The Definitive Guide for Strengthening the Gluteus Medius for Hip and Back Pain.Sep 13, 2021
By now, we’ve all heard the common glute activation advice. Something like:
- “Back pain? Activate the glutes!”
- “Hip pain? Activate the glutes!”
- “World hunger? Activate the glutes!”
When it comes to activating the gluteus medius, the usual prescription is clamshells. Then more clamshells. Ok you did that for a few months, more clamshells!
But no matter how many clamshells you do, you see no difference in your pain. Not only is your pain not getting better, but you don’t even know if your gluteus medius is actually getting stronger. Or activating or whatever it’s supposed to be doing. It’s even possible that you might be….wasting your time?
The problem is not with clamshells. They are a popular exercise for good reason. They are an excellent exercise that work the gluteus medius in one of its main functions - external rotation. In fact, it’s one of the exercises (with some modifications) that I share in this article.
But the gluteus medius has other important functions as well. And if we ignore those other functions, we are only targeting a fraction of this muscle's potential.
Another problem with simple activation drills like clamshells is….well...they are a little too simple. Corrective exercise does not need to feel like a CrossFit class done in a hot yoga studio. But exercise is pointless if it doesn’t challenge us.
Activation drills may challenge us for some time. But eventually, we need to progress to more challenging strength exercises. This is the only way we will continue to see results in our gluteus medius strength. In this article, I'll show you how to do that.
This article is broken down into 4 sections. In section 1, I’ll explain the main functions of the Gluteus Medius. In section 2, I’ll help you determine which of these main functions you’re weakest in.
In section 3, I’ll provide exercises categorized by each function so you can focus on your weak points. And in section 4, I’ll discuss the connection between a weak Gluteus Medius and various joint pain issues. It’s time to do some glute med strengthening the smart way.
What are the main functions of the Gluteus Medius?
Before we start performing exercises, we must understand what the Gluteus Medius does. Why? Because strengthening and stretching exercises should mimic a muscle’s function.
For example, one of the main functions of the bicep is elbow flexion (i.e., bending the elbow). This is why we do barbell curls to strengthen our biceps. This seems obvious when we talk about our arms but oftentimes we forget this concept when we shift our attention to the hips.
Muscles have many functions. The Gluteus Medius is no exception. For the purposes of this article, we will only talk about the MAIN functions of the Gluteus Medius. If we examined every single function of this muscle, you'd be reading for a while.
So what are the main functions of the Gluteus Medius? There are 3 main functions that we need to be aware of:
(1) HIP ABDUCTION - bringing the leg out to the side.
(2) HIP EXTERNAL ROTATION - rotating the hip out to the side.
(3) HIP INTERNAL ROTATION - rotating the hip inward (with flexion).
Now that we understand what the Gluteus Medius does, let's find out where our weaknesses are.
Do you have a weak Gluteus Medius?
If we do believe our Gluteus Medius is weak, weak how? In which function of the muscle is it weak? Which primary movement of the Gluteus Medius are we weak in?
These are important questions. One person can have a Gluteus Medius that acts well in hip abduction but poorly in internal rotation. Another person can have great function in external rotation but not in hip abduction.
This is one reason people don't make progress in corrective exercise. They might be performing exercises that they don’t even need. This is why I push assessments so hard in my content. If we’re not assessing, we’re just guessing.
It doesn’t take very much time and you’ll know where your weak links are. Plus, many assessments are exercises too so you’ll be getting a headstart in your training!
Gluteus Medius Weakness Tests
I recommend testing the 3 main functions to see if we find any obvious signs of weaknesses. Here are some assessments that can get you started:
(1) Hip Abduction Assessment - Fire Hydrant
- Should be able to perform 6-8 reps with 3 second holds with relative ease.
- Pay attention to whether you shift too much bodyweight to the opposite hip. This is a sign of weakness.
- Pay attention to any signs of cramping, shakiness, extreme difficulty or muscular fatigue. These are all signs of weakness.
- Should be able to do 15-20 reps with relative ease.
- Pay attention to any signs of cramping, shakiness, extreme difficulty or muscular fatigue. These are all signs of weakness.
(3) Internal Rotation Assessment - Reverse Clamshell
- Should be able to perform 10-12 reps with relative ease.
- Pay attention to cramping, shakiness, extreme difficulty or muscular fatigue. These are all signs of weakness.
