One of the biggest culprits to hip, knee and back pain can actually stem from the fact that your butt muscles don't work. Many people may not even realize that their gluteal muscles (I'll be using glutes for short form) don't fire properly or even at all. The inability to activate your glutes can lead to bigger problems, long-term consequences and needs to be addressed immediately. The glutes are essential to help stabilize the hip and pelvis and plays an important role with the back, knees and ankles.
Image courtesy of [apexosteopathy.com]
For many years, I didn't even know how to activate my glutes. I didn't know what those muscles even felt like to be activated. Only now can I safely say that I know what it feels like and have the awareness of whether or not they are working.
If you've been following my blog, you've seen my sister, Elisa, modeling in almost all my write ups. Recently after a knee injury, she has been unable to activate her left glute. This has left her overusing her hamstrings and low back while she works out and limiting her activities. Elisa doesn't like to have any barriers to working out.
After many weeks of some hard-core training and dedication, she is just starting to activate her glutes in more functional movements like the squat and the lunge. Although she has been at it for several weeks, she must still maintain and continue the work on her glutes. It may be a long process for some, but those who continue will reap the benefits later on.
There Are Many Reasons Why Your Glutes May Not Be Working
1. Pain and injury
- Those with chronic low back pain have a tendency to have weaker and greater fatigability of glute max compared to their healthy counterparts
- Low back pain can also change the sequence of muscle firing from a bottom-up approach to a top-down approach. A study from Wong et al. showed that those with low back pain had a tendency to activate the low back musculature before glute max, while the control group activated glute max before lumbar extensors with lumbar flexion.
Image courtesy of [stockimages] / FreeDigitalPhotos.net
- Those with knee pain associated with Patellofemoral Pain Syndrome had weaker and slower activation of glute med and glute max when compared to non-injured side and healthy controls.
- Essentially any pain to the back or any part of your lower extremity can affect whether or not your glutes function in the manner they are supposed to
- With increased levels of sitting at the computer, these large gluteal muscles don't have the opportunity to be activated
Image courtesy of [Stuart Miles] / FreeDigitalPhotos.net
- When you don't require those muscles to be stimulated and activated everyday, they get the message that they can just shut off and become lazy
- The neuromuscular pathway or the electrical signal from your brain to the muscle becomes weakened which in turn makes it harder for you to activate this muscle
- Every muscle, including your glutes, goes with the saying, "use it or lose it"
- You may have one butt check or glute that works well but for some reason the other doesn't even flinch
- With many of our daily activities and sports, we have one side that we prefer to throw with, kick with, land with, and write with
- We become dependent and more comfortable using one side compared to the other, therefore the other side becomes our non dominant side
- This leaves us with one side that becomes stronger and stronger, whereas the other becomes weaker and weaker
How to Get Those Glutes Firing and Stronger
1. Isometric Contractions in Various Positions
- Start by squeezing your glutes in sitting, standing, prone (lying on your stomach) and supine (lying on your back)
- It helps to close your eyes and visualize the glute muscles contracting
- Place your index and 2nd finger in the middle of your butt to feel those muscles contract and harden
- Work on holding the contractions for 10 seconds and repeat 10x/day
Start position of the isometric hold in prone
End position of the isometric hold in prone with self-feedback. Ensure that you maintain neutral spine to prevent overuse of the low back musculature.
- Clamshells are one of the best exercises to activate the gluteus medius without over activation of TFL (tensor fascia latae). TFL muscles are located at the front/side of your hip.
- Greatest activation of gluteus medius is with the hips neutral and with hip flexion at approximately 60 degrees of flexion
- Add a band above your knees for greater resistance
- 10 reps x 3 sets
Overhead view of the start position of the clamshell
Frontal view of the start position of the clamshell
End position of the clamshell
3. Side Lying Leg Raise
- While lying on your side, make sure your hips stay neutral by making sure they are stacked on top of each other
- The bottom leg can have a slight knee bend to help with stabilization
- The top leg is the leg that will be performing the leg raise
- Make sure your leg is slightly behind you to gain that hip extension. If you have your leg in front of you, you will begin to fire the TFL (tensor fascia latae) and other hip flexors, which we do not want.
- You should feel your buttock working hard, not the front of your hip
- 10 reps x 3 sets
Overhead view of the start position of the side lying leg raise
Frontal view of the start position of the side lying leg raise
End position of the side lying leg raise
4. Quadruped Hip Extension
- Maintain neutral spine while on your hands and knees in 4 point
- Lift your heel towards the ceiling to engage your glutes
- Do not hyperextend (arch) your low back while performing this exercise
- 10 reps x 3 sets
Start position of the quadruped hip extension
End position of the quadruped hip extension
The overall goal is to be able to integrate the gluteals with functional movements like the squat, deadlift and the lunge. It may take some time before you feel like you have control over these muscles but your back, hips, and knees will eventually thank your for taking the time to work on them. These exercises can be used as a warm up prior to the functional movements previously mentioned.
There are many reasons why one's gluteal muscles may not be functioning optimally. Whether it's because of your sedentary lifestye, low back injury or chronic knee pain, your gluteal muscles may become inhibited and difficult to activate. Switching on your gluteal muscles and establishing non-compensatory movements will help normalize your body's function and performance.
Happy glute training!
Jessie Wong, Physiotherapist
Resources: J Orthop Sports Phys Ther 2013;43(5):325-331. Epub 13 March 2013. doi:10.2519/jospt.2013.4004. The Influence of Varying Hip Angle and Pelvis Position on Muscle Recruitment Patterns of the Hip Abductor Muscles During the Clam Exercise. Which Exercises Target the Gluteal Muscles While Minimizing Activation of the Tensor Fascia Lata? Electromyographic Assessment Using Fine-Wire Electrodes,” J Orthop Sports Phys Ther 2013;43(2):54-64. doi:10.2519/jospt.2013.4116. J Orthop Sports Phys Ther 2009;39(7):532-540, Epub 24 February 2009. doi:10.2519/jospt.2009.2796. Gluteal Muscle Activation During Common Therapeutic Exercises Back and Hip Extensor Fatigability in Chronic Low Back Pain Patients and Controls http://www.folsomphysicaltherapy.com/back_and_hip_extensor_fatigability_...
*The exercises provided on this website are for educational purposes only, and are not to be interpreted as a recommendation for a specific treatment plan, or course of action. Exercise is not without its risks, and this or any other exercise program may result in injury. They include but are not limited to: risk of injury, aggravation of a pre-existing condition, or adverse effect of over-exertion such as muscle strain, abnormal blood pressure, fainting, disorders of heartbeat, and very rare instances of heart attack. To reduce the risk of injury, before beginning this or any exercise program, please consult a healthcare provider for appropriate exercise prescription and safety precautions. The exercise instruction and advice presented are in no way intended as a substitute for medical consultation. We disclaim any liability from and in connection with this program. As with any exercise program, if at any point during your workout you begin to feel faint, dizzy, or have physical discomfort, you should stop immediately and consult a physician.