This is a question you made need to ask of your gluteals and core if you have hip or knee, or lower limb pain, or if you want to enhance your chances of avoiding injury in the future. We have put short videos together to show you how to perform some simple observations of your leg movement and determine whether you need to focus on gluteal strengthening. It will also show you whether your core strength / posture has an impact on your leg alignment.

Research (e.g. Fredericson and Barton et al,) now firmly points to strengthening and activating the gluteus medius and minimus as key part of the rehabilitation of knee pain such as patellofemoral pain (pain under the kneecap) or iliotibial band pain (ITB) at the outside of the knee.

Gluteus medius

Gluteus medius

The knee sits between the shin bone (tibia) and the thigh bone (femur) so factors that affect the alignment of either of these two bones and hence the knee joint need to be taken into account. Weakness in the gluteal area can cause the knee to excessively dip or rotate inwards which affects alignment at the knee joint.  It can also be a contributor to excessive pronation at the ankle which can lead to shin pain, Achilles issues, as well as pain felt behind the ankle bone on the outside of the foot. This video will give you an idea how to have a high level look at your leg alignment in the mirror and determine if there is a gluteal issue. It’s not foolproof and in the clinic it is usually accompanied by a lot of other tests to cross check findings.

Gluteal weakness can come from our alignment of our pelvis. The biggest factor impacting our alignment will be the posture we spend most of our day in. So if we work at a desk, our body will adapt to hold us in a seated position for 8-10 hours per day, plus time spent commuting, plus any time sitting down at home. The muscle adaptions that occur to facilitate a sitting down posture, or bending over posture if working at a bench etc, lead to changes in muscle tension all around the pelvis and lower back. They can also lead to some muscles “switching off or deactivating”. Then when we go to train or exercise, the muscles are not at their optimum alignment or may not be working correctly which can lead to injury. By looking at your posture you can determine if your core and muscle balance around the lower back and pelvis is not “optimal” possibly a contributor to injury. The video here shows how you can have a high level look at your posture.

While in the clinic gluteal strengthening helps with knee pain, we find it’s only one piece of the jigsaw. In the clinic we do a lot of testing to assess the muscle balance all around the pelvis. We find best results are found when gluteal strengthening and activation is combined with correcting muscular imbalances around the pelvis using a combination of specific muscle strengthening exercises, stretches, activation exercises and functional exercises.

Areas frequently in need of strength:

Transversus abdominus

Transversus abdominus

  • The transversus abdominus (TVA) – a functioning TVA has a large positive impact on lower back and pelvic posture, particularly the most common posture seen (anterior pelvic tilt). From our experience here in the clinic getting the TVA working is a major piece of the jigsaw when working on any leg, hip or back injury. It’s not as glamorous as the rectus abdominous (6 pack) and it can be hard for some people to figure out how to even engage the TVA. It can shock some clients who feel they have a strong core to discover how weak their TVA is
  • The obliques – they work with the gluteals to provide stability to the body
  • Activation and strengthening of the gluteus max – sometimes we find that once the body is in the correct posture the gluteus max will start to work correctly (activation part), and we generally provide exercises that strengthen and activate at the same time
  • The iliopsoas – this is one of the hip flexors  and is particularly active holding us in a seated position as it attaches from our back to our hip. It also helps to drive knee upwards when cycling or running. In some people the iliopsoas can be weak which means other hip flexors (e.g. rectus femoris, Sartorius) mainly located in the leg have to work harder. These hip flexors also help to extend the knee so as they tighten up due to the additional load which can put more pressure on the knee leading to pain.
  • Adductor – these are the inside thigh muscles which work in opposition to the gluteus medius and minimus. For proper alignment around the pelvis all muscles need to be in balance so any weakness observed in the adductors will also be addressed.

Areas often in need of flexibility:

  • External rotators / gluteal area
  • Hip flexors
  • Lower back
  • Hamstrings …….  Often stretching the hamstrings leads to no or very little improvement in flexibility. In many cases I find that hamstring tightness can be due to tightness in the lower back and gluteals, and if these areas are stretched out it leads to increased flexibility in the hamstrings – this is referred to a “neural hamstring”. A neural hamstring is where tightness along the nerve supply to the hamstring leads to increase tension in the hamstring. The nerve (sciatic nerve) passes from the lower back into the gluteals and then into the hamstring. So stretch the back and gluteals first and if your hamstring remains tight then try some stretching of the hamstring itself
  • Quads – in the case of knee pain
  • FOAM ROLL leg and back


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