Gluteus Medius eccentric exercises

The gluteus medius , one of the three gluteal muscles, is a broad, thick, radiating muscle, situated on the outer surface of the pelvis.

File:Gluteus medius muscle - animation01.gif    File:Gluteus medius muscle - animation04.gif

Origin:

– outer surface of illium, between the posterior and anterior gluteal lines.

Inseration:

-lateral and superior surfaces of the greater trochanter of femur.

Action : on the tigh ( femur )

– abduction

– medial rotation

-lateral rotation

      

Gluteus medius strengthening

Gluteus medius eccentric loading exercise

The aim of this exercise is to work the tendon of the gluteus medius muscle on the outside of the hip in a very specific way. The tendon and muscle are worked whilst they are being lengthened, not while they are contracting.This is what eccentric loading means.

Stand squarely on the floor next to a wall good leg facing the wall.  ( see pic. 1)

Using your arms and your good leg, but not your bad leg, lift your pelvis up so that you are tipped over towards your bad side. On tip toes on your good side. ( see pic. 2)

Now lift you good leg off the floorbending at the knee. Slowly and gradually lower your pelvis so that you are tipped over to your good side stretching your bad side. Use only the muscles (gluteus medius) only your bad hip to control the decent. You can use your hands to steady yourself, but the idea is that your bad hip is taking all of your body weight as you tip over and gradually lowering you down as far as you can go. ( pic 3 )

Return to the start position using your good leg and arms, but not using your bad leg.   The bad side works only on the way down, not the way up.

Repeat 10 times and have a rest.

Aim for 3 sets of 10 exercises morning and evening, but be guided by your discomfort. It is normal to ‘feel’ the exercise, but it should not be really painful. If it is not to bad you can do more repetitions. If it is very uncomfortable you should do fewer repetitions.

Other exercises :

One leg squat : ( you can help yourself with a chair )

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Side-lying abduction

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Side plank abduction

This is reproduced from Boren et al. 2011 who did an excellent study and also compared their results with earlier work. Their top 3 exercises for Glute Medius were side plank abduction with dominant leg down, side plank abduction with dominant leg up and single leg squat (in that order). Notice again that these positions, despite being “non-functional” do create a lot of activity in Glute Medius and again more so than weight bearing positions such as single leg squat. Of note too is that they found less activity with side-lying abduction than the previous studies. This raises a good point with research and rehab. Nothing is concrete. You simply cannot say “this exercise has no role” as you will find evidence to support your claim and evidence to refute it. Also they used a slightly different technique which might account for the difference.

The Clam

Single Limb Squat

Front Plank

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Single leg balance- focus should be on maintaining a level pelvis without adducting the hip. Use support initially if needed. Aim for 10-15 seconds, repeat 5-10 times (stop if painful).

Running may need to be avoided or at least reduced during a reactive tendinopathy. This is the last thing you want as a runner but may be a necessity in early management of GT. The issue with tendinopathy is that if you continue to overload the tendon it can progress from a reactive tendon, to dysrepair and degeneration during which stages the tendon structure starts to change. Reactive changes are reversible but degeneration of the tendon generally isn’t. That doesn’t mean it can’t be managed it’s just better to prevent it happening in the first place!

In mild cases you may continue to run but try to ensure running remains pain free and there is no reaction for at least 24 hours after. Your Physio should guide you on continuing to run and/ or returning to running after rehab

Tips :

  • Try to find the exercises that best suit you and the ones that bast work for you.  If you find sidelying exercises are getting you results without causing symptoms then great. If not try some of the others above and see which ones seem to work your glutes and get results.
  • Try to do 3 sets of 10-15 reps with a 1-2 minute break between the sets.
  • Then progress up towards 20-25 repetitions, you’re aiming to fatigue the muscle so there will be lots of individual variation in the reps needed to do that. That said if you can do more than 30 reps without fatigue than try to find a harder exercise.

The best advice is to see a Physio who can assess you and provide appropriate exercises and help you perfect the technique.

Information and Pictures courtsey of :

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14 thoughts on “Gluteus Medius eccentric exercises

  1. Pingback: Eccentric loading for glute tendinosis | Gluteal Tendinosis Rehab

  2. Thank you for the article. I was seeing a physical therapist who was directing me to continue to load the tendon, until I ended up crying at night from the pain and couldn’t get out of bed. His approach made no sense to me, since if it’s an overuse injury, then wouldn’t you want to downgrade exercise to let it heal? This article supports my suspicion, and I’ve already changed physical therapists. The new one says to do what I can, but to listen to my body and downgrade if it hurts after the exercise is over.

    • hey,thank you for your message!
      i am really sorry for your experience.. it was wrong what he did…. u don´t have to do more than you can and when you do exercise you must not feel pain… when pain starts you need to take a break or even change exercises….
      hope you will get better soon and don´t force yourself.!!

