What is the Gluteus Medius and Why is it so Important for my Running?

The Gluteus Medius is one of the most important, yet often forgotten muscles in preventing and rehabilitating running injuries, both around the hip or further down the leg at the knee or ankle and foot. Adequate strength, activation and endurance of the Gluteus Medius muscle is required to allow optimisation of biomechanics for walking, running and reducing future injuries.

The Gluteus Medius is one of three major gluteus muscles, which originates on the outside of the pelvis and converges into a large flattened tendon as it attaches to the hip.

This allows the muscle to act as a hip flexor and internal rotator or a hip extender and external rotator depending on what part of the muscle is firing. When the whole muscle fires together it acts as well as a hip abductor (lifts the leg to the side) and pelvic stabilizer during weight-bearing – in particular during running.

If we take a look at its function for a runner. The role of the Gluteus Medius muscle is to help absorb ground reaction forces as the foot strikes the ground, stop the inward movement of the knee (adduction) and steady the pelvis over the leg as you load the lower limb.

When we run we put all of our weight on one leg at a time, as our foot travels under our body. The gluteus medius contracts at this time to provide support to our body every time our foot hits the ground. Just think about how many steps you would take every time you run. We know that our body experiences 3 times our body weight in force with every step that we take whilst running. Therefore our muscles have to be strong enough to withstand those forces upon impact with the ground. When a muscle isn’t strong enough to do this it becomes overloaded. It has been worked beyond its capacity and this is when an injury can occur.

Injuries are common amongst runners, particularly as athletes increase speeds, distances or vary training programs. It is important to understand how multiple factors play a role in developing Gluteus Medius pain, overload and/or weakness. So key risk factors for developing pain are;

Genetic predisposition – females and females with greater ‘Q Angle’ – the angle between the hip and the knee, are at more risk. So would say hormones play a role here, as well as the genetic makeup of our muscles.

A sudden increase in training load – whether it be speed, distance or frequency. Typically muscles, and in particular those that are required to handle the impact forces of running, tend to require a steady, gradual increase in load over time.

Overload or repetitive loading is a common term used in runners. Overload can present in a number of forms – running surface or footwear, hills or stair climbs, sports that require a change of direction, even static postures – sitting or standing for too long can place unnecessary strain on soft tissues of the back, hip and pelvis.

A running assessment can be a very handy tool to help to determine the potential of you developing issues relatable to your gluteus medius muscle. There are a number of common biomechanical traits that can predispose a runner to injury, and gluteus medius strength may play a role here. Common running relatable technique issues we see are, but are not limited to;

Cross over gait; where one foot crosses over the midline of your body as it comes to land on the ground in front of you. (Quick tip – if you notice you clip the inside of your ankle when you run, it’s likely this is you!)

Trendelenburg gait; you will notice your hip juts out to the side when you land and on the other leg (the swing leg), the hip drops down. This can give off a lopsided look to a runner or a knocked knee visual.

Reduced stiffness; the runner will look like they are running in a mini squat position. Or when they land you will notice a large amount of knee bend – like a slow-motion spring. You may notice their knee roll inwards more, as well as the foot and ankle.

Gluteus medius strength and endurance may play a large role in controlling the above biomechanical traits. If you believe you fit into any of the above running techniques, I would strongly recommend getting a running assessment where the cause of this technique can be investigated and discussed. Your likelihood of getting injured will reduce dramatically.

Typically seen in the majority of running based injuries, the gluteus medius plays a major role in the overall biomechanics of a runner. There are multiple injuries, and or pain/symptoms that you may feel if you have a weak or poorly functioning gluteus medius muscle. You may experience pain in the gluteus medius muscle or you may not – pain does not have to be present to indicate a gluteus medius problem.

Common hip-related injuries include gluteal tendinopathy – an injury that causes changes in the gluteal tendons resulting in pain on the outer side of the hip. Commonly, but not always associated, are gluteal muscle strains or tears as well as greater trochanteric bursitis. Muscle tears in runners tend to develop over a period of time and are usually associated with muscle weakness and overall. A biomechanical assessment, such as our running assessment, can assist you in identifying early potential risk factors for injury.

Injuries surrounding the knee include, but are not limited to, Patellofemoral Joint Pain – pain associated with your kneecap, also known as Runner’s knee. As well as ITB friction syndrome – pain located on the outside of your knee. Typically these symptoms tend to present over time and can be linked to weakness in the kinetic chain. A thorough strength assessment – like that performed in our running assessment, can help to assist in understanding potential underlying causes.

Injuries of the lower leg usually involve the calf. This is a very common area of pain for runners and is closely linked to hip weakness. Pain may present in the calf – as a strain or tear. It may present near the shin, or at the site of the Achilles – Achilles tendinopathy. Pain may be a slow build-up or sharp pain in the centre of the calf, the inner shin or the outer side of the leg or at the Achilles.

