In a previous article, we discussed the importance of the gluteus medius muscle in controlling lower extremity alignment during the squat. This muscle also plays a critical role in positioning and stabilizing the pelvis in many other functional activities. This includes any activity requiring a period of single-leg support such as walking, climbing stairs, throwing, and running. Individuals with knee pain, chronic back pain, hip arthritis, and ankle injuries have been shown to have weakness in this important muscle. Thankfully, there are several options for gluteus medius exercise that can help. This article is the first in a series of 3 (Part 2 and Part 3) devoted to glutues medius exercise.
Getting Started with Gluteus Medius Exercise
Basic resistance exercise for the gluteus medius can be initiated in non-weight bearing positions such as lying on the side. Progressions can include partial weight-bearing positions such as on all fours or plank positions. As muscular endurance and strength improve, exercises can be progressed to standing. Standing exercises are initiated in a double-limb stance, or with both legs fixed to the floor and then progressed to single-limb stance. Each exercise should be performed 2 to 3 times per week to optimize improvements in muscular endurance, strength, and hypertrophy.
It is recommended that each of these basic resistance exercises is initiated with 3 sets of 8 to 15 repetitions. When 15 repetitions can be performed, the intensity of the exercise can be progressed by adding weight or increasing the resistance band strength. Muscle strength and hypertrophy can be achieved with any range of repetitions. However, to optimize strength, higher intensities with lower repetitions are best. The main objective of this strengthening program is to progressively overload the gluteus medius so that muscular control, endurance, and strength are developed in a systematic manner.
Clam Shell
Begin by lying on one side with the hips flexed to approximately 45 degrees. The knees are flexed and the feet kept together. A resistance band can be placed around the thighs just above the knees. Start the exercise by rotating the top hip to bring the knees apart. Hold this position for 2 seconds and then return to the start position slowly. Be sure to remain completely on the side with one hip stacked on top of the other. Allowing the pelvis to roll back during the movement is the most common mistake with this exercise. The clam shell is a great exercise to start with because it elicits high levels of gluteus medius activity with minimal activity of the tensor fascia latae (TFL). This is beneficial because the TFL is commonly overactive in individuals with hip and knee pain.
Side-Lying Hip Abduction
Begin by lying on one side with the bottom hip and knee flexed. The top knee remains straight. The top hip is maintained in neutral or slight hip extension with the toes pointed forward. The toes are pointed forward to orient the hip in slight internal rotation. This increases gluteus medius activation and decreases TFL activation. Initiate the movement by lifting the top leg about 30 degrees. Hold this position for a count of two and then slowly lower the leg to the start position. Ankle weights can be added for resistance once 15 proper repetitions can be performed.
This exercise activates the gluteus medius to a greater level than the clam shell. However, it is also more challenging to perform correctly. Similar to the clamshell, it is important to remain completely on the side with one hip stacked on top of the other. Allowing the pelvis to roll back during the movement is the most common mistake with this exercise. Also, as the muscle tires, the leg will drift forward into hip flexion. It is important to maintain the leg lined up or slightly behind the trunk and upper body.
1-Leg Bridge
Begin by lying on the back with both hips and knees bent. Perform a bridge with both legs by raising the hips to a neutral trunk, hip, and knee position. A common mistake is to excessively arch the low back. Be sure to achieve the bridge position by extending through the hips. From the bridge position, straighten the knee of one leg while keeping the upper thighs parallel. Be careful not to allow the pelvis to drop on one side. Hold this position for 2 seconds then return the leg to the bridge position. Lower the body back down before repeating another repetition on the same side. Complete the desired number of repetitions on one side before beginning with the other leg. Resistance can be added by placing a band around the thighs just above the knees.
Prone Plank with Bent Knee Hip Extension
Start facedown supported on the elbows in a plank position with the trunk, hips, and knees in neutral alignment. Initiate the movement by lifting one leg with the knee bent. Extend the hip slightly past neutral by bringing the heel toward the ceiling. Hold this position for 2 seconds. Maintain the plank position throughout all repetitions on one side. Complete the desired number of repetitions on one side before beginning with the other leg. A common error with this exercise is to arch or overextend the spine when lifting the leg. Also, as the abdominal muscles tire, the hips may rise. Be sure to maintain a neutral trunk, hip, and knee alignment throughout the exercise.
Side Plank with Hip Abduction
Start side-lying supported on one elbow with the shoulders, hips, knees, and ankles in line. Rise to a side plank position with the hips off the floor to achieve neutral alignment of trunk, hips, and knees. Maintain the side plank position and raise the top leg into abduction approximately 30 degrees. Hold this position for 2 seconds then slowly lower the top leg. Maintain the plank position throughout all repetitions on one side. Complete the desired number of repetitions on one side before beginning with the other leg.
A common error with this exercise is to allow the pelvis to tip forward or backward. Also, as the top gluteus medius tires the abducting leg will move into flexion. As the bottom side tires, the side plank position will be lost. This exercise has been shown to activate the gluteus medius on both sides at very high levels. It is also very challenging and may not be an option for everyone.
Closing Thoughts on Gluteus Medius Exercise
These 5 exercises do not need to be performed at once. Instead, choose 2 to 3 exercises to get started with. Exercise selection is based on your preferences and the level of challenge each presents. The clam shell is the least challenging and side plank with hip abduction is the most challenging. Within 6 to 8 weeks, the exercises may feel less challenging indicating a need for progression. Progression may include adding resistance or substituting with a new exercise. For more challenging gluteus medius progressions read part 2 and part 3 of this series.
