Lower Back Pain: Gluteus Medius Weakness

Chiropractic care has historically done well in the treatment of lower back pain. But lets be honest here,one treatment miracles are few and far between. I usually tell patients after their first treatment that the true test of any modality is not how it feels right now but how it feels in 24-48 hours. Increasing joint motion and thus relieving the mechanical pain is a relatively easy task; restoring muscular balance and returning long term stability to the lower back and lower extremities is a different animal. One of the muscles that is central to many low back cases is the gluteus medius.

The gluteus medius muscle originates at the dorsal ilium below the iliac crest and inserts at the top outside surfaces of the greater trochanter. It is the major abductor of the thigh. The anterior fibres rotate the hip internally and the posterior fibres rotate externally. The muscle is innervated by the superior gluteal nerve (L4, L5, S1) and gains its blood supply via the superior gluteal artery.



When bearing weight on one leg, such as the stance phase of running or walking up steps, the normal role of gluteus medius is reversed, causing it to act as a pelvic stabilizer.

For example, when the right leg is bearing all the body's weight and the left leg is in the swing phase (in the air), the glute medius muscle contracts on the right side to slow the downward motion of the left side of the pelvis. If the gluteus medius is not functioning well enough to achieve this control, the left (unaffected) pelvis will drop and the athlete is said to have a "Trendelenburg gait".
Often, but not always, you may see the same weakness in walking (producing a waddling motion or, in extremis, a limp), and the dysfunction will then be more marked when they run.

Weakness in gluteus medius will have implications all the way down the leg to the foot.
Gluteus medius weakness allows:

• the femur to adduct and internally rotate excessively-Hip & Back pain

• the knee to fall into a valgus position-Medial Knee pain

• the tibia to rotate internally relative to the foot-Foot & Ankle Pain, Lateral shin pain

• an increase in weight transfer to the medial aspect of the foot.-Achilles tendon pain, plantar fascitis

The glute medius being less than a full participant can lead to the patient needing hip and/or knee replacement!

Spare yourself the agony and the expense by taking the time to stretch & strengthen the glute medius.



Pictured at left is one stretch that can effectively lengthen the glute medius. In a seated position place the affected leg over the unaffected leg. Gently apply pressure against the upper thigh/knee until you feel the stretch in the buttock. Hold the stretch for 10-15 seconds and repeat 3 times. I always recommend stretching both legs.



The Clamshell Exercise for External Hip Rotation




If you belong to a gym, you can use the Abduction/Adduction Machine or any cable machine with the aid of an ankle strap.





Dr David Marcon
Work Smarter Not Harder!
Cincinnati, Ohio
drdavidmarcon.com