Glute Training: Why you should care
The Glutes are a voluminous muscle group, right at the transition point of the lower and upper body. This position gives these muscles the ability to impact a variety of physical areas, which we will discuss in the following.
What are the glutes?
The term "Glutes" is used as an umbrella term for three different muscles, that are each located at the back of the hip. The gluteus maximus (by far the largest of them), the gluteus medius (the medium sized one) and the gluteus minimus (the smallest one). Although they all have different functions, the main joint action of the glutes are hip extension, hip abduction and hip external rotation (while some fibres will in some positions also assist with hip flexion, internal rotation and adduction).
The gluteus maximus (GM), being the biggest muscle in the body, acts as a local and global stabilizer while at the same time being a global mobilizer. Meaning that the muscle (when activated) can stabilize not only the hip joint but assist in total core and lower body stability (by tightening up the thoracolumbar fascia and the iliotibial band), and also acting as a primary mover for the same areas.
Therefore, dysfunction of these muscles will have undesirable effects above and below.
How the glutes impact different areas of the body:
Hamstrings:
When the gluteal muscles are weak, other muscles need to take over in order to fulfill movement requirements. This is called "synergistic dominance". And in physically active individuals, hip extension (which is a primary function of the GM) will have to be executed mainly by the hamstrings. This leads to increased demand on the secondary musculature, causing them to overexert, which can eventually lead to injuries such as hamstring strains, that are correlated with gluteal weakness (Schuermans et al., 2017).
Feet:
There has been research conducted on how strengthening the gluteus maximus can help to decrease foot pronation and arch collapse. As foot pronation (flat feet) usually includes adduction and internal rotation of the hip (which happen when the gluteal muscles are not activated). Therefore, training your gluteus maximus can help in correcting foot pronation (by keeping the femur from rotating internally during gait, which lessens the pressure on the middle aspect of the foot) (Goo et al., 2016).
Knees:
When the gluteus medius does not activate the way it should, the lower leg is more likely to internally rotate and to adduct during gait, which also puts the knee into a internally rotated position, called a "knee valgus" and this can lead to pain and increase the likelihood of an ACL (anterior cruciate ligament) rupture (Khayambashi et al., 2016). This is a similar problem as with the feet. Gluteal strength will keep the knee in a straight line, not letting it go into internal rotation and adduction unwillingly.
Abnormal activation patterns of the gluteus medius are also associated with patellofemoral pain (Payne et al., 2020) and the same muscle has been stated as being an essential muscle in the rehabilitation after meniscal surgeries (once again showing the impact downwards of its location) (Kim, 2016).
Lower back:
One meta-analysis of 2021 looked at how strengthening the posterior chain (the muscles located at the back-side of the body = glutes included) cut off in comparison to other training regimes. And they came to the conclusion that posterior chain strengthening has a greater effect compared to general exercise on pain and level of disability for patients with chronic low back pain (Tataryn et al., 2021).
When specifically looking at the glutes, this makes a lot of sense, as people with weak gluteal musculature will likely compensate for lack of strength by generating motion in the joint above the hip (which would be the spine), in order to lift up heavy objects or while performing daily chores. Therefore, if we regain that lost hip strength, the back can stay in a more stable position and doesn't have to make up for our hip weakness.
Especially the gluteus medius needs to be looked at when assessing low-back pain, which has often been recommended to be a culprit for referred low back pain. And after assessing patients with low-back pain in a study of one hundred participants, the gluteus medius syndrome was present in nearly 40% of them. Proving it to be a non-negligible factor in low-back pain (Kameda & Tanimae, 2019).
Athleticism:
For all athletes that are in disciplines where sprinting and explosive lower-leg actions are required, glute training is probably already part of their training programme or else they are missing out. As research suggests, the GM is one of the primary muscle for forward propulsion when running. Therefore, heavy glute training is a non-negotiable factor for athletes. In one study, the authors even suggested that glutes maximus volume alone can explain 33-44% of variance in sprinting performance (Miller et al., 2021).
Treatment suggestions and takeaway:
In general, when treating muscular dysfunctions, a combination of strengthening and stretching exercises needs to be applied. Strengthening the agonist, while lengthening the antagonist. Soft tissue release can be used for the agonist as well, when pain is present.
In this particular scenario, the positioning of the pelvis has to be assessed and corrected with specific exercises, if needed. As well as addressing the other musculature surrounding the pelvis (hamstrings, psoas, rectus femoris, erector spinare and the abdominal musculature), which could play an important part to restoring gluteal function (e.g., having an anterior pelvic tilt could put the gluteus maximus in a mechanically disadvantageous length-tension relationship). Especially the hip flexor musculature should be looked at in detail, as for one part they play a role in anteriorly tilting the pelvis and for the other part they have been shown to reduce gluteus maximus muscle activity when tight (Mills et al., 2015).
All in all, the gluteal muscles should be considered for a variety of physical complaints!
References:
Goo, Y.-M., Kim, T.-H., & Lim, J.-Y. (2016). The effects of gluteus maximus and abductor hallucis strengthening exercises for four weeks on navicular drop and lower extremity muscle activity during gait with flatfoot. Journal of Physical Therapy Science, 28(3), 911–915. https://doi.org/10.1589/jpts.28.911
Miller, R., Balshaw, T. G., Massey, G. J., Maeo, S., Lanza, M. B., Johnston, M., Allen, S. J., & Folland, J. P. (2021). The Muscle Morphology of Elite Sprint Running. Medicine & Science in Sports & Exercise, 53(4), 804–815. https://doi.org/10.1249/MSS.0000000000002522
Tataryn, N., Simas, V., Catterall, T., Furness, J., & Keogh, J. W. L. (2021). Posterior-Chain Resistance Training Compared to General Exercise and Walking Programmes for the Treatment of Chronic Low Back Pain in the General Population: A Systematic Review and Meta-Analysis. Sports Medicine - Open, 7(1), 17. https://doi.org/10.1186/s40798-021-00306-w
Payne, K., Payne, J., & Larkin, T. A. (2020). Patellofemoral Pain Syndrome and Pain Severity Is Associated With Asymmetry of Gluteus Medius Muscle Activation Measured Via Ultrasound. American Journal of Physical Medicine & Rehabilitation, 99(7), 595–601. https://doi.org/10.1097/PHM.0000000000001367
Kim, E.-K. (2016). The effect of gluteus medius strengthening on the knee joint function score and pain in meniscal surgery patients. Journal of Physical Therapy Science, 28(10), 2751–2753. https://doi.org/10.1589/jpts.28.2751
Schuermans, J., Danneels, L., Van Tiggelen, D., Palmans, T., & Witvrouw, E. (2017). Proximal Neuromuscular Control Protects Against Hamstring Injuries in Male Soccer Players: A Prospective Study With Electromyography Time-Series Analysis During Maximal Sprinting. The American Journal of Sports Medicine, 45(6), 1315–1325. https://doi.org/10.1177/0363546516687750
Khayambashi, K., Ghoddosi, N., Straub, R. K., & Powers, C. M. (2016). Hip Muscle Strength Predicts Noncontact Anterior Cruciate Ligament Injury in Male and Female Athletes: A Prospective Study. The American Journal of Sports Medicine, 44(2), 355–361. https://doi.org/10.1177/0363546515616237
Kameda, M., & Tanimae, H. (2019). Effectiveness of active soft tissue release and trigger point block for the diagnosis and treatment of low back and leg pain of predominantly gluteus medius origin: A report of 115 cases. Journal of Physical Therapy Science, 31(2), 141–148. https://doi.org/10.1589/jpts.31.141