Signs of Glute Dysfunction and its Corrective Rehab

One of the most common injury presentations seen at Elite Health and Performance is “tight hamstrings and low back pain.” So often these hypertonic muscles are due to inhibited gluteus medius and gluteus minimus muscles, forcing the muscles above and below to overcompensate. As this muscle group is one of the largest and strongest in the body, dysfunction or gluteal injury can lead to a high risk of hip pain, lower back pain, or knee pain.

The two main reasons the gluteal muscles will show poor firing patterns are firstly that they are not being used, a common problem in prolonged sitting, and poor posture. The gluteus medius muscle, glute max, and piriformis muscle are rarely activated, leading to weak glutes and gluteal amnesia. The hamstrings are then chronically shortened as they are flexed in the seated position and adopt this tightened position.

Once chronically short, the hamstrings are overactive and begin doing the glute muscles’ job, creating dysfunctional movement patterns such as dead butt syndrome. The second issue leading to inhibited gluteal muscles is prior low back injury or gluteal tendinopathy. When injured, the body naturally creates muscle spasms to stabilise the hip joint.

When this occurs, the larger muscles overcompensate and again create dysfunctional movement patterns if physical therapy and rehabilitative exercises are not incorporated early into the treatment plan.

There are many warning signs indicating gluteal muscle inhibition, glute weakness, and muscle imbalance. Here we will describe a few.

Poor hip mobility and lateral hip pain – when there is dysfunction through the hip joint or a gluteus medius tear, the first action the body will take is to stabilise the area through muscle spasm, often involving the gluteal tendon or piriformis muscle. Many patients will constantly be stretching the area; however, without proper glute activation and physical therapy, there will never be lasting pain relief.

Anterior pelvic tilt and low back hyperlordosis (Sway back) – The hip flexors are the antagonist muscles of the glutes and glute max. Their job is to do the opposite of what the glute muscle group does. Therefore, if there is glute weakness or poor glute strength, there will be an imbalance in pelvic force, causing the pelvis to be pulled forward and reducing hip stability.

Low back pain – With anterior pelvic tilt the low back will be in a chronically shortened position and will be very tight. This tightness reduces the endurance of the muscles and can lead to excessive pressure through the lumbar discs. Tight glutes and gluteal strain can also contribute to this discomfort, necessitating targeted physical therapy.

Hamstring strains – The hamstrings will often be the lead hip extensor when the glute muscles are not activated properly. When running or creating strong contractions, the hamstring muscle will be under much more load than it is designed for, as it has to do the job of two muscles. This overload of force will create muscle strain and can lead to tears. This muscle imbalance is a hallmark of gluteal tendinopathy and piriformis syndrome. To fix this common movement fault, I have broken down the rehab into three phases.

Phase 1

The first exercise is glute bridges with a theraband wrapped around the knees. Perform 3 sets of 10 reps. Be sure to engage your glute muscles, especially the gluteus medius and glute max, to promote proper glute activation as you lift your body.

The second exercise is a side bridge, holding each side for 30 seconds for 3 sets per side, which helps strengthen the lateral hip muscles and improve hip stability. The third exercise is sideband walks, 10 steps each direction for 3 sets, targeting the gluteus medius muscle and helping combat weak glutes and gluteal amnesia.

Phase 2

First exercise is to drop one leg down about 20cm off the side of a box, focusing on keeping the pelvis level and stable to promote hip stability and target the gluteus medius muscle on the affected leg. Perform 3 sets of 10 reps per side. The second exercise is glute bridges with the theraband again, performing 3 sets of 10 reps to continue improving glute activation and strength.

Third exercise is the side bridge again, but this time adding clamshells for 3 sets of 10 reps each side, which helps strengthen the gluteal tendon and gluteus minimus. The fourth exercise is one-legged kettlebell deadlifts, 3 sets of 10 reps per side, to address muscle imbalance and build strong glutes while enhancing hip joint control.

Phase 3

First exercise is done in a plank position with one leg off the ground and the knee flexed to 90 degrees. Extend the hip, squeezing through the gluteus medius and glute max to activate the glute muscle group, performing 3 sets of 10 reps per side.

The second exercise is a side bridge with hip abduction for 3 sets of 10 reps per side, targeting the lateral hip muscles and improving hip stability. Third exercise is a one-legged glute bridge for 3 sets of 10 reps per side, focusing on glute strength and addressing any glute weakness or muscle imbalance.