Gluteus Medius & Rotational Stability of the Hip 1/29/13
Does this sound familiar? Your knee hurts every now and then. You take some rest time or decrease your miles for the week. Maybe you ice, change your shoes, or get on a foam roller and stretch. While these are all logical steps to take to alleviate the pain, there is one factor that is often overlooked by runners. A muscle called the gluteus medius can be the culprit in chronic, recurring conditions such as Runner’s Knee, Iliotibial Band Friction Syndrome, Achilles issues, and low back pain to name a few. To add to the core exercises that I have been discussing in the Sports Medicine Corner for the past few weeks, I am going to add two exercises to specifically address the gluteus medius.
The gluteus medius is one of three muscles that make up the gluteals. It, along with the gluteus minimus, abducts (lift the leg away from the body) and internally rotates the hip. During the mid-stance phase of running (or walking), the gluteus medius must contract to stabilize the femur and pelvis. While some rotation of the hips while running is normal, excessive rotation can be problematic. Try these 2 simple tests at home to see if your gluteus medius is weak:
1) While standing in front of a mirror, perform a single leg squat. If the opposite hip of the leg that you are standing on drops, or if the knee of the leg you are standing on rotates inward, that indicates a weakness in the gluteus medius.
2) Perform a bridge. You should feel a contraction in your glutes. If you are feeling this exercise predominantly in your hamstrings, the firing pattern of your glutes is off (you are not contracting your glutes when you should be). Now, from the bridge position, lift one leg up off of the ground so you are now supporting yourself on one leg. If your hip drops (or rotates), that indicates a weakness in the gluteus medius of the leg that is currently supporting your body weight.
Another interesting thing to look at is a video of yourself running from behind. Next time you are in Fleet Feet trying out shoes and a Fit Professional is recording you on the treadmill, ask them to zoom out so your hips are in view. See if your hip drops while you are in the mid-stance phase of running. With the use of our Dartfish video motion analysis software, we can look at the entire kinetic chain as you run, not just what’s going on with your feet / shoes. So much of what goes on in the foot is related to what is going on at the hip. Being able to see this can not only help us give you the best fit for your shoes, but we can also help you identify areas that you can work on to make yourself a better, less injured runner!
If any of those tests revealed a weakness in the gluteus medius, you must address the weakness if you are going to correct the cause of any injuries you are experiencing due to that weakness. Simply taking rest time will not correct the underlying cause of your issues.
The first exercise to address a weak or poorly firing gluteus medius is called a clam shell. To begin this exercise, lay on your side and be sure to keep your spine straight. Your body should be in alignment from the hips all the way up through the torso, don’t let your body slump into the ground. This way, you will ensure that you are using the correct muscle to perform the exercise and not compensating with other muscles. Bend your knees and rest your feet on top of one another. From this position, lift only the knee of the top leg until is it level with your hip. Now you have “opened the clam shell.” You should feel this contraction in your gluteus medius the entire time. Perform 2 – 3 sets of at least 20 reps. Make sure to perform this exercise on both sides of the body.
The next exercise is a little more advanced and requires either a trip to the gym or a theraband tied to your doorknob at home. You should be able to comfortably perform a clamshell and be able to balance on one leg for 30 seconds before adding this next exercise to your routine.
The single leg cable row is an efficient exercise to train single leg balance, rotational stability, as well as scapular stability. Set up the cable row machine so that when you reach your arm out straight in front of you, your hand will be in line with handle of the machine. Stand on one leg, and grip the handle of the cable with the opposite hand (stand on left leg, grip handle with right hand).
Before you begin, you should engage your core muscles. Imagine you are about to be hit in the stomach, Tighten up your muscles to brace for the hit, but don’t hold your breath. This is the contraction you should feel in your core throughout this exercise.
Now, pull the cable towards you so your right hand will end up near your right hip. Focus on bringing your right shoulder blade towards your spine. You want to “pinch” the shoulder blades together. While you are focusing on this upper extremity movement, your left gluteus medius is going crazy to maintain rotational stability of your femur and hip. It is firing to keep you upright, otherwise, the force of the cable pulley would cause you to lose your balance. Perform 2 – 3 sets of 10 reps on each leg.
The day after I did this exercise for the first time, my glutes were soo sore! I was thinking back to my workout the day before and I swear I did not do any leg exercises. Then I remembered that I did the single leg cable row. Once I realized how weak I was, this exercise quickly became my new favorite as I tried to rectify that weakness. Another great thing about this exercise is that it is very functional for running. It incorporates single leg stance and opposite upper extremity rotation, which occurs with each step that we run. I hope you enjoy this exercise as much as I do, or at least find it challenging for your gluteus medius!
Remember; icing, stretching, and rest time are all good things if done appropriately, but don’t forget the strengthening!