Now that we know our weaknesses, we can target exercises that improve those movements.
The 6 Best Exercises to Strengthen the Gluteus Medius
Below are exercises for the Gluteus Medius, categorized by movement function. You can experiment with each of them but I recommend focusing on the movements that you tested poorly in. This will give you the most ROI on your time and effort.
For each category, I've included a beginner exercise and an intermediate exercise. You can experiment with both but I'd recommend trying the beginner exercise first. If that feels easy after a week or two, you can progress to the intermediate exercise.
(1) Hip Abduction Exercises
SIDE-LYING LEG LIFTS (Beginner)
- Recommended Volume: 3-4 sets, 8-15 reps + 2 second holds. Start at low rep volume and increase as you get stronger.
- Pointing the toes down can be helpful.
- Do not allow pelvis or torso to move too much. The only body part moving is the upper leg.
PISSING DOG (Intermediate)
- Recommended Volume: 3 sets, 2-5 reps + 3 second holds. Start at low rep volume and increase as you get stronger.
- Drive stance hip into the yoga block to prevent pelvis shifting.
- Think activation first and increasing range later. No reason to fight for more range without feeling the Gluteus Medius activate.
(2) Hip External Rotation Exercises
CLAMSHELL ON WALL (Beginner)
- Recommended Volume: 3 sets, 12-20 reps. Start at low rep volume and increase as you get stronger.
- Set yourself up so ankles are aligned with knees, knees are aligned with hip and hips are aligned with shoulders.
- Try not to allow the low back to slouch. If you notice it is, cue a little bit of a low back arch.
- The rotation comes from the hip, not the pelvis. Keep the belly button pointing straight. A helpful cue with this is "imagine a tug of war being played between the target hip and the belly button."
- Recommended Volume: 3 sets, 15-45 second holds. Start with shorter holds and work yourself up to longer holds as you get stronger.
- The horse challenges external rotation of the hips but it also challenges abduction, adduction and internal rotation. It is a more advanced movement but it's a great way to start practicing more full-body movements that challenge the hips.
- Keep your legs as wide as comfortable. As you squat down, push your knees out to engage the glutes the best you can. This should engage not just your Gluteus Medius but also your Gluteus Maximus and Gluteus Minimis.
- Keep your spine neutral or even a little bit of an anterior tilt (low back arch).
(3) Hip Internal Rotation Exercises
SUPINE HIP COMPRESSIONS (Beginner)
- Recommended Training Volume - 3 sets, 3-6 reps, 5 second holds. This one is all about the hold. It's better to do less reps for longer holds than more reps for shorter holds.
- Try to keep the low back as neutral as possible (so not arching or slouching excessively).
- Use your hips to push the band out, not your feet or ankles.
SEATED KICK OUTS (Intermediate)
- Recommended Training Volume - 3 sets, 3-5 reps, 5 second holds. This one is all about the hold. It's better to do less reps for longer holds than more reps for shorter holds.
- If using band, use hips to push band out, not your feet or ankles.
- Don't let knees drop too low. Keep knees parallel with hips.
Now we have the tools to optimize the function and strength of our Gluteus Medius. This can help with pain for many people. Pain is complex though. And there are some considerations you should be aware of.
A Weak Gluteus Medius and Pain
As a corrective exercise specialist, I never tell anyone they are in pain because of a weak Gluteus Medius. This is outside of my scope as a personal trainer. But more importantly, I don’t think it’s common for any individual muscle to be the sole reason for a chronic pain pattern.
But clients tell me they are in pain because of a weak gluteus medius all the time. In their minds, this is the reason for their hip back, ql or whatever joint pain they are experiencing.
And I understand why. It makes it easier. If we can pinpoint that one muscle that is causing all this discomfort, the faster we can get out of pain. We can “fix” the Gluteus Medius with a couple of exercises and then go about living our lives. Unfortunately, these types of "magic pill" exercises usually don't exist.
And I’ve been there. It took me a long time to step away from this type of reductionist thinking. A wise mentor once told me, “pain is a person problem.” There are many ways to interpret that quote. Here is how I chose to. I believe most chronic joint pain is a result of 3 things.
(1) how the person moves their body;
(2) a person's emotional and psychological relationship to their pain pattern (i.e., obsessing over pain, fear of certain movement, etc.); or
(3) a combination of 1 and 2.
