Gluteal Amnesia

The purpose of this blog is to provide an overview of gluteal amnesia – what it is, its history, the claims around it, what the evidence actually says, and some strategies for concerns associated with it.

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What is Gluteal Amnesia?

Gluteal amnesia is a “condition” where the individual is believed to have lost the ability to contract their gluteal muscles – generally the gluteus maximus, though some report it as the gluteus medius. This can take many different names, such as “dead butt”, “sleeping glutes”, or glutes that are “turned off”.

Where Did The Concept Of Gluteal Amnesia Come From?

Vladimir Janda was a physician and physical therapist who had seen a pattern in patients he treated where they had an increased lumbar lordosis and anterior pelvic tilt, secondary to the pattern of muscle “imbalances” he believed to cause it, which he called a lower cross syndrome [1].

Stuart McGill is a biomechanist who began to specialize in back mechanics and treating patients with back pain. He found many of his patients showing a similar pattern as Janda had, coining the term “gluteal amnesia” in those with back troubles. This term was initially published in his book, “Low Back Disorders”, and quickly began getting utilized by his followers [2]. With many rehab & performance specialists utilizing the terminology, it was introduced to popular media and spread like wildfire being used in many top magazines, blogs, and news centers.

How Does Gluteal Amnesia Claim To Happen?

The original discussion of the term (McGill’s Book) does not reference an origin, just stating “From measuring groups of men with chronic back troubles during squatting types of tasks, it is clear that they try to accomplish this basic motion and motor pattern of hip extension emphasizing the back extensors and the hamstrings – they appear to have forgotten how to use the gluteal complex”.

From here, various hypotheses were created about what may be leading to this perceived concept of reduced gluteal usage – quantity of time spent sitting, tight hip flexors, and reciprocal inhibition from hip flexor dominance as being the main theories.

For each of the proposed concepts, it is believed that through either time spent sitting, having tight hip flexors, or reciprocal inhibition from the hip flexors, our glutes gradually lose the ability to contract.

In the case of the first argument where people point to high amount of time spent sitting, there are varying claims made for why this is problematic. Two of the main arguments are that sitting on the glutes leads to poor blood flow, ultimately leading to atrophy, and the other argument being that sitting causes the muscles to forget how to “turn on”.

The proposed idea of tight hip flexors argues that with the hip flexors being in a shortened position, which occurs when someone is in an anterior pelvic tilt, leads to the glutes being lengthened and unable to contract properly, causing “dysfunction” in the glutes.

Finally, the hypothesis around reciprocal inhibition is that the hip flexors are contracting frequently and cause reflexive relaxation of the gluteal muscles. The prior hypothesis focused on a length issue leading to issues, whereas this focuses on a contraction theory leading to neurological deficits.

Why Is Gluteal Amnesia Bad? What Are The Results Of It?

Gluteal amnesia is claimed to lead to a wide range of deficits and injuries, affecting three main areas: aesthetics, performance, and pain.

One of the most proclaimed results of “dead butt” is poor development of the glutes, leaving the person with a “saggy butt”. It’s theorized that due to inability to contract the glutes, they lose their shape and no longer maintain their lift and curvature. For some, this aesthetic aspect may be the first sign that he/she becomes concerned with. For others, issues with performance or pain may be what leads to learning about gluteal amnesia.

We see this “condition” blamed for a number of different faults, generally categorized in two areas – “poor” movement or “reduced” sensation/contractility. This is often proclaimed when an individual is performing an activity – such as a squat or jump – and presents with the knee(s) moving inwards (valgus) or when performing a movement involving hip extension – such as a deadlift or glute kickback – and extends their low back and not their hip. As well, if individuals perform these movements, or more simple ones – such as a glute bridge – and are unable to “feel” their glutes contract, this is a common claim for “dead butt syndrome.”

For many people, presenting with a wide range of conditions, generally involving the lower body, gluteal amnesia will often be identified as the cause, or contributor, for their pain. These conditions range from lateral ankle sprains to low back pain and are often stated as occurring due to poor glute activation.

