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Illustration of the gluteus medius.

How to have a sexy butt and stay young – work the gluteus medius

The gluteus medius muscles keep your hips straight, give you balance, improve performance and prevent injuries in runners, and help you age gracefully

When people talk about a sexy butt they talk about lifting and toning up your gluteus maximus – the muscle that gives your rear end its main curvy (or not) shape. But the maximus in fact works together with the minimus and medius, the latter being a powerful muscle that’s often the key to ageing gracefully with a powerful gait, balance and motor control in the lower extremities, and improving athletic performance and injury reduction.

Yet, the average person’s daily lifestyle typically does little to strengthen the gluteus medius. The humble medius plays a critical role in pretty much everything we do. For runners in particular, strengthening the muscle is often critical for reducing hip and knee pain and injury, and improving endurance.

The gluteus medius.
The gluteus medius originates from the crest of the pelvis and inserts into the back of the thigh bone. When the leg is straight, the muscle abducts the thigh (i.e. pulls the thigh away from the midline). While walking, it stabilises the hip when the opposite leg is lifted off the ground. The gluteus medius also internally rotates the thigh when the hip is flexed; when the hip extends, it externally rotates the thigh.

To feel the muscles, stand with feet parallel about hip distance wide. Without actually moving your feet, push outward with your heels as if you were trying to stretch the carpet wider. The muscles tapering in the sides of your hips are your gluteus medius.

Notice the domino effect when these muscles are switched on: the foot arches and kneecaps lift, knees and thigh bones draw outward slightly, the pelvis tilts back slightly, and the pelvic floor and abdominals engage. Your spine also recalibrates the balance point of the head, and draws the chin back slightly, easing neck tension. In essence, you are no longer “sagging,” but are lifted upright. Impressive, right?

You probably now have a very good idea of what happens when the gluteus medius is weak: the opposite. This destabilised hip position makes all muscles work at unnatural angles.

Powerful gluteal muscles (left) maintain the position when standing on the left leg; weakness of the right gluteal muscles (Trendelenburg’s sign) results in pelvic tilt when standing on the right leg.
When the gluteus medius doesn’t function properly (in conjunction with the gluteus minimus), the condition is described as Trendelenburg’s sign. People with this condition experience a significant drop to one side of the pelvis as they walk. Think about a runway model’s “sashay” walk with excessive movement of the hips; this is a common gait pattern for those with weak gluteus medius.

The muscle is very important during the stance phase of the gait cycle as approximately three times the body weight is transmitted to the hip joint. The gluteus medius’ action absorbs approximately two-thirds of that body weight and stabilises the hips.

It’s important to maintain strong gluteus medius muscles.
As people age, if the gluteus medius isn’t kept strong and balanced, a person’s gait is reduced to a shuffle, with the feet close together (not under the hips); this is because the body is no longer able to handle a weight transfer from side to side. Many studies have found that older individuals should indeed undertake gluteus medius strength training and postural control exercises to maintain stability and balance in daily activities.

For athletes who spend many hours of running, this chain of misalignment wreaks havoc on the hips, knees, ankles and feet, often causing hip and knee problems, shin splints and tendonitis of the Achilles.

“Dead butt syndrome” is a term loosely coined by doctors and physios who regularly see injuries in runners. Technically termed gluteus medius tendinosis, it is an inflammation of the tendons in the gluteus medius, that can stop runners in their tracks with stabbing pains in the hip.

“A new thought in running medicine is that almost all lower extremity injuries, whether they involve your calf, your plantar fascia or your iliotibial band, are linked to the gluteus medius,” says Dr Darrin Bright, a sports medicine physician with Riverside Methodist Hospital in Columbus, Ohio, and medical director of that city’s marathon. “In the past five to 10 years, we’ve just realised how much of an important role the gluteus medius plays in stabilising the hips and the pelvis in running.”

Weak gluteus medius muscles can lead to injuries to the hips, knees and ankles.

Even for non-runners, if this is not corrected, there will be risks of structural overload to the lumbar spine, sacroiliac joint, hips and knees, causing excessive wear and tear on these joints.

Often neglected during workouts, the less the gluteus medius works, the more effort there is from the other surrounding muscles, thereby further weakening it. It’s a vicious cycle.

To strengthen it, an effective starting exercise is side-lying leg abduction with the shoulder and hips flush against the wall to provide alignment feedback. It can be done with resistance such as an ankle weight or stretch band, or in a forearm or full side plank. This exercise is for sheer muscle strengthening. .

The side lying hip abduction pose with muscles used highlighted.
Resisted lateral “monster steps” might come next; this involves a hip-wide stance with knees bent, a resistance band around the ankles and taking broad, side parallel steps against the resistance. It is imperative that the hips, knees and ankles stay aligned.

Moving into a more functional upright, weight-transfer environment however, probably offers the best solution. Position a low stool in front of you, and step up with the right leg. Swing the left leg forward as if you are about to take a step, then take the left leg back down to the floor. This must be done in front of a mirror for visual feedback of the hips (they should stay level), and knee and ankle (they should stay aligned under the hip and not roll internally). Repeat this exercise on both sides, until the hips, knees, and ankles unconsciously stay correctly aligned when taking the step.

Finally, the most challenging exercise is the single leg squat. Place the stool behind you. Extend the right leg out (it can stay low to the floor) lower your bum to the stool maintaining proper alignment through the left side, and stand up again. Repeat until fatigue or poor alignment sets in, then move to the other side. See if there is an imbalance in the fatigue point, and first, work towards evening out the strength on both sides, then begin to increase your reps evenly.

So, if you’re setting your workout programme for the new season, be sure to include gluteus medius training for balance and stability, to avoid injury, and to maintain a youthful stride for all your years to come.

This article appeared in the South China Morning Post print edition as: How strong glutes are key to the bottom line
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