Addressing Gluteus Medius Weakness with Biofeedback

The gluteus medius muscle, which is responsible for abducting the hip, is commonly weak and often problematic across physical therapy rehab programs. The gluteus medius plays an essential role in the stability of the hip, rotational control of the femur, and kinematics of the lower extremity. Impairments in the activation and strength of this muscle can lead to significant alterations in lower extremity joint forces and biomechanics. This can ultimately lead to pain and dysfunction throughout the lower body. 

Numerous injuries and conditions have been linked to a lack of glute med strength, stability, and/or control. Let’s briefly review a few of these injuries, then create a guide for how to use mTrigger sEMG visual biofeedback to optimize rehabilitation and enhance strength of the gluteus medius muscle.

Starting with the Knee

25-40% of knee disorders are attributed to patellar femoral pain syndrome (PFPS).¹ Although it is a “bucket” diagnosis lacking specificity, “pain around or behind the patella aggravated by activities that load or compress the patellofemoral joint such as squatting, ascending and descending stairs, jumping, and running,” is something that effects many active people.¹ When walking, the gluteus medius muscle contracts and exerts a force on the distal and proximal ends of the femur, placing them under considerable shear force. When the knee joint is not aligned well or functioning properly, this shear force can be a source of knee pain.² Additionally, a weak glute med muscle can cause increased hip internal rotation, leading to relative lateral patellar tracking at the knee and faulty lower extremity movement patterns.³ These faulty movement patterns have been linked to anterior knee pain in several different studies.^1–3 Similarly, when the muscles of the skeletal system are not well balanced, other structures must adapt to balance out those forces.² For individuals with proximal glute med weakness, it is common to see altered forces acting on the knee joint, leading to compensatory movement patterns, increased joint stress, and eventually increased knee pain.² 

At the Ankle

Patients with repeated ankle sprains and ankle instability have also shown changes in their strength and stability profiles at the hip. For instance, chronic ankle sprainers have altered hip muscle activation during gait following subsequent ankle sprains.⁴ This reduced proximal control of the gluteus medius muscle can result in poor foot placement during activity, further disposing athletes to ankle injury.⁴ Furthermore, athletes with chronic ankle instability demonstrated delayed glute activation during prone hip extension, balance, and jumping/landing exercises.^4,5 Specifically, female basketball players who underwent a structured gluteus medius strengthening program for chronic ankle instability demonstrated improved gluteus medius strength, decreased jump landing forces, and improved landing positions (knees in line with toes) upon completion of the program.³

Now the Low Back

Weakness of the hip abductors, specifically the gluteus medius muscle, has also been shown to play a role in low back pain. Since the glute med works to stabilize the pelvis in the frontal and transverse plane during functional motions such as walking and standing, a lack of activation and stability here can lead to pain further up the chain.⁶

Finally, the Hip

Lastly, studies have shown a link between hip pain and glute med, weakness. This may seem obvious given their proximity, but regardless, patients with hip OA demonstrate decreased glute muscle volume compared to their uninvolved side and healthy controls.⁷

Clinical Application

Now let’s dive into some ways to use mTrigger surface EMG biofeedback for enhancing the activation, strength, and performance of the gluteus medius muscle. As a reminder, we’re looking for maximum activation during these exercises – more here on setting your MVC goal level.

Based on existing studies, high glute med activation is seen in the following exercises: 

Example #1: Side plank

This is an excellent way to isolate an isometric contraction of the gluteus medius muscle of the support side hip (here, the left side). Make sure this exercise is mastered before progressing on to more difficult plank variations!

Example #2: Side Plank Clamshell

This variation challenges the gluteus medius muscle through either an isometric contraction or an isotonic motion. Adding resistance makes it even more challenging. Ideally, perform the exercises slowly to allow for appropriate muscle control.

Example #3: Single Leg Squat

This exercise challenges the glute med in standing, which requires it to both stabilize during single leg stance and also work to control the hip and femur during the exercise. 

Example #4: Suitcase March

In this exercise, a contralateral (opposite side) load helps to activate the gluteus medius muscle during standing as it works to stabilize the pelvis. Here, we’re in single channel mode to help focus attention on the involved side.

Example #5: Contralateral Weighted Step Up

Finally, in this exercise, the glute med is challenged to maintain stability through the hips throughout the performance of the exercise. 

Summary 

Regardless of the injury or impairment, when looking to improve muscle recruitment, biofeedback plays a vital role. It challenges patients to move better, achieve better results, and create lasting change in their movements. By reinforcing the strength and control of the hip via the gluteus medius, we can help address chronic pain and performance issues down the chain.

More uses for mTrigger biofeedback 

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References

1. Kasitinon D, Li WX, Wang EXS, Fredericson M. Physical Examination and Patellofemoral Pain Syndrome: an Updated Review. Curr Rev Musculoskelet Med. 2021;14(6):406-412. doi:10.1007/S12178-021-09730-7
2. Rowe J, Shafer L, Kelley K, et al. Hip Strength and Knee Pain in Females. N Am J Sports Phys Ther. 2007;2(3):164. /pmc/articles/PMC2953297/. 
3. Bolgla LA, Malone TR, Umberger BR, Uhl TL. COMPARISON OF HIP AND KNEE STRENGTH AND NEUROMUSCULAR ACTIVITY IN SUBJECTS WITH AND WITHOUT PATELLOFEMORAL PAIN SYNDROME. Int J Sports Phys Ther. 2011;6(4):285. /pmc/articles/PMC3230156/.
4. Fatima S, Bhati P, Singla D, Choudhary S, Hussain ME. Electromyographic Activity of Hip Musculature During Functional Exercises in Participants With and Without Chronic Ankle Instability. J Chiropr Med. 2020;19(1):82-90. doi:10.1016/J.JCM.2019.07.002
5. Kondo H, Someya F. Changes in ground reaction force during a rebound-jump task after hip strength training for single-sided ankle dorsiflexion restriction. J Phys Ther Sci. 2016;28(2):319-325. doi:10.1589/JPTS.28.319
6. Yoo WG. Effects of individual strengthening exercises on subdivisions of the gluteus medius in a patient with sacroiliac joint pain. J Phys Ther Sci. 2014;26(9):1501-1502. doi:10.1589/JPTS.26.1501
7. Loureiro A, Constantinou M, Diamond LE, Beck B, Barrett R. Individuals with mild-to-moderate hip osteoarthritis have lower limb muscle strength and volume deficits. BMC Musculoskelet Disord. 2018;19(1). doi:10.1186/S12891-018-2230-4