What Does The Evidence Say About Gluteal Amnesia?

This terminology is relatively new and fairly unsubstantiated. When the term was first introduced by Prof. McGill, he did not have any evidence beyond experience and used post hoc reasoning [2].

Post hoc reasoning is where someone believes that when one thing follows another, the second must have been caused by the first. In this case, McGill would have people in back pain do glute exercises and these people improved. The assumption was that the people’s improvements were due to improvements in glute activation. This seems like a reasonable process of thinking, however our study of this line of reasoning has been shown it is usually flawed and does not consider many confounders (which we will discuss).

Since that time, research has been gradually building, with a large portion of the research using McGill’s book as their reference for supporting the notion that this condition exists – which was never justified or demonstrated with validity. However, there is still a plethora of research we can draw on to help guide us in understanding more on this topic.

For this topic, what really matters is: do the glutes lose ability to contract in general, what is the relevance of this for gluteal aesthetics, what is the impact of this for performance, and how does this affect pain?

Do The Glutes Lose The Ability To Contract?

Unless someone has experienced a significant injury leading to nerve damage, we do not lose the ability to contract our glutes. However, this does not mean people may lose the ability to feel the contraction, the ability to maximally contract them actively, the glutes could have atrophied, or a variety of other possibilities.

Freeman et al. 2013 completed a trial to examine if arthrogenic neuromuscular inhibition* caused reduced gluteal activation [3]. The summary of their study did show that those with induced arthrogenic neuromuscular inhibition had reduced EMG activity of the gluteal muscles during movements. This initially looks very supportive of the concept, but when we consider that this was an induced maneuver requiring the injection of radiopaque fluid to maximally distend the hip capsule, it’s not applicable to real life. As well, this study did not look at the ability of the individual to compensate over time as it was an acute intervention with one immediate follow up investigation.

*”Arthrogenic or neuromuscular inhibition is defined as continued reflex inhibition of musculature surrounding a joint following injury or joint effusion.” Freeman et al. 2013

If we contrast that with findings from Dwyer et al. 2013, where the group looked at individuals who have been living with hip osteoarthritis, which is not acute and these people would have time to accommodate it, we can see that this is not straightforward. The group found that when comparing those with hip OA to those without, those with hip OA had higher levels of gluteal activation during functional tasks. This higher activation was likely secondary to weakness and a compensatory strategy to accomplish the task with their given capacity [4].

If we look at the concept of the hip flexors leading to inhibition or limited usage of the glutes, this is quickly challenged from studies such as Van Gelder et al. 2015, Mills 2015, Heino 1990. In these studies we see that there is a poor relationship between hip flexor length, pelvic positioning, and gluteal activation [5,6,7].

Finally, there is no current study that demonstrates there is a link between reduced perfusion of blood and contraction ability in the gluteals. This idea is actually quite interesting given the current popularity of blood flow restriction for purposes of retention of muscle mass and hypertrophy. Given most people change positions often, which would accommodate a capillary refill if perfusion was reduced, it is unlikely that this is a plausible scenario.

In summary, we don’t know why people may lose this active perception and control, but something that should be considered is trying to optimize individual response to it and positioning for control.

It is unlikely that sitting directly leads to a reduced ability to utilize the gluteal complex, however with sitting typically comes a generally more sedentary lifestyle. For those who sit a lot, he/she also is unlikely to be performing challenging exercises which require usage of the gluteals. This likely leads to a cycle of inactivity, insufficient stimulus, atrophy, reduced perception, etc. In many cases, this may help explain why this sensory deficit coincides with other issues (such as pain as we will discuss later).

For other people, it may just be a learned response that over time the individuals were able to find a strategy to be successful with greater usage of other musculature (which some may call compensation). We do not have any strong literature demonstrating this is inherently an issue, though for those looking to maximize their gluteal development it is not optimal, and for many performance situations it is likely not ideal either.

