Are your gluteals causing your lower back or hamstring pain?

The gluteal muscles are a group of three muscles which make up the buttocks: the gluteus maximus, gluteus medius and gluteus minimus. The three muscles originate from the ilium (hip), sacrum (lower part of your spine) and insert on the femur (top of the leg).

The gluteus maximus (bum muscle) is the strongest and biggest muscle of the body. The gluteus maximus is not only a  hip extender (taking the leg behind you), but helps with abduction of the hip (leg out to the side). It also plays an important role in pelvic and spinal stabilisation, alongside the gluteus medius and minimus with assisting hip rotation.

The Gluteus maximus links the lower spine to the upper leg and influences knee stability via the iliotibial band (ITB). It also has fascial connections to the latissimus dorsi muscle (a powerful muscle through the side of your back), therefore even effecting available movement in the arms and shoulder. The Gluteus maximus can have a significant influence on all aspects of the body, if it becomes weak and tight then this tightness may influence the shoulder and knee movements too.

Image: anatomy of the gluteal region. Source: Rochester Institute of Technology

 

The gluteus maximus role with stability:

  • Force closure of the sacroiliac joint

The gluteus maximus provides stability to the sacroiliac joint (SI joint) by bracing and compression. If the glutes are weak then it can cause excess movement at the SI joint, compromising the L5-S1 intervertebral joints and disc (typical disc of sciatic pain), which could lead to SI joint dysfunction and ongoing lower back pain.

  • Control and centralise the femur in the hip socket (acetabulum)

This joint is found where the ball-shaped head of the femur (thigh bone) fits into the socket, called the pelvic acetabulum. It is surrounded by articular cartilage and a labrum, or lip, made of fibrocartilage and dense connective tissue, this is to help hold the ‘ball in the socket’. The joint capsule is a thin, fluid-filled sac surrounding the joint, held by ligaments (flexible fibres that connect bone to bone). On top of that, the more superficial structures are many tendons (dense fiberous tissue that connect muscle to bone) and the surrounding muscles. All of these layers provide local stability of the hip joint, preventing hip hypermobility or injury. ¬†¬†

Gluteus maximus has an attachment point at the gluteal tuberosity of the femur, supporting femoral head & pelvis alignment especially through arising from a deep squat, walking up a steep hill or the push off phrase in sprinting, while gluteus minimus has attachments to the superior aspect of the capsule, supporting the contention that they are important stabilisers of the femoral head in the acetabulum.

Gluteus medius plays an important stabilising role of the pelvis on the hip by contracting prior to and after foot contact when walking or running, preventing adduction of the hip, supporting optimal positioning of the femoral head in the acetabulum during functional activities.

  • Co-contraction with psoas major provides pelvic stability, especially with movements like walking, running, stair climbing, but also effects lower body postural alignment.

When an anterior tilt is present (excessive lumbar lordosis, lower back curve) your gluteus and abdominal (core) muscles may also be weak. Tightness in the iliopsoas and rectus femoris (hip flexor) muscles combined with tightness in the erector spinae, multifidus and quadratus lumborum (back extensor) muscles produce the anterior tilt, typically resulting in ongoing back pain and inhibiting correct gluteal activation.

  • Segmental stabilisation of the vertebras:
    1. directly by tensing the thoraco-lumbar fascia
    2. indirectly by triggering the deep lumbar multifidus, especially during up right chain movements.

The gluteus maximus provides lower back stability through its connection with the erector spinae and thoraco-lumbar fascia Рallowing us to stand up right. The lumbar multifidus are predominantly composed of Type I slow twitch muscle fibres making them fatigue resistant, thus being ideal for postural control with their tonic muscle contraction allowing vertebral stability through the spine.

 

When the Hamstrings take over (wrong activation pattern):

The prone leg extension test is commonly used in the evaluation of lumbopelvic function, we test the activation or firing pattern of the glutes-hamstring-lower back. Commonly lower back complaints, or chronic injuries the firing pattern is off – with the hamstring’s dominating the movement and occasionally the lumbar paraspinals.

Poor movement patterns often lead to improper activation of the gluteal muscles. When the glutes are not helping perform the movement, a different muscle overcompensates- in this case it is typically the hamstrings or lumbar paraspinals (lower back).

This can be problematic because the gluteals are meant to act as a hip stabiliser and extensors. When they do not fire first, the gluteals do not stablise. The hamstrings attempt to act as both a prime mover and stabiliser, meaning long term you are more prone to ongoing hamstring niggles, tears or ongoing lower back pain.

