Best Exercises for Gluteus Medius Strengthening - A Key Hip Stabiliser

The gluteus medius (gMed) is a key stabiliser of the hip joint, which acts to abduct and both externally (posterior fibres) and internally (anterior fibres) rotate the hip. It therefore plays an important role in knee joint alignment.

There are many injuries associated with a weak or inactive gMed. These can include IT band syndrome, patellofemoral pain syndrome and Achilles tendinopathy, just to name a few.

It’s no coincidence that the injuries listed above are commonly suffered by runners. Running is performed largely in one plane of motion – the sagittal plane (i.e. forwards), whereas the gMed works hardest in the two other planes – frontal (side to side) and transverse (rotation). Therefore, if an individual’s sole form of exercise is running, the gMed doesn’t get used very much and can become, relatively speaking, weak or inactive.

A weak gMed will cause the pelvis of the stance leg to drop when weight bearing on a single leg. To compensate, the hip will excessively adduct and internally rotate. This motion then translates down the femur to the knee. This can be seen in severe cases as the knees turn in and fall together.

Strengthening the gMed What is agreed upon by many is that in these cases, the gMed needs to be strengthened to help stabilise the pelvis and align the knee. Yet to be agreed upon is the best exercise(s) to achieve this. Below is a description of the exercises most commonly prescribed by rehabilitation professionals.

Side-lying Hip Abduction This is one of the most simple exercises used to strengthen the hip abductor muscles. The patient lies on their side, working leg on top, knees straight and hips stacked. The top leg is lifted up as high as possible, whilst maintaining pelvic stability.

Positives: simplicity, shown to have approx. 80% maximal voluntary isometric contraction (MVIC) of the gMed on EMG testing, low level of pain reproduction (especially for knee injuries). Negatives: lack of weight-bearing functionality

Clam Shells Performed in a side-lying position with the working leg on top and hips stacked, knees bent to around 60 degrees and hips also slightly flexed. The feet stay in contact as the top knee is lifted away from the bottom one. Try not to roll your pelvis back as the knee is lifted. Positives: includes several variations of the exercise which can increase gMed MVIC from 40 to as high as 77%. Negatives: lack of weight-bearing functionality

Side Plank Performed whilst in a side lying position resting on your forearm, hips stacked, resting on either your bottom foot (if knees straight) or lateral bottom knee (if knees bent), raising your hips up off the ground. Positives: has been found to have the highest %MVIC Negatives: not considered to be a functional exercise

Single Leg Squat A favourite among many rehab professionals and is fairly self-explanatory. It is one of the most functional exercises out there for many sporting actions and day-to-day tasks. However, it has been shown to produce mixed results with one study reporting a 82% MVIC, and two others coming in at 64% MVIC. The mixed results I believe are partially due to execution of the exercise amongst researchers.

Wall Press (knee to wall press) This exercise is a single-leg weight bearing exercise that involves standing side-on to a wall and flexing the knee and hip of the leg closest to the wall to 90 degrees. The lateral surface of the thigh, knee and ankle are then pushed against the wall in an isometric abduction force, holding for 5 seconds and repeating. Positives: tested to have a 76% MVIC and weight-bearing Negatives: some debates as to the level of functionality

Lateral Band Walk (crab walk) The lateral band walk uses a resistance/theraband tied around the ankles of the patient. In a quarter-squat position, the patient then walks in a lateral direction, abducting the hip against the resistance of the band. Positives: weight-bearing and functional, reduced risk of knee pain reproduction, sports-specific if lateral movement is required (for e.g. in tennis). Negatives: tested to have an MVIC of 61%, the lowest of the above exercises.

In Conclusion A successful gMed strengthening program should be: progressive, functional, specific and pain-free. Each exercise program may not be the same for each patient.

The program must start at a point at which they can perform the exercises with proper form and technique, yet still be challenging. For e.g. some people may not be able to perform a single leg squat whereas others may be able to start this from the get-go.

The exercises selected should relate to the sport, exercise or activity the patient performs. What is functional for one patient may not be for another – think runner vs tennis player.

Finally, the exercises given should not aggravate the patients injury and should be relatively pain-free (slight discomfort can sometimes be acceptable). This may mean that in the early stages of rehab, some functional exercises are not possible.

There is no one gold standard exercise for strengthening the gluteus medius. Although exercises such as the side-lying hip abduction are nonweight-bearing or have little functional relevance, they may still have a place in injury rehabilitation as it produces a high level of gMed activation. Thus, it may very well be the ideal starting point for those unable to perform weight-bearing exercises from the start.

If you would like to know more about how to improve your hip stability then feel free to send us a message at Infinite Health Chatswood - Physiotherapy, Exercise Physiology & Massage Therapy or book in for a consultation with one of our therapists today. Similarly, if you would like to read more feel free to click here.