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, 14 (4), 655-669

ASSESSING AND TREATING GLUTEUS MAXIMUS WEAKNESS - A CLINICAL COMMENTARY

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ASSESSING AND TREATING GLUTEUS MAXIMUS WEAKNESS - A CLINICAL COMMENTARY

Matthew Buckthorpe et al. Int J Sports Phys Ther.

Abstract

The Gluteus Maximus (GM) muscle is the largest and most powerful in the human body. It plays an important role in optimal functioning of the human movement system as well as athletic performance. It is however, prone to inhibition and weakness which contributes to chronic pain, injury and athletic under-performance. As such, understanding how to assess and treat GM dysfunction is an important aspect of sports science and medicine, as it has relevance for injury prevention, rehabilitation and performance enhancement. Despite GMs considerable importance there is little research attempting to translate evidence into practice to support practitioners when faced with 'sleepy glutes'. This clinical commentary discusses the importance of GM for athletic performance and injury risk; factors which contribute to GM dysfunction and then provides evidenced informed approaches to assess and treat GM dysfunction. This can be used as part of rehabilitation or injury prevention practices as well as athletic performance training.

Level of evidence: 5.

Keywords: Gluteus maximus; movement system; muscle imbalances; performance training; rehabilitation.

Conflict of interest statement

There were no funding sources for the paper. The authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.
Qualitative assessment of movement patterns can allow for indication of specific muscle function. The femoral internal rotation and adduction (1a), and so medial knee displacement (1b) may indicate insufficient function of gluteal muscles, presented here by two young male athletes during a jumping and a deceleration task.
Figure 2.
Figure 2.
Example of some local and global core stability exercises which should be included as part of the holistic programme, including single leg bridge with trunk on swiss ball (2a); front plank (2b); side plank (2c) and alternating leg lifts whilst stabilising trunk and pelvis on long foam roller (2d).
Figure 3.
Figure 3.
Examples of functional weight bearing exercises to train gluteus maximus. The appropriate technique is crucial to load the whole kinetic chain. Exercises included bilateral squat (3a), single leg Romanian deadlift (3b), single leg squat (3c), split squat/lunge (3d), frontal step up (3e), lateral step up (3f). Each exercise can be loaded with additional weight to provide the necessary loading to develop strength.
Figure 4.
Figure 4.
An example of a knee/quadriceps dominant movement strategy with upright trunk, resulting in greater knee load. This is most commonly associated with the knee excessively positioned anterior to toes (4a). An optimal movement strategy balancing hip and knee contributions, with the knee slightly but not excessively over the toe and similar hip and knee flexions (4b).
Figure 5.
Figure 5.
Use of real-time feedback for motor patterning technique on the sagittal plane using a system of high-speed cameras. Use of video-analysis techniques can facilitate different forms of feedback (from real time to delayed feedback) to the patient as part of movement education, as well as assessing motor performance.
Figure 6.
Figure 6.
Example exercises of using a band during a bilateral squat (6a) or cable around the knee during a split squat (6b). The added resistance will force increased activation of gluteal muscles to prevent adduction and/or internal rotation of the femur. It also acts as a cue to train control of the limb and avoidance of dynamic knee valgus in functional movement tasks.
Figure 7.
Figure 7.
Example of specific exercises. Double leg squat with one arm overhead resistance (7a) single leg Romanian deadlift with weight in opposite had to the stance limb (7b). The exercise challenges the rotation and load transfer requirements of the task and also challenges gluteus maximus as part of the posterior oblique system.
Figure 8.
Figure 8.
Non-weight bearing exercises for the gluteus maximus muscle including clam (8a), side leg raise in hip extension (8b), single leg bridge (8c), bilateral glute bridge (8d), side plank with abduction (8e), bird dog exercise (8f).
Figure 9.
Figure 9.
Simple model of GM treatment strategy, beginning with a thorough assessment, tailored corrective programme followed by motor pattern retraining to re-integrate GM into normal function and then training to optimise GM function in sport-specific tasks.

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