Gluteus Medius Training

The purpose of this blog is to discuss the anatomy and function of the gluteus medius, demonstrate weight bearing and non weight bearing exercises and progressions, and provide the rationale behind the exercise selection, including any limitations.

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Gluteus Medius Anatomy & Function

The gluteus medius is a fan-shaped muscle that attaches from the lateral aspect of the pelvis to the greater trochanter of the femur and is comprised of 3 distinct parts – anterior, middle, and posterior. The gluteus medius, along with the tensor fascia latae and gluteus minimus, is innervated by the superior gluteal nerve (L4-S1).

All three aspects of this muscle act to abduct the hip, and of the primary hip abductors, the gluteus medius accounts for about 60% of the total cross sectional area. Additionally, the anterior portion serves as a secondary hip flexor and internal rotator, whereas the posterior portion acts as a hip extensor and external rotator. With the hip flexed to 90 degrees, all compartments contribute to hip internal rotation.

The gluteus medius is also well-known for its role in frontal plane stability during gait and single limb stance. Let’s reference a seesaw or teeter totter and imagine the femoral head as the fulcrum. Bodyweight sits on one side of that seesaw tipping the pelvis downward. On the other side, the hip abductors are pulling down on the pelvis to counteract the forces due to bodyweight to help maintain that frontal plane stability.

As I discuss the exercises, make sure to keep the anatomy and function in mind.

Gluteus Medius Non Weight Bearing Exercises and Progressions

The most well-known and often-used non weight bearing exercise for the gluteus medius is side lying hip abduction. Although it’s relatively easy to set up and execute, there are several cues that might help you maximize its effectiveness.

• Start on your side with the bottom hip and knee bent to increase your base of support.
• Your ankle should be in line with your shoulder so that your knee and hip are straight, or the ankle can be behind you to preposition the hip into extension.

To increase the activation of the gluteus medius, the hip should be slightly internally rotated.

To make sure that your pelvis doesn’t rotate back, you can either put an object behind you to serve as a tactile cue or perform the exercise against a wall. The wall has the added benefit of allowing you to slide your heel along it to maintain the sagittal plane position of the hip in neutral or extension.

• As you abduct your hip, you can think about your leg getting “longer” or reaching the bottom of your foot away from you so that you minimize the amount of trunk lateral flexion/side bend.

There are a several ways to progress the movement (in addition to adding more sets or reps):

• Add a cuff weight to the knee and then transition to the ankle as you get stronger.
• Place a band around your knees.
• Hold a weight at the thigh/knee.
• Increase the range of motion by performing the movement off a bench, box, or bed (not shown).
• You can perform standing hip abduction with resistance which will also challenge the standing limb.

I’ll give specific set and rep recommendations toward the end of the blog, but each exercise can be done isotonically or isometrically depending on your goals.

Gluteus Medius Weight Bearing Exercises and Progressions

Another similar weight bearing progression is the side plank which has been shown to elicit high activation of the gluteus medius. To make this even harder, you can do a side plank with hip abduction which further challenges the bottom leg.

If you’re really strong, add a weight around the ankle or band around the knees again.

Simple regressions include the short side plank and short side plank with hip abduction with or without added resistance.

For any of the side plank variations, keep the hips elevated and maintain a straight line from your shoulders to your ankles.

If you’d rather transition to standing exercises, the most common movement is probably some variation of a banded side step.

Few things to keep in mind:

• Perform the exercise in a squat position if possible.
• Keep your feet facing forward the entire time so that they don’t externally rotate (based on the research cited above).
• Don’t just focus on the moving limb because the stance limb hip abductors are actually working harder.

Now, research does show that band position influences the degree of gluteus medius activation with a band around the feet being the most effective.

However, I don’t solely base my recommendation on that data. Instead, I’m interested in the technique.

• Are you able to perform the exercise without a lateral trunk lean?
• Are you leading with your knees so that you aren’t moving into internal rotation of the hip?
• Are you keeping your feet facing forward?
• Is your head staying at relatively the same height so you’re not bobbing up and down?

I also want to know where you’re feeling the exercise. If a band around the knees allows you to maintain all of those technical cues and you’re feeling a burn in the glutes, I’d rather just increase the resistance of the band over time before moving it to the ankle or feet in most cases.