Humans are highly variable and often do not all respond in the same way to the same stimulus. A great example here is the commonly used method for teaching people to feel their glutes. The most commonly used method is the prone bent knee hip extension, which can elicit a high contraction; however, this is not consistent and some may be better off with an alternative. Contreras et al. 2015 compared individual response to two different testing movements for glute activation through EMG – the standard prone bent knee hip extension and the “SQUEEZE” position [8].

In their study the authors saw a high variability between these movements for achieving high EMG ratings, which they concluded no single position is best for maximal contraction of the gluteal complex [8].

Worrell et al. 2001 tested subjects knee flexion and hip extension isometrics at varying hip angles while measuring MVIC (maximum voluntary contraction, essentially how hard the muscle could contract) for the gluteus maximus and hamstrings. Interestingly, while measuring the knee flexion isometric the researchers saw a highly variable contraction between participants from the glutes – seeing some have high levels of contractions and others with nearly none – which was theorized to be due to the individual strategies used by participants in stabilizing their hip to perform the task [9].

Lehecka et al. 2017 investigated the effect of knee angle on gluteal muscle activity for a single leg glute bridge using 5 different positions and demonstrated that using a higher knee bend (135*) than traditional (90*) had greater preferential activity of the glutes (greater glute:hamstring activity) overall. However, we still see a wide range of gluteal activity in different positions of the bridges and an individual’s ability to perceive it may be about finding which position provides them the best contraction [10].

These studies guide us that glute contraction is highly variable, highly unique to each person, and something that people will likely need to experiment with and focus on if that is of importance to them.

What Causes A Saggy Butt?

Aesthetics is a major concern for people and the persons aesthetics are also utilized in an attempt for diagnosis of poor muscle usage – saggy butt = poor usage of glutes. Due to these, it is valuable to consider what causes a saggy butt.

  • Genetics – Genetics are hard to challenge, some people will inherently have great gluteal development without having to work for it, whereas some people will have less development regardless of their efforts. With that said, it is safe to say that everyone (without a predisposing nerve condition) has the ability to make a significant impact on the gluteal development with consistent training devoted to it.
  • Exercise Selection – When we look at what many people do for gluteal work, this is an area where many mistakes are made.
  • Exercise Set Up – Looking at the prior section, there are many movements which have great capacity to help work the gluteal complex, but if we perform them in a way that reduces the gluteal usage, it has reduced benefit. A few examples:
    • Back squats with a more externally rotated foot placement show higher gluteal activity. If you are using a back squat to work the glutes, you should be having a more externally rotated foot stance.
    • Full squats show better growth than partial squats for gluteal development. Whether you are performing goblet squats, back squats, front squats, etc., if you are trying to grow your glutes, you should be performing as much range as you can control.
    • Hip Thrusts have been demonstrated to have a higher activation of the glutes when the feet are slightly wider and the person is actively attempting to rotate their feet outward (attempting, not actually) and ensures to have a posterior pelvic tilt.
    • Glute Bridges should be performed with 90* or greater knee flexion. A higher amount of knee flexion tends to emphasize gluteal contraction through minimizing hamstring contraction.

Exercise Parameters (these main factors are often not considered when looking at gluteal growth):

  • “Compound” vs “Isolation” – Compound movements of things like squats, deadlifts, and hip thrusts are likely more beneficial than isolation type movements like seated hip abductions, clamshells, etc. However, it is likely beneficial to have a mixture of both for maximal growth, with an emphasis on compound movements.
  •  Effort – In general, we see a strong trend that training closer to failure leads to higher amounts of muscular hypertrophy. We see that there is a “sweet spot” for most people where training at around 2-3 reps for proximity to failure (where the person would only be able to perform 2-3 more reps if it was absolutely necessary) leads to a sufficient level of effort for hypertrophy, but does not take away from the ability to keep repeating efforts for multiple sets. In contrast, lower effort tends to not provide as much benefit for hypertrophy, and higher effort tends to make repeatability difficult.
  •  Volume – This builds off the prior point and volume and effort are a balance – too high of volume requires less effort, and too high of effort restricts volume. For most people a range of sets between 3 and 9 for the glutes provides more than enough stimulus in one session.
  • Frequency – If you struggle with active control/perception, having a greater frequency of lower effort but highly contracting movements may provide high benefit. This treats the goal like a skill and we work on it as such.

