Is Your Glute Med Really Shut Down?

 

Is your glute med really shut down?  Anyone can make someone fail a glute med test and then claim to fix them, usually by having them do hundreds of meters of band walks or squats with a band around the knees.  Never seen it?  Scroll Instagram for all of 5 minutes and I guarantee you see what I’m talking about.  Knees cave in?  Some of the world’s strongest Olympic lifters have knees that cave in.  I would not presume to say that someone who can snatch 180kg has “weak glutes”.  The adductor magnus has a strong hip extension moment arm, especially when the hips are flexed.  And so, we will often see a valgus twitch coming out of the whole which does not justify the “glute not firing” categorization.

In the industry today, there is still an obsession about the glute med weakness.  I wrote an article about it on Thibarmy.com in 2016, A Word on Glute Activation, and yet I still find myself talking about it today.  Don’t get me wrong, I am not saying that there isn’t a need for many people to have better access to their glute med.  I just think that 1) the language needs to change (it’s not shut down!) and 2) the way we address glute med function can be more optimal.

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FAILING THE GLUTE MED TEST

Gluteus medius muscle test

Admittedly, most people test poorly on standard manual muscle testing for the glute med.  We could also argue that the fact that this test is done in a mechanically disadvantageous position and that this position is unusual for most means that you could easily outmuscle a client just to prove a point.  Just saying.

If you are interested in doing it right, here is how it should be done:

The client should be side lying with the bottom hip and knee flexed to help stabilize the pelvis and the pelvis rotated slightly forward.  Your hand will help stabilize the pelvis and note any tendency to roll the pelvis backward or hike the hip, indicating an attempt to compensate with the anterior hip musculature (tensor fasciae latae, lateral quads) or the lateral abdominal muscles (obliques, QL).

The hip is positioned in abduction with slight extension and slight external rotation, with the knee in extension.  If someone is really weak, they may have difficulty just holding this position.  Pressure is exerted against the distal leg in the direction of adduction and slight flexion, without any pressure on the rotation component.  As mentioned before, this is a long lever, allowing me to exert greater force even if I am small and the client is big.  But if I lean my entire body on the leg, I can make a 200-lb guy fail.  When I teach my Movement Optimization Course, I always make a point of picking the bigger guy and making him fail this test to prove my point, lol.  Again, just saying.

The right way to test is to have the client push into your hand to meet your resistance.  Once they have met your resistance, increase the resistance by about 5lbs and see if they can still hold.  This should last maybe 3-4 seconds.  Not 10 seconds of fatiguing the client until they fail.

Watch the video above to see how to perform the test.

Now the questions.  How hard do I resist?  How much is 5 lbs?

Here’s the thing.  Muscle testing takes practice.  Lots of it.

The fact is that muscle testing is a clinical tool.  It originated as a system for grading the strength of postural muscles for disability evaluation in polio and other neuromuscular diseases was presented by (Kendall & Kendall, 1936) and then expanded to the identification and treatment of postural disorders (Kendall & Kendall, 1952).  Like many clinical tools, it made its way into the gym setting, but seems to be being misused as a performance assessment.  A way of convincing the client that the reason their knees cave in during squats is because (both) their glute med are “not firing”.

 

FUNCTIONAL GLUTE MED TEST

The actual most important role of the glute med is lateral stability of the pelvis.  It maintains your pelvis aligned when you stand on one leg.  This is actually a reverse action, where the glute med pulls down on the pelvis – think closed-chain hip abduction.  If someone’s glute med was really “shut down”, this is what you would actually be looking at:

 

Trendelenburg sign

To me, this is a much more functional way of looking at the glute med.  Ask the person to stand on one leg and see whether the opposite hip drops.  It should normally rise slightly.

Language aside, we can still agree that it is important to upregulate the glute and find optimal ways of doing this.

Movement Optimization online course

START WITH THE FEET

Squat therapy for the glute med typically involves people squatting with bands around their knees or doing Monster walks with bands around their knees.  This isn’t all entirely wrong.    But it also isn’t where I would start, and more importantly, it isn’t the means to all ends.  Throw a band around it and it will fix it.  Reminds me of using duct tape…on everything.  We’ll get back to that in a second.

One thing that is often under-rated is the foot.  At best, people are rolling the ball around under their feet and using the cues “spread the floor” and “screw the feet”.    But what we need to remember is that cues only remind, not explain.  A cue is a signal that causes the client to correct something or remember something specific about the movement.  This means that the intent and expected result of the cue need to have been previously discussed, taught and understood.

In my blog article, Stop Blaming the Glute Med, I talk about how to activate the foot.  Check it out to get some tips and tricks!  I also have another article coming up on the topic!

 

BANDS AROUND THE KNEES

I could throw a wrench in here and say that where glute med activation is concerned, some studies have actually shown higher percentages of maximum voluntary isometric contraction (MVIC) in side-lying hip abduction when compared to resisted side-stepping (such as band walks), while others have shown higher % of MVIC in weight-bearing vs non-weight-bearing exercise.  Open-chain exercises that isolate the glute med certainly can be effective when programmed appropriately, especially for someone who has very little mind-muscle connection.

As far as bands around the knees, I’m not all against them but if you’re going to do them, do them right.  Here are a couple of things to consider:

  1. Focus on positioning. Band walks, shuffles, Monster walks, resisted side-stepping, etc. should be done in a semi-squat position.  It is proposed that the TFL will contribute to hip abduction if there is glute med weakness.  Side-stepping in a squat posture versus an upright posture has been shown to reduce activation of the TFL (Berry et al.).
  2. Spend some time in the stance phase.  In the same study, Berry et al. found greater activation of the glute med in the stance limb (as did Youdas et al).  To put it simply, shuffling too quickly mitigates your results.

Stop using the manual muscle test for the glute med to tell people their glutes are shut down.  As a matter of fact, stop using the test altogether as a performance test.  That’s not what it was meant for.  If you’re suspicious of gluteal amnesia, look at the feet first.  Then work your way up the chain to find ways to integrate the foot and hip.  To help you, I’m going to put out another article on glute med activation – look for it on the blog!

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References:

Cambridge ED, Sidorkewicz N, Ikeda DM, McGill SM. Progressive hip rehabilitation: the effects of resistance band placement on gluteal activation during two common exercises. Clin Biomech (Bristol, Avon). 2012;27(7):719–724.

Berry, J., Lee, T., Foley, H., & Lewis, C. (2015). Resisted Side Stepping: The Effect of Posture on Hip Abductor Muscle Activation. Journal of Orthopaedic & Sports Physical Therapy, 45(9), 675-682.

Youdas JW, Foley BM, Kruger BL, et al. Electromyographic analysis of trunk and hip muscles during resisted lateral band walking. Physiother Theory Pract. 2013;29:113-123.

 


 


Mai-Linh Dovan M.SC., CAT(C)
Certified Athletic Therapist
Founder of Rehab-U

 

 

 

 

 

 

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