orthop. 2002;162-169.
  36. [^] Comerford MJ, Core stability: priorities in rehab of the athlete, SportEx Medicine 22, 15-22, 2004.
  37. [^] Zimmermann, C. L., Cook, T. M., Bravard, M. S., Hansen, M. M., Honomichl, R. T., Karns, S. T., Lammers, M. A., Steele, S. A., Yunker, L. K. and Zebrowski, R. M. (1994). Effects of stair-stepping exercise direction and cadence on EMG activity of selected lower extremity muscle groups. J. Orthop. Sports Phys. Ther. 19, 173-180.
  38. [^] Stern, J. T., Pare, E. B. and Schwartz, J. M. (1980). New perspectives on muscle use during locomotion: electromyographic studies of rapid and complex behaviors. J. Am. Osteopath. Assoc. 80, 287-291.
  39. [^] McLay, I. S., Lake, M. J. and Cavanagh, P. R. (1990). Muscle activity in running. In Biomechanics of Distance Running (ed. P. R. Cavanagh), pp. 165-186. Champaign, IL: Human Kinetics Books.
  40. [^] Ayotte N, Stetts D, Keenan G, Greensway E. Electromyographical analysis of selected lower extremity muscles during 5 unilateral weight-bearing exercises. J Orthop Sports Phys Ther. 2007;37(2):48–55 .
  41. [^] Zeller BL, McCrory J, Kibler B, Uhl TL. Differences in kinematics and electromyographic activity between men and women during the single-legged squat. Am J Sports Med. 31(3):449–456, 2003.
  42. [^] Ekstrom R, Donatelli R, Carp K. Electromyographical analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises. J Orthop Sports Phys Ther. 2007;37(12):754–762.
  43. [^] Selkowitz DM, Beneck GJ, Powers CM, Which Exercises Target the Gluteal Muscles While Minimizing Activation of the Tensor Fascia Lata? Electromyographic Assessment Using Fine-Wire Electrodes. J Orthop Sports Phys Ther. 2012 Nov 16.
  44. [^] Guskiewicz, K., S. Lephart, and R. Burkholder. "The Relationship Between Sprint Speed and Hip Flexion/Extension Strength in Collegiate Athletes." Isokinetics and Exercise Science. 3 (1993): 111–116.