with Jacinta Carroll
Recently in the clinic a patient posed a question to me. She wanted to know why every Physio tells her as a 62yr old to strengthen her glutes, yet when she took her 16yr old granddaughter to a Physio for knee pain they said the exact same thing.
As a patient it can be very confusing to hear similar recommendations for different presentations, so I’m going to spend the time to break it down using these two cases.
Case 1 – Osteoarthritis of the hip
Osteoarthritis (OA) is a degenerative condition resulting from mechanical overload in a weight bearing joint. Hip OA affects the articular cartilage as well as causing changes to the bone, ligaments and capsule of the joint. As a result, this process leads to a loss in joint space which in some people may be symptomatic. It has been suggested that Hip OA is present in roughly 10% of people aged 65 and above, and in this 10%, 50% of cases will be symptomatic.
Role of the Gluteus muscles in OA
Clinical practice guidelines recommend exercise and education as the first-line management of OA in both the hip and knee. The ultimate goal of exercise participation is to improve symptoms, physical function and quality of life. Maximum hip abductor strength (gluteus medius is a hip abductor) during walking are associated with symptoms of OA. It has also been found that hip abductor muscle atrophy (muscle wasting) is present in people with hip OA and this is associated with the severity of the condition. In short if you have weaker or atrophied gluteal muscles you are more likely to have symptoms in your hip. The use of progressive resistance training for the hip abductors (Gluteus medius) may have a significant positive impact on symptoms during functional tasks including walking.
My Top 3 Exercises
- Side-lying hip abduction – Use the wall as a guide to place your hips in the right position. Make sure your heel is in contact with the wall as you are lifting and lowering your leg.
- Single leg squat – Use a chair as a guide, initiate the movement from your hips and make sure your hip, knee and foot are aligned.
- Banded walks – Lean over from your hips so you can see your show laces and maintain this position throughout. Your feet should be pointing straight and your knees should be in line with your feet.
Case 2 – Patellofemoral Pain syndrome (PFPS)
PFPS is a medical term used to describe pain felt at the front of your knee arising from where your patella (kneecap) articulates with your femur (thigh bone) or the surrounding soft tissues. The pain most commonly occurs when load is put on the extensor mechanism (quadriceps and it attachments) when climbing stairs, running, squatting, cycling or sitting with bent knees.
Role of the Glutes in Patellofemoral Pain Syndrome
The gluteus medius (1 of 3 glute muscles) acts to abduct (figure) and externally rotate (figure) the hip. It is a common conception that weakness in Gluteus Medius leads to an increase in hip adduction (when the femur moves in towards the other leg) and internal rotation as you can see in the image below. (Image of knee valgus)
This position is thought to increase the load on the patellofemoral joint, predisposing to PFPS. Current literature has found there is delayed activity and contraction of shorter duration of Glute Medius during various physical activities including stair ascending/descending and running in those with PFPS. Runners with PFPS have also been found to display weaker hip abductor muscles (glute medius) which resulted in greater hip adduction and increased load on the patellofemoral joint.
As you can see, whether you are 62 and suffering from symptomatic OA, or a 16 year old with painful knees during sport, strengthening and learning to activate your Gluteus Medius can be of benefit. Working on your glutes is important to the biomechanics of multiple lower limb issues whether it be your knees, ankles or hips. Having poor hip function will affect the positioning of these lower limbs and can lead to further issues. Having consistent glute strengthening exercises included as part of your regular exercise will help your hips have a strong foundation to operate from.
It must be kept in mind however that everyone is unique. Each patient will have different fitness, strength and endurance capacities prior to rehabilitation and the demands of their situation whether it be walking pain free or playing an elite level sport needs to be taken into consideration. One exercise of the glutes, is by no means the be all and end all, however it does provide you a starting point, where you as the patient can make changes towards a stronger future.