The last group of exercises includes anything that emphasizes single limb stance as they have been shown to elicit high activation of the gluteus medius such as a single leg squat or single leg deadlift. Even something like a reverse lunge with a weight in the opposite hand may be a viable option.

The possibilities are endless here. A few unique exercises:

• Single limb stance with a weight in the opposite hand while squeezing the glutes, keeping the pelvis level, and having the opposite hip flexed.
• Marching in place with a weight hanging from a belt.
• Or a physical therapy favorite – the “Captain Morgan” in which you’re standing on one leg with the opposite hip flexed while pushing into the wall with that leg and maintaining stability. The stance leg is working here.

Why Target the Gluteus Medius?

Why try to isolate the gluteus medius? Shouldn’t we be focusing on movements rather than muscles? For the most part – yes, I agree with that line of thinking. However, sometimes specific movements are required to maximize the adaptations of certain muscles.

For example, I did a video and wrote a blog on reverse nordics discussing how squats and leg presses don’t train the rectus femoris very well because they incorporate simultaneous hip and knee extension. Therefore, if you want to potentially reduce the risk of rectus femoris injuries or rehab from a rectus femoris injury, incorporating something like a reverse nordic is probably a good idea.

Not convinced? What if you want Arnold-like biceps? Okay, that’ll never happen. But what if you want bigger biceps? Will compound movements like seated rows and pull-ups be sufficient? Probably not. So just do isolated elbow flexion? Yes and no. Is your forearm pronated or supinated? Is your shoulder flexed or extended? Are you going through a full range of motion? The details matter.

Squats probably activate the calves quite a bit too, but no one would argue that they’re better than deficit heel raises at improving strength and hypertrophy. I’m beating a dead horse so you get the idea. I don’t overemphasize these concepts with patients, but I don’t completely dismiss them either like many people do. If you want to maximize the adaptations of the gluteus medius, you’ll likely need hip abduction specific exercises.

I think there’s generally four reasons why anyone aims to target a specific muscle (and I know you can’t isolate a muscle!):

1. Aesthetics – I think this one is pretty self explanatory. Who doesn’t want glutes that salute?
2. Rehabilitation – I wrote about this in-depth in the lateral hip pain blog, but individuals with certain diagnoses such as gluteal tendinopathy demonstrate hip abductor muscle weakness. Chicken or egg? I don’t know, but it can be a starting point for things to address.
3. Injury Prevention/Risk Reduction (whatever terminology you fancy) – I don’t know of any research that suggests that having a stronger gluteus medius is protective of injury, but the previous paper and prospective evidence that found greater hip adduction in healthy female runners who go on to develop patellofemoral pain might lead some to argue for the need to include hip abductor strengthening and motor control exercises into a comprehensive program.
4. Performance – Once again, I don’t know of any research that suggests that hip abductor specific strengthening improves performance, but an argument could be made for sports that require lateral maneuvers.

This isn’t an all-inclusive list or complete literature review because the purpose of this blog isn’t to sell you on gluteus medius strengthening. If you don’t want to do any of these exercises for the reasons listed, you’ll get no arguments from me. If you do, hopefully these tips help.

Summary & Practical Recommendations

As promised, here’s my summary and practical recommendations with sets and reps. If you train legs at least twice per week (which is ideal), you can incorporate one unilateral hinge or squat/lunge exercise per session. For example, Day 1 could be back squats and single leg deadlifts while Day 2 could be conventional deadlifts and reverse lunges (along with any hamstring, quad, or calf isolation work). Now, you’re going to have to take the rest of your programming into consideration, but 3-5 sets of 8-12 reps is a good starting point. For the hip abduction specific exercises, you could do them 1-3 times per week for 3-4 sets of 10-20 repetitions or 30-60 second holds. Isometrics can be a great choice because the hip abductors produce the most torque near that neutral hip position which coincidentally is where they most often function.

Limitations

Although the exercises are built on a solid understanding of anatomy and biomechanics, the main limitation with a lot of the research presented is that it’s based on EMG data. If you want to learn more about why that’s a limitation, listen to our podcast episode with Andrew Vigotsky who is much more knowledgeable than any of us on the topic. Find it on Spotify, iTunes, and iHeartRadio.