Gluteus Medius

Original Editor - Alex Palmer,

Top Contributors - Alex Palmer, George Prudden, Ahmed Nasr, Joanne Garvey and Kim Jackson;

Description

Gluteus medius is overlapped posteriorly by gluteus maximus.
Gluteus medius is located on the lateral aspect of the upper buttock, below the iliac crest. The superior muscle is broad with the muscle narrowing towards its insertional tendon giving it a fan-shape. Gluteus maximus covers all of the gluteal muscles except for the antero-superior third of the Gluteus medius. This uncovered part of Gluteus medius is the safe area at which we should apply buttocks dorso gluteal intramuscular injections .

Origin

Gluteal, or lateral surface of the ilium between the posterior and anterior gluteal lines and gluteal aponorosis . This is a large area, reaching from the iliac crest above to the almost the sciatic notch below.[1][2]

Insertion

Glutes medius is divided into three portions similar to deltoid muscle of the shoulder joint :[1]

  1. Fibers of the posterior portion pass forwards and downwards.
  2. Fibers of the middle portion pass downwards.
  3. Fibers of the anterior portion pass backwards and downward. All Fibers combine to form a flattened tendon which attaches to the posterior and lateral part of the superior portion of the greater trochanter of the femur.

Nerve supply

The gluteus medius is supplied by the superior gluteal nerve (root L4,L5 and S1). Cutaneous supply is mainly provided by L1 and 2.[1][2]

Function

  • Gluteus medius is the prime mover of abduction at hip joint .
  • Anterior portion of Gluteus medius abduct , assist in flexion and medial rotation of hip.[3]
  • Posterior portion of Gluteus medius abduct , assist in ext and lateral rotation of hip.
  • In hip flexion all portions internally rotate the hip and it has shown that at 90` of hip flexion the leverage of medial rotation of Gluteus medius is increased eight folds.[1][3]
  • All portions of Gluteus medius will produce hip abduction regrades the position o the hip. [1]
  • Glutes medius is an extremely important muscle in maintaining frontal plane stability of the pelvis it forms with the ipsilateral tensor fascia latae and contralateral quadratous lumborum a lateral fascial sling which it`s main role is to provide frontal plane stability .
  • .Gluteus medius is an important muscle in walking, running and single leg weight-bearing because it prevents the opposite side of the pelvis from dropping during walking, running and single leg weight-bearing.When a limb is taken off the ground the pelvis on the opposite side will tend to drop through loss of support from below. Gluteus medius works to maintain the side of the pelvis that drops therefore allowing the other limb to swing forward for the next step.[1][4]
  • Gluteus medius also supports the pelvis during gait by producing rotation of hip with assitance from gluteus minimus and tensor fascia lata. Conversely, the hip is supported during the stance phase by acting on on the same side.

Anatomy Overview

Inhibition of Glutes medius

As mentioned by vladmir janda`s Glutes Medius is one of phasic muscles that tends to be inhibited in our body by many causes :

  1. Standing with body weight shifted mainly on one lower limb with the pelvis swayed sideways and hip joint adducted.[4]
  2. Sleeping sideline with no billow in between two lower extremities will lead to the top leg flexed and adducted. over the other leg[4]
  3. Sitting with crossed legs for a long period of time will potentially weaken the hip abductor muscles by putting the muscle in a somewhat elongated position (beyond resting physiological length) .
  4. Tight hip adductors which sends a reciprocal inhibition to Glutes medius
  • When Glutes Medius is inhibited body must try to compensate by other muscles to maintain frontal plane stability and preventing pelvis from dropping so the activity of ipsilateral tensor fascia latae and contralateral quadratous lumborum will increase causing these muscles to become tight and overactive. [5]N.B Janda mentioned that quadratous lumborum and tensor fascia latae are tonic muscles that tend to be tight and overactive.
  • Weakness in this muscle has been associated with lower-limb musculoskeletal pathology[6] and gait disturbance following stroke.[7]
  • There is a relationship between a weak or dysfunctional GM and many lower extremity injuries such as :Trendelenburg gait,Illio-tibial band (ITB) syndrome , Patellofemoral pain syndrome (PFPS) ,Anterior cruciate ligament (ACL) and other knee injuries,Ankle injuries. [4]
  • The Trendelenburg sign is when the muscle is unable to work efficiently due to pain, poor mechanics or weakness, the pelvis will drop on the opposite side to the weakness. A trunk compensation is often observed with a Trendelenburg gait.[1] A very impressive research about the validity of Trendelenburg test shown that the test should`nt be used with healthy individuals whose glutes medius has a strength of greater than 30% BW. It`s only could be used with marked weakness patients. This means that you could actually have an inhibited Glutes medius and the Trendelenburg test is negative .[8]


