ADVICE

Gluteus Maximus and Lower Back Pain

I’m reading a book* about buttocks. Yes, an entire book that talks about nothing but the importance of the correct functioning of the gluteal muscles. If that doesn’t get your attention, you might be interested to know that dysfunctional glutes can cause problems from low back pain to pain in the shoulders, knees and ankles.

Unfortunately, due to the disproportionate amount of time spent sitting, a surprisingly high number of people demonstrate lazy glutes. You don’t have to be inactive to suffer from lazy glutes either, proving that a daily run or high intensity workout can’t counteract 8-12 hours of sitting every day.

It’s safe to say that strong, muscular glutes aren’t just the latest celebrity body fad; their central position in the body and role in maintaining stability in the pelvic region make their correct function essential in preventing injury of more peripheral muscles and joints.

I want to talk more specifically about the role of the gluteus maximus (Gmax) in lower back pain. The Gmax, as the name suggests, is the largest of the glutes. In fact, the Gmax is the largest muscle in the body.

So, what does the Gmax do? Well, it has several functions, but its primary role is to extend the hip – that’s taking your leg backwards away from the central line of the body. Synergist muscles help the Gmax to perform this movement and in hip extension the synergists are the hamstrings and the erector spinae muscles of the lower back.

The Gmax, hamstrings and erector spinae need to contract in sequence to maintain balance and stability in hip extension whilst walking, running, climbing stairs etc. The correct muscle activation sequence begins with the contraction of the gluteus maximus, followed by the hamstrings (although either of these can contract first) and finally the erector spinae (contralateral – that’s the opposite side to the Gmax first, followed by the ipsilateral – the same side).

Weakness or inhibition of the Gmax causes an altered pattern of contraction in hip extension, where the muscle firing sequence changes as the synergists become dominant. The erector spinae begin contracting first to initiate hip extension and stabilize the pelvis. This leads them to become overactive, fatigued and hypertonic (with higher than desired tension in the muscle) causing an increase in load on the lumbar spine and lower back pain.

The hamstrings also begin to work harder to compensate for the inactivity of the Gmax, leading to their hypertonicity and tightness.

So, what causes a weak Gmax? There are several potential triggers: –

• Injury to the muscle
• Lack of use because of illness or injury limiting the activity of walking
• Overuse due to excessive repetitive motion
• Overactivity of antagonistic muscles (perform the opposite action)

Of these, the one I see most commonly is overactivity of the antagonist muscles. In the case of hip extension, the hip flexors are the antagonists and are responsible for bringing the knee up to the chest when standing or performing a sit-up from lying. Before you consider strengthening the glutes, you must first stretch out the hip flexors. See my article on hip flexors for more information on this.

So, how do you know if you’ve got weak glutes? Well, there’s a test rather brilliantly named “The Chair of Death”, which you can easily do at home.

First, stand in front of a chair with your feet under it and your knees just touching the seat. Put your arms out in front of you. Now squat down, trying not to let your knees push into the chair.

If the knees come forward to push into or even move the chair, you are initiating the squat movement with your quads, which puts unnecessary stress on the knees. The idea is to try to initiate the squat from the hips, so try sticking your bum out before trying to bend your knees – this will engage the Gmax.

OK, so now you know your glutes are weak, but before starting on strengthening them, you must stretch out the hip flexors. Then ensure you know how to engage your glutes in a contraction by the prone hip extension exercise, which is as follows: –

Lie on your front as in the diagram below and engage the glutes on one side before lifting that leg slowly off the ground, ensuring the glutes remain fully engaged until you have slowly lowered the leg back to the floor. Perform 2 sets of 10-15 reps on each leg.

John Gibbons has a useful clip on Youtube, which explains glute reactivation.

https://www.youtube.com/watch?v=PjcAKd1aCrE

And now you’re ready for the glute strengthening to begin! Here’s a great series of exercises suggested by Runners World.
http://www.runnersworld.com/wor…/glute-strengthening-workout

James Dunne, of Kinetic Revolution, has some good ideas for glute strengthening. They are aimed at runners, but are equally relevant to anyone with weak glutes.

https://www.youtube.com/watch?v=F265xoevqrY

*The book is “The Vital Glutes” by John Gibbons and opens with a fascinating example of how someone’s inactive right gluteus maximus caused debilitating pain in the left shoulder blade. Read it!