Rehab for Gluteus Medius – My Strategies

Thanks for all of the shares for my rant about rehab for glureus medius…and I promised I would back up my rant with a few of my strategies for gluteus medius.  I think I’ll use the same 3 points as the last post and describe my strategies within each.

  1. It’s a Conscious, Isolated Movement
  2. That’s not how the Glute Med. Works in Function
  3. Poor Carryover from the treatment

1.  It’s a Conscious, Isolated Movement

So if I don’t like the conscious, isolated movements we need to find another way to fire the glute medius.  I like pivots if the patient is able to do them.  I would use all planes of motion as actually I don’t want to focus on one muscle, but to generate good hip movement and as a result of the good hip motion you can fire the glute medius.  The frontal plane pivot will have the biggest direct effect, but you gain good co-ordination through the other movements, so they are definitely worth doing.

The big advantages I see in firing the muscle in this way is that you:

  • Fire the muscle in a functional pattern that directly translates into the patients everyday function
  • The timing of the contraction is controlled subconsciously, so will be perfect
  • The strength of contraction will be controlled subconsciously, so will be perfect
  • Fire the muscle in coordination with both local and global muscle, joints, fascia, etc etc
  • and many more!!

2.  That’s not how the Glute Med. Works in Function

To a degree most of the bases are covered by the strategies in point 1.  But if for example you want to get closer to a specific function (gait, tennis, golf?) I would either adapt the pivots or use different drivers to fire the glute med.  Lets say for instance they are a golfer and your trying to fire their right glute med.  How would you make golf specific glute med. exercises?  Here’s one way I might try:

I know the glute med. will fire with hip flexion, adduction and internal rotation, which is great, but in the back swing of golf that should be happening…so we need to do something more.  Assuming you’ve already done your assessment, I would fire the glute and then re-test.  For golf I would try just using hand drivers, using the left hand to drive a normal golf swing, but then use the right hand to drive over-head towards the left.  The right hand will therefore drive a lot more hip adduction in the right hip and encourage a greater reaction from the right glute med.

I would then re-test and see what’s changed.  If I needed to change things a little more I might start tweaking the foot position, use either a slightly narrow, right foot forward, right foot turned in…etc…etc.  You can change so many parameters your imagination is your only limitation.  Again, I tend to re-test after each change to the movement as what works is important to know.

3.  Poor Carryover from Treatment

The carry over is fundamental to me, it’s no good repeating the same treatment week after week only for them to consistently regress within a short period of time.  If you can encourage the muscle to fire with the above strategies they are far more likely to continue firing the muscle when they leave your clinic.  If we continue with the gold example.  Once I’ve tweaked the movement and found a way to fire the muscle I will then gradually decrease the tweak until you are back at just doing the pure function.

If you are wanting to bullet proof the person I would then disadvantage the glute medius and make them go through their functional movement again.  If you can fire their glute med. even when it is disadvantaged they are far more likely to continue firing the muscle ongoing.

Hopefully that gives you plenty of alternatives to the side lying hip abduction 🙂

Physioblogger

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15 Responses to Rehab for Gluteus Medius – My Strategies

  1. dominic meacher May 10, 2012 at 9:47 am #

    Thanks Neil, could you elaborate on disadvantaging the glute med, do you mean lots of adduction internal rotation and flexion, or the opposite. Or something else entirely?

    • physioblogger May 10, 2012 at 1:01 pm #

      Thanks Dominic, all I mean is just to tweak out one of the planes…so less adduction or more neutral in the sagittal and transverse planes.

      Neil

  2. Tom May 23, 2012 at 9:13 pm #

    Hi Neil,
    Interesting article with some good points.
    I have a different take on glutes rehab;
    http://runningphysio.wordpress.com/gluteus-medius-evidence-based-rehab/
    Any comments welcome
    Tom

    • physioblogger May 24, 2012 at 5:28 am #

      Hi Tom, thanks for that, an interesting read,

      Neil

  3. Tony November 27, 2012 at 11:03 am #

    Hi Neil

    Could you please explain what a pivot is ?

    Cheers Tony

    • physioblogger November 27, 2012 at 12:37 pm #

      Hi Tony,
      A pivot is where you move one foot back and fore past the other. For example, right foot stays stationary and the left foot moves forward and back past it in sagittal, frontal or transverse plane.

      Hope that helps,

      Neil

  4. Tony November 27, 2012 at 9:36 pm #

    Hi Neil

    @ the end of the blog you mention “firing the glue when it is disadvantaged”
    Could you please tell what that means ??

    Not sure if it’s me being silly !! But Ive never heard that saying before & I can’t seem to work it out !!

    Cheers Tony

    • physioblogger November 27, 2012 at 11:04 pm #

      Hi Tony…no worries, if giving the glute every chance to fire is taking the hip through large ranges of flexion, adduction and internal rotation you can disadvantage it by trying to get it to fire with only 2 of those motions…or maybe just one. For example, flexion, abduction and internal rotation…or flexion, adduction and external rotation. If you can train it to fire at a disadvantage it is more likely to fire when at a disadvantage in sports where you really need it to save your knee (for example).

      Hope that makes sense!!

      Thanks for reading,

      Neil

  5. Tony November 28, 2012 at 6:57 pm #

    Hi Neil that makes great sencse when you talk about disadvantage training a muscle !! I’m actually playing around with a process @ the moment to gain range in a joint/muscle – if I’m not getting the muscle to fully lengthen or the full joint motion I want I’ll then give the motion & lengthen in only one or 2 of the planes & then feed in all 3 planes later on !! I find this releases the muscle & gives range a lot easier !! Wheras Sometimes if I’m to aggressive & try to bang straight into the 3 planes it kind of back fires & is a lot more stubborn, giving no extra range !!
    Please let me know your thoughts??

    Cheers Tony

    • physioblogger November 28, 2012 at 7:13 pm #

      Great strategy and very well written,

      Keep up the good work,

      Neil

  6. ben July 3, 2013 at 5:52 am #

    nice post. What do you think abt Janda’s concept of muscles being inhibited? or other more recent journals that show that the glute med firing can be off secondary to ankle injuries.
    is there a way to let GMed be the dominant firer (pardon the bad English 😉 rather than TFL, QL, etc?
    thanks
    ben

    • physioblogger July 3, 2013 at 7:42 pm #

      I don’t think anyone can say for say for sure why things do or do not happen. I think the theories provide a framework for people to work within, which is no bad thing. I prefer to train the movement no the muscles, so everything I try to do is based on what I see in the movement. Hope that helps?

      Neil

  7. ben July 4, 2013 at 4:04 am #

    thanks for the reply Neil. Assuming someone has difficulty contracting glute med when doing a particular exercise, what would you do? eg. MET/PNF to reset the tone etc??

    • physioblogger July 4, 2013 at 8:02 am #

      I use the strategies I wrote about here. I would find a way to drive adduction through the hip, usually a same side hand driver over head if it’s appropriate, maybe add some ground reaction force, maybe with a sloped surface to increase eversion? I keep trying different things until I see the reaction I want.

      Neil

  8. mishie July 11, 2014 at 4:24 am #

    Hey.. Umm, i didn’t quite get the exercise u mentioned can u brief me up in simple terms ?

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