    • Hello,i am happy it helped.
      I had a look a bit for iliopsoas bursitis…..
      It is most commonly the result of the following:

      Hip Pathology
      Rheumatoid Arthritis
      Osteoarthritis
      Recreational Injuries which require repeated hip flexing, such as
      Soccer
      Ballet
      Jumping Hurdles
      Martial Arts
      Infection of the bursa (which is rare)

      How is Iliopsoas Bursitis treated?

      Your APM physician will do a thorough evaluation, ask about your symptoms and examine the affected region.
      Treatmment may include:

      Rest and ice to the painful region
      Modification of activities—avoiding the activities that worsen symptoms
      Use of nonsteroidal anti-inflammatory drugs (NSAIDs)
      Use NSAIDs cautiously and for limited periods. Talk with your doctor about the NSAIDs you use.
      Use of a walking cane or crutches for a week or more when needed
      Physical Therapy
      Instruction on how to stretch your hip flexor and rotator muscles
      Corticosteroid injections with a local anesthetic.
      This is an injection into the bursa. Typically long lasting relief is achieved when combined with lifestyle changes. If pain and inflammation do return, another injection may be considered.
      If an infected bursa is suspected (a rare circumstance), fluid is removed from the sac for testing.

      please contact a doctor if u want to take pills.

      i will try to find some exercises for you …some streches…and i will post an article .

    • Here are some streches ….. try to see if they help…

      1.Straight Leg Raises
      Straight leg raises focus on strengthening the iliopsoas and quadriceps muscle in your thigh. To perform this exercise, lie down on your back and straighten your injured leg. Bend your opposite leg and place your foot flat on the ground. Contract the muscles in your thigh and slowly raise your leg up until it is level with your opposite thigh. Pause for a second and then lower it back down to the ground. Do 10 repetitions and then do the same on your opposite leg. To increase the difficulty of this exercise, try wrapping an ankle weight around your lower leg.

      2.Sitting Hip Flexion
      This exercise is also beneficial for strengthening the iliopsoas. Sit down on a table or chair. Bend your knee and slowly raise your right knee up as high as possible. Hold for a second and then lower your leg back down to the starting position. Do 10 repetitions. An ankle weight may be placed around your lower leg to make this exercise harder.

      3.Standing Resisted Hip Flexion
      Similar to the sitting hip flexion, this exercise also improves the strength of your iliopsoas. For this exercise you will need a rubber resistance band, which can be purchased from a sporting goods store or your physical therapist. Tie the ends of the band together to create a loop. Place the band in a door jam or around the leg of a table. Put your foot into the loop and stand with your body facing away from the band. The band should be looped around the front of your ankle. Contract your hip muscles and slowly pull your foot forward. Do three sets of 10 repetitions.

  3. Hi thanks for your article I have Gluteus medius tendinosis and bursitis of the greater trochanter of the same hip. Can I still do these exercises above? I have been overdoing my yoga practice which led to this? Can swimming help? Feeling so frustrated as not been able to do much yoga for about 3 months now and still no improvement..Also have achy pain in my tibialis anterior of the same leg which seems to be getting worse. Thanks so much for any advise you can give me…also been for a few ultrasound treatments.

    • Hello, sorry to answer late ,i just saw the message yesterday and i wanted to read a bit about your problem.
      I found out that ¨ Most often, there is no “cause” or acute trauma they have suffered before having the pain.¨
      ¨¨If a patient has greater trochanteric pain syndrome, typically they will try anti-inflammatories or Tylenol, and note some, but incomplete, pain relief with this. If the pain persists, one should see a physician. Physical examination testing and possibly X-rays can rule out other causes of lateral sided hip pain. If the diagnosis is confirmed, initial treatment consists of physical therapy for stretching the IT Band (a band of tissue running down the outside of the hip) and strengthening of the weak gluteal muscles. If this does not help, the physician may perform an ultrasound guided hip injection, to alleviate the pain, and help the patient progress with physical therapy.¨¨
      Did you see a physio? if so,what treatment did he/she give you?
      And yes, the exercises should help you but if u feel pain you should stop immediately ! Dont over do it!
      ¨¨ in summary, EET(eccentric exercises) is currently considered to be the most efficient treatment for tendinopathy, even though some studies are contradictory. Nevertheless, in order to be effective, this treatment needs specific modalities: slow speed, low intensity and gradual intensification, with minimum 20 to 30 sessions of exercises often being needed.¨
      You should defenitely try swimming too,it is suppose to relax you.
      Let me know please about the progress.
      Best wishes!

  4. U need a video or pictures on the first exercises instead of stick figure like drawings as I have no idea how to do it even with the instructions. Thanks.

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