Want to Prevent Knee and Low Back Pain. . .Try Starting with Gluteus Medius Strengthening

In gait, the hip abductors and extensors play a crucial role in trunk stabilization, as well as the transference of force from the lower extremities to the pelvis.   During single leg stance (60% of a typical gait cycle), the stance leg’s gluteus medius activates to control the contralateral pelvis, which tilts downward.  If there is a delay or inefficiency in the firing of the gluteus medius, increased forces are loaded through the knee as well as the low back due to incorrect loading through the pelvis (as well as a lateral thrust of the thorax to keep a center of gravity over the stance leg).  Because of the detrimental effects of gluteus medius weakness, keeping the hips strong is an important deterrant for knee and low back pain.

I typically strengthen the gluteus medius in both open and closed chain positions.  Here are some great closed-chain exercises to strengthen the gluteus medius which were featured in a 2010 article in Sports Med Arthrosc Rehabil Ther Technol.  They are listed in order of difficulty and level of gluteus medius activity (easy–>hard, least–>most activation).

1. Single leg wall squats (could also be performed on a total gym to reduce body weight if experiencing difficulty):  Have the patient lean their back against the wall and slowly lower the non-WBing heel towards the ground.  Hold the squat position for 5 seconds and return to neutral.  Have the patient control the stance limb such that it does not aB/aDduct.

2. Pelvic Drop:  The patient places the stance limb on a step and while maintaining knee extension in both knees, drops the other foot toward the ground.  The drop phase should be slow and controlled.

3.  Wall Press:  Have the patient stand with their one side against a wall.  The foot furthest from the wall will be their stance foot and foot against the wall will be off of the floor with the hip at 60deg and knee bent to 90deg.  The patients goal is to maintain single limb stance while pushing their knee and hip of non-WBing limb against the wall. They want to hold this isometric contraction for at least 5 seconds before rest.