If we focus on improving the strength of the gluteus medius muscle for running, you will notice greater stability around the hip and pelvis, which therefore takes the pressure off your back and knees, helping to prevent overload of those areas of the body. Research strongly supports the use of strength training to improve running biomechanics and therefore overall performance for speed, endurance and longevity. As we discussed earlier in the blog, the body has to withstand 3 times our body weight in force as each foot strikes the ground. If we want to best prepare our bodies for the impact of an activity like running, then we have to try and match the load that our soft tissues will experience. And that is where strength training can start your injury-free running journey. Strength training has been proven to not only reduce injury risk but also improve overall performance. The greater your muscle strength the greater the ability to produce power and force, which results in improved speed and endurance!

So what exercises can you do for your gluteus medius?

Prioritising exercises can be difficult at times, so a good way to incorporate these exercises is by using them before a run. Activating your glutes before you run allows your body and mind to connect with those muscles and then improve their use during running.

Below are 5 exercises that can help you to get started on improving your gluteus medius activation and strength. Utilise these as your pre-run glute activation routine.

Now that your glutes are nice and warm and ready to go, your mind will be already focused on their activation. This is a great way to start to learn how to use your glutes whilst running.

Running with your glutes can be difficult to do when you first start out but give it practice and persistence. Try to use the activation exercises to awaken those muscles first. Then when you’re running try to consciously tighten your gluteal muscles with every step you take. Specifically, as your foot travels under your hip, engage your glute by squeezing, and making your hip nice and stiff. This is a great starting point to improving your glute activation and impact on your running.

Try these exercises below as your glute activation workout pre-run!

Single-Leg Bridge x30 each leg

1. Lie on your back with your hands by your sides, knees bent, and feet flat on the floor. Lift one foot, extending the leg fully so it is in line with your knee.
2. Raise your hips, tightening your abdominals and buttock muscles to support the lift, until your shoulders and knees are in a straight line. At the top, pull your belly button in toward your spine to activate your core.
3. Lower the hips to the floor slowly and with control to return to the starting position. The one leg remains extended as you repeat.
4. Repeat on the other leg.

Single-Leg Wall Squat x10 for each leg

1. Standing side onto the wall. Bend your inside leg up and press your knee into the wall
2. Sit your hips back and down into a squat
3. Keep your body straight, engage your core
4. Press through your heel as you stand up to feel your glute working
5. Repeat on the other leg

Crab and Monster walk boxes x10 boxes total

1. 1. Put a band around your knees. Sit slightly back and down with your hips to create a mini squat position.
   2. Hold this position as you sidestep 4 times to one side
   3. Then keep your feet wide as you take 4 steps forward
   4. Repeat 4 side steps to the other side
   5. Then keep your feet wise as you take 4 steps backwards
   6. You will have created a box with your steps
   7. Repeat this 10 times.

Single leg Romanian deadlift or Arabesque x10 each leg

1. 1. 1. Stand on one leg, with a soft knee
      2. Hinge at your hips as you lower your body over your standing leg
      3. Keep your back straight
      4. You should feel a pulling or tightening sensation in your hamstring, once you reach this point, slowly control your body back to the upright position
      5. Repeat 10 times and then complete on your other leg

Side plank with top leg raises x10 each leg

1. 1. 1. Lying on your side, propped up on your elbow with your knees stacked on top of each other.
      2. Lift your hips up as you press through your elbow.
      3. Once your shoulder hip and knees are in a straight line, extend out the top leg.
      4. With the top leg perform raises x10 before lowering back down.
      5. Repeat on the other side, repeat each side x 3.

So we can strongly say that if you give your gluteus medius the time of day. Make it strong, focus on improving its ability to tolerate load, then this will translate into your ability to use them whilst running and therefore result in reduced risk of injury and overall improved running performance!

If you’re in Melbourne and would like professional guidance, I’d encourage you to book a running assessment. In the assessment, we will look at your running and injury history and assess your body through a series of physio tests. Sessions are designed to give you expert advice and ideas to enhance your technique and also discuss possible causes of loading issues you may be experiencing.

References:

“Running related gluteus medius function in health and injury: a systematic review with meta-analysis” – Adam Semciw et al. J Electromyogr Kinesiol. 2016 Oct

“Male and female gluteal muscle activity and lower extremity kinematics during running” – John D Wilson et al. Clin Biomech (Bristol, Avon). 2012 Dec.

“Hip abductor strength and lower extremity running related injury in distance runners: A systematic review” – Matthew D Mucha et al. J Sci Med Sport. 2017 Apr.

The Best Practice Guide to Conservative Management of Patellofemoral Pain: incorporating level 1 evidence with expert clinical reasoning. Barton, C.J., Lack, S., Hemmings, S., Tufail, S. & Morrissey, D. (2015). British Journal of Sports Medicine, 49, 923-934.

The relationship of anticipatory gluteus medius activity to pelvic and knee stability in the transition to single-leg stance. Kim, D., Unger, J., Lanovaz, J. & Oates, A. (2016). American Academy of Physical Medicine and Rehabilitation, 8, 138-144.

Running related gluteus medius function in health and injury: a systematic review with meta-analysis” – Adam Semciw et al. J Electromyogr Kinesiol. 2016 Oct

Male and female gluteal muscle activity and lower extremity kinematics during running – John D Wilson et al. Clin Biomech (Bristol, Avon). 2012 Dec.

Hip abductor strength and lower extremity running related injury in distance runners: A systematic review – Matthew D Mucha et al. J Sci Med Sport. 2017 Apr.