Activation of Glutes medius

There are many exercises that help in activation of Glutes medius each exercise activate Glutes medius by a certain percentage as shown by EMG activity. We divide them as following[3]:

level of Gluteus medius activation Types of exercises
Moderate-level activation (21–40% MVIC)
  1. Prone bridge plank (27% ± 11% MVIC)
  2. Bridging on stable surface (28% ± 17% MVIC)
  3. Lunge-neutral trunk position (34% MVIC)
  4. Unilateral mini-squat (36% ± 17% MVIC)
  5. Retro step-up (37% ± 18% MVIC)
  6. Clam with 60° hip flexion (38% ± 29% MVIC)
  7. Sideways lunge (39% ± 19& MVIC)
  8. Clam with 30° hip flexion (40% ± 38% MVIC)
High-level activation (41–60% MVIC)
  1. Lateral step-up (41% MVIC)
  2. Quadruped with contralateral arm and leg lift (42% ± 17% MVIC)
  3. ) Forward step-up (44% ± 17% MVIC)
  4. Unilateral bridge (47% ± 24% MVIC)
  5. Transverse lunge (48% ± 21% MVIC)
  6. Wall squat (52% ± 22% MVIC)
  7. Side-lying hip abduction (56% MVIC)
  8. Pelvic drop (57% ± 32% MVIC)
  9. Single-limb deadlift (58% ± 22% MVIC)
Very high-level activation (>60% MVIC)
  1. Single-limb squat (64% ± 24% MVIC)
  2. Side-bridge to neutral spine position (74% ± 30% MVIC).
  • MVIC = maximum voluntary isometric contraction The prone bridge/plank are unique from the other exercises because of it`s static nature to maintain a neutral hip and spine position during this exercise so it focuses on GMed’s role as a hip and spine stabilizer..

Assessment

Palpation

Find the middle of iliac crest which is located above the greater trochanter.Two fingers below is the bulk of gluteus medius. The contraction of the muscle can be felt by alternate single leg stands.[1]

Power

  • Hip abduction in side-lying
  • Double or single-leg stance test
  • Adding an upper body movement to the single-leg stance test
  • Assessment of functional tasks that require single-leg stance such as step-downs, walking or running.[4]

Length

Treatment

first you have to find the causes for inhibition or weakness of the Glutes medius and try to prevrnt it and then try to activate Glutes medius.

Pressman and colleagues describe a progressive program for strengthening gluteus medius weakness.[4]

  1. Nonweightbearing and basic weightbearing exercises such as clam shell exercises, sidelying hip abduction, standing hip abduction, and basic single leg balance exercises. Progress when the patient can hold their pelvis level during single leg stance for 30 seconds.
  2. Weight-bearing exercises and gradually progresses stability exercises by (i) translating the center of gravity horizontally via stepping and/or hopping exercises; (ii) reducing the width of the base of support, (iii) increasing the height of the center of gravity by elevating the arms and/or hand-held weights, or (iii) performing the exercises on unstable surfaces.
  3. Sport-specific movement patterns.Resources

Related Pages

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Palastanga N, Soames R. Anatomy and Human Movement: Structure and Function. 6th ed. London, United Kingdom: Churchill Livingstone; 2012.
  2. 2.0 2.1 Kendall F.B , McCreary E.K ,Provance P.G .Muscles: Testing and Function, with Posture and Pain (Kendall, Muscles) Fifth, North American Edition. Philadelphia. Lippincott Williams & Wilkins, 2005. Jump up↑
  3. 3.0 3.1 3.2 Reiman, M. P., Bolgla, L. A., & Loudon, J. K.. A literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises. Physiotherapy Theory and Practice,2012: 28(4): 257–268. 
  4. 4.0 4.1 4.2 4.3 4.4 4.5 Presswood, L., Cronin, J., Keogh, J. W. L., & Whatman, C. . Gluteus Medius: Applied Anatomy, Dysfunction, Assessment, and Progressive Strengthening. Strength and Conditioning Journal. October 2008 : 30(5):41–53 .
  5. Kim H.J , Lee H.S, Jung H.G . Difference of Muscle Activity by Pelvic Tilt in Side-Lying Hip Abduction .Journal of The Korean Society of Physical Medicine. 2017:12(3): 59-66 .
  6. Barton CJ, Lack S, Malliaras P, Morrissey D. Gluteal muscle activity and patellofemoral pain syndrome: a systematic review. British journal of sports medicine. 2012 Sep 3:bjsports-2012.
  7. Buurke JH, Nene AV, Kwakkel G, Erren-Wolters V, IJzerman MJ, Hermens HJ. Recovery of gait after stroke: what changes?. Neurorehabilitation and Neural Repair. 2008 Nov 1;22(6):676-83.
  8. KendallK. D., Patel C., Wiley J. P., Pohl M. B., Emery C. A., etal .Steps Toward the Validation of the Trendelenburg Test. Clinical Journal of Sport Medicine.jan 2013: 23(1): 45–51.