Are Sleepy Glutes To Blame For Performance Issues?

When it comes to a variety of tasks, poor activation of the glutes are blamed. However, does this actually hold up in the research?

Knee valgus during squatting and jumping is a common movement that is claimed to be due to poor glute activation. To correct this, people will often utilize a band around the individual’s knees. Gooyers et al. 2012 and Foley et al. 2017 investigated this intervention and in each study the authors had individuals perform tasks with the band around their knees and progressively increase their challenge. The authors did find that the gluteal muscles did have greater activation, however there was not an increase in desired mechanics – which is contrary to the concept. This could suggest that the valgus effect noted during the movements is not due to poor activation of the gluteal muscle group [11,12].

Similarly, Zebis et al. 2016 conducted a study across 12 weeks, 3x/wk, focusing on neuromuscular control drills for at risk female athletes. At the end of their trial the group noted that there were no changes within the groups for valgus moment, valgus angle or knee and hip flexion angles. This suggests that during demanding tasks we are unlikely to be able to have a significant impact on the degree of valgus – at least with only a 12 week in length intervention [13].

Pohl et al. 2015 examined what would happen if they created a significant deficit to the glute medius (essential a nerve block) and then watched the individuals perform gait tasks. Interestingly, the individuals did not demonstrate a trendelenburg gait – which is classically associated with poor glute medius usage [14.]

From these studies we can see that glutes are not necessarily solely to be blamed for these common movement “faults” and there may be more going on than just poor activation of glutes.

Does Gluteal Amnesia Cause Pain?

People will often point to the glutes as the cause of various conditions. However, the research doesn’t necessarily agree that poor glute activation is the reason. When we look at those experiencing back pain, we see that many studies have shown increased activation of the back, gluteal, and hamstring musculature (Arab 2011, Kim 2014) [15,16]. Similarly, for athletes who have experienced hamstring strains, we see a greater activity of the gluteal musculature over hamstring musculature (Emami 2014) [17]. Further, with patellofemoral pain syndrome, gluteal strength has been an inconsistent factor for predisposing someone to it and is likely not what solely causes it (Thijs 2011) [18].

Pain is very complex and not the focus point of this article, with that said, it is entirely possible that performing gluteal based exercises may provide benefit to people in pain, but their pain is not due to poor gluteal activation.

Gluteal Amnesia Summary

Gluteal amnesia has gained a great deal of attention across the last decade, however it is not a true pathological diagnosis. For most people (anyone outside of a few instances), their glutes are able to contract and blaming an inability to contract as a cause of aesthetics, performance or pain is unlikely to be of benefit or accurate. In contrast, whether the person has an issue with aesthetics, performance, or pain, there is likely a range of possibilities as to why – anatomical structure, individual preference, historical volume, exercise technique, exercise consistency, etc.
In general, if we help individuals take time to adjust their movements to meet their unique anatomical structure, have them be consistent with performance of gluteal training, all people should be able to improve their ability to feel their gluteals contract and/or have greater development of the gluteals to their needs.

If you want to learn more, I highly recommend checking out our podcast episode with Dr. Bret Contreras:

Want to learn more? Check out our some of our other similar blogs:

Knee Valgus With Squats, Gluteus Medius Training, Hip Flexor Stretches

Thanks for reading. Check out the video and please leave any questions or comments below.