This article is only focusing on number 1. I plan on dedicating an entire article about number 2. Send me an email if you're interested and I'll push it up on the queue.
Let's dig a little deeper into how our movement can contribute to pain.
Gluteus Medius Pain
Some people will experience pain where the Gluteus Medius muscle actually is. This may lead people to believe that the problem is with the Gluteus Medius. More often than not, this is not the case.
Usually, this is self-diagnosed by people after they look up a muscle anatomy chart online. But within centimeters of the Gluteus Medius are other muscles, not to mention tendons, ligaments, cartilage, attachment points and many other anatomical structures.
I’m not saying the pain is coming from these other things either. I’m saying it’s just as easy to blame the pain pattern on any of these other normal parts of our body too. In another article, I discuss this phenomenon in detail for a similar issue people have with the TFL. It seems that recently, the TFL has taken the reins from the Glutes and is getting blamed for everything under the sun.
So what do you do with Gluteus Medius pain then? I recommend sticking to what you can identify objectively. Do the assessments for the Gluteus Medius and try the exercises in this article. If you find some weaknesses, focus on some targeted exercises for a few weeks to see how that goes.
Weak Gluteus Medius and Hip Pain
There is no denying that the Gluteus Medius plays a huge role in the hip joint’s function. In this tutorial that focused just on the Gluteus Medius, we were exposed to 3 of the 6 main hip movements. This shows how integral this muscle is for healthy hip function. But there are many other muscles that play major roles in how the hip functions as well.
Glute max, hamstrings, TFL, quads, hip flexors and many more work with and against the Gluteus Medius to ensure healthy function of the hips. And because the hips, along with the shoulders, are the most dynamic joints in the body, these muscles are capable of a lot.
I can do a tutorial for each of these different muscles and we would see a similar workload as the Gluteus Medius. So if you’re troubleshooting your hip pain, consider this Gluteus Medius tutorial as a template on how to navigate these other muscle groups. It’s a great first step but there is a lot more work to do!
Weak Gluteus Medius and Low back Pain
There was an epidemic in this world way before Covid-19 and that was low back pain. Low back pain is one of the leading causes for doctor visits in the US. It’s debilitating, frustrating and sometimes, completely paralyzing.
So are you in low back pain because of a weak gluteus medius? The answer is maybe. As we learned, the Gluteus Medius is a major contributor for healthy movement of the hips. And poor movement function of the hips can absolutely cause pain and discomfort in the low back.
The hips are meant to take on most of our daily movement demands, not our low back. Don’t get me wrong. We need the low back to flex, extend, stabilize and perform necessary functions as well. BUT, the hips and their incredible dynamic capacity are the star of the show for lower body movements.
Think of the hips like Michael Jordan and the low back like Scottie Pippen. Maybe Jordan is not as successful without Pippen. But Pippen without Jordan...exactly!
This is why a logical first step in troubleshooting someone's low back pain is to see what the hips are doing. I prefer to perform assessments focusing on hip movement versus hip muscles. I’m less concerned about how each hip muscle functions as opposed to how all the hip muscles work together to perform a certain hip movement.
But, if you have a sneaky suspicion that your Gluteus Medius is weak, then by all means, you can test the Gluteus Medius first. The assessments and exercises in this tutorial still apply. It doesn't matter if we're in hip pain or back pain. The Gluteus Medius functions the way it functions.
If you find a weakness, work on it for a couple of weeks or a month to see if it improves your symptoms. If you perform well on the assessments and exercises in this tutorial, you can conclude that a weak Gluteus Medius is likely not the cause for your pain pattern.
Conclusion - Assess the Gluteus Medius and Move On
This tutorial gives you more than enough information to start investigating the function of your Gluteus Medius. You are starting with a hypothesis that your Gluteus Medius is weak and responsible for your pain. This is definitely possible. But it’s unlikely that this is the ONLY reason you are in pain.
So test your hypothesis with the assessments in this tutorial and focus on the exercises that target your weak links. Then, move on to something else. Maybe you decide to start experimenting with other muscles like your hamstrings or quads. Or maybe you want to shift your attention to more full body dynamic movements like squatting or forward folds.
My point is that strengthening your Gluteus Medius is not the “magic fix” to your pain. It’s a stepping stone. It’s an opportunity to learn more about your body and how to troubleshoot certain muscles and movement patterns. I always advise clients to focus on their movement capacity and not their pain. And as their movement improves so does their pain.