 

What causes the glutes to misfire?
A few common causes are:

  • Disc injury

The gluteus maximus is supplied by the inferior gluteal nerve (L5, S1, S2) and the superior gluteal nerve (L4, L5, S1) supplies the gluteus medius, gluteus minimus and the Tensor Fascia Latae muscle. If the lower lumbar disc compression or the inflammation presses on the nerve, neural innovation can affect the activation of the glutes and also cause pain through the glutes and posterior leg.

  • History of lower back injury or pain
  • Poor posture (in particular anterior tilt)
  • Jobs that involve a lot of sitting (desk & computer work, truck drivers, taxi drivers etc) or inactive lifestyle
  • Ankle sprains (gait changes)
  • Foot/ arch pronation (collapsing or flat feet)
  • Incorrect weight training techniques

 

Image:  Nerve supply of the gluteal region, showing the location of the Superior and the Inferior Gluteal Nerve (source: memorang flash card)

 

What are the symptoms or problems of misfiring or weak glutes?

Weak or delayed activation of the gluteus maximus and gluteus medius is a root cause for many injuries and chronic pain. Such as:

  • Hamstring strains, especially reoccurring ones:

Due to delayed gluteus maximus activity, the hamstring muscles become dominant during hip extension, which can cause hamstring strains or tendinopathy.. Reoccurring hamstring injury patients are often mislead to strengthen their hamstrings, which is just reinforcing a compensation pattern instead of reactivating their inhibited glutes.

  • Low back pain:

Gluteus maximus activation plays an important role in stabilising the pelvis as explained above. Typically during lifting, if glutes are delayed in activating or poor posture occurs, the load will cause excessive compensation of the back extensors, resulting in lower back pain or facet joint injury.

  • Anterior knee pain:

The excessive internal rotation of the femur as a result of glute weakness increases the pressure on the patellar cartilage (especially if glute medius if weak), which can lead to knee valgus & patella tracking issues.

  • Anterior hip pain:

Decreased force production from the gluteus maximus during hip extension is associated with increased anterior translation of the femur in the acetabulum. The increased femoral anterior glide could lead to increased force and wear and tear on the anterior hip joint structures, potentially leading to conditions like a labral hip tear or the onsite of arthritic changes.

Gluteal weakness also has been associated with anterior cruciate ligament (ACL) sprains, chronic ankle instability, shin splints and iliotibial friction syndrome.

 

How can glutes be tight and weak at the same time?

When a muscle is weak the nervous system will try to find stability by tightening up or ‘slamming the brakes’ in that area to provide a solution for the lack of muscular strength. Our nerves help control muscle tension and allow muscle activation, if a muscle is weak or misfiring, to naturally protect itself through movement your nervous system will then substitute the lack of muscular strength with tension or other muscles will over compensate to find stability instead. ¬†If you feel like you have ongoing tight glutes, or through palpation they still feel switched on when resting, then a simple rule of thumb is that they are possibly also weak.

 

~ Written by & credit to Gemma Linnell (Myotherapist)

Do you have on going lower back pain? Or reoccurring hamstring injuries?
Then organise a treatment with us for pain relief and to get to the underlying issues.
Learn corrective exercises with us for gluteals activation and hip stability.

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References:

  • Brukner and Khan – Clinical sports medicine
  • Distefano LJ, Blackburn JT, Marshall SW, Padua DA, Gluteal muscle activation during common therapeutic exercises. J Orthop Sports Phys Ther.
  • Shirley Sahrmann, Diagnosis and treatment of movement impairment syndromes, Mosby, 2002.
  • Marzke MW, Longhill JM and Rasmussen SA (1988): Gluteus maximus muscle function and the origin of hominid bipedality. American Journal of Physical Anthropology
  • Travell & Simons’ – Myofascial pain and dysfunction
  • O’Rahilly, Muller, Carpenter & Swenson – Basic human anatomy
  • Stuart McGill – Low Back Disorders, Evidence base prevention and rehabilitation
  • Leinonen V, Kankaap√§√§ M, Airaksinen O and Hanninen O (2000): Back and hip extensor activities during trunk flexion/extension: effects of low back pain and rehabilitation. Archives of Physical Medical Rehabilitation
  • Vogt L, Pfeifer K and Banzer W (2003): Neuromuscular control of walking with chronic low-back pain. Manual Therapy
  • H. Retchford, K.M. Crossley, A. Grimaldi, J.L. Kemp, S.M. Cowan (2013): Can local muscles augment stability in the hip?

 

 

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