References

  1. Key J. The pelvic crossed syndromes: a reflection of imbalanced function in the myofascial envelope; a further exploration of Jand’s work J Bodywork & Movement. 2010;14:299-301.
  2. McGill S. (2007). Low back disorders: Evidence-based prevention and rehabilitation. Champaign, IL: Human Kinetics.
  3. Freeman S, Mascia A, McGill S. Arthrogenic neuromusculature inhibition: a foundational investigation of existence in the hip joint. Clin Biomech (Bristol Avon). 2013;28(2):171-177.
  4. Dwyer MK, Stafford K, Mattalcola CG, Uhl TL, Giordani M. Comparison of gluteus medius muscle activity during functional tasks in individuals with and without osteoarthritis of the hip joint. Clin Biomech (Bristol Avon). 2013;28(7):757-761.
  5. Van Gelder LH, Hoogenboom BJ, Alonzo B, Briggs D, Hatzel B. EMG analysis and sagittal plane kinematics of the two-handed and single-handed kettlebell swing: a descriptive study. Int J Sports Phys Ther. 2015;10(6):811-826.
  6. Mills M, Frank B, Goto S, Blackburn T, et al. Effect of restricted hip flexor muscle length on hip extensor muscle activity and lower extremity biomechanics in college-aged female soccer players. Int J Sports Phys Ther. 2015;10(7):946-954.
  7. Contreras B, Vigotsky AD, Schoenfeld BJ, Beardsley C, Cronin J. A comparison of two gluteus maximus EMG maximum voluntary isometric contraction positions. PeerJ. 2015;3e1261.
  8. Worrell TW, Karst G, Adamczyk D, Moore R, et al. Influence of joint position on electromyographic and torque generation during maximal voluntary isometric contractions of the hamstrings and gluteus maximus muscles. J Orthop Sports Phys Ther. 2001;31(12):730-740.
  9. Lehecka BJ, Edwards M, Haverkamp R, Martin L, et al. Building a better gluteal bridge: electromyographic analysis of hip muscle activity during modified single-leg bridges. Int J Sports Phys Ther. 2017;12(4):543-549.
  10. Gooyers CE, Beach TA, Frost DM, Callaghan JP. The influence of resistance bands on frontal plane knee mechanics during body-weight squat and vertical jump movements. Sports Biomech. 2012;11(3):391-401.
  11. Foley R, Bulbrook BD, Button DC, Holmes M. Effects of a band loop on lower extremity muscle activity and kinematics during the barbell squat. Int J Sports Phys Ther. 2017;12(4):550-559.
  12. Zebis MK, Andersen LL, Brandt M, Myklebust G, et al. Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes: a randomised controlled trial. Br J Sports Med. 2016;50(9):552-557.
  13. Pohl MB, Kendall KD, Patel C, Wiley JP, et al. Experimentally reduced hip-abductor muscle strength and frontal-plane biomechanics during walking. J Athl Train. 2015;50(4):385-391.
  14. Arab AM, Ghamkar L, Emami M, Nourbakhsh MR. Altered muscular activation during prone hip extension in women with and without low back pain. Chiropr Man Therap. 2011;19:18.
  15. Kim CY, Choi JD, Kim SY, Oh DW, et al. Comparison between muscle activation measured by electromyography and muscle thickness measured using ultrasonography for effective muscle assessment. J Electromyogr Kinesiol. 2014;24(5):614-620.
  16. Emami M, Arab AM, Ghamkhar L. The activity pattern of the lumbo-pelvic muscles during prone hip extension in athletes with and without hamstring strain injury. Int J Sports Phys Ther. 2014;9(3):312-319.
  17. Thijs Y, Pattyn E, Van Tiggelen D, Rombaut L, Witvrouw E. Is hip muscle weakness a predisposing factor for patellofemoral pain in female novice runners? A prospective study. Am J Sports Med. 2011;39(9):1877-1882.

2 Comments. Leave new

  • It has taken over a year to recover my glutes from literally years of amnesia despite avid aerobic exercise. I am a physician and my doctors are unaware of gluteal amnesia. Thank goodness for the internet and YouTube which provided education for my problem. I suspect unrecognized inadequate gluteal strength contributes to many orthopedic disorders. Gluteal amnesia is a real condition. Thanks for the blog.

    Reply
  • Thanks for the effort you make to sift through the relevant research and provide reliable information. It’s surprising how many exercise professionals pass on outdated theories as facts. It would be more intellectually honest to say “I don’t really know for sure, but you could try this – it seems to help some people. If it doesn’t help you, we can try this variation instead.”
    Please keep putting out your videos – they are always thought-provoking.

    Reply

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