Throughout my clinical internship here at Sports PT, a common theme continued to present itself: injured patients generally do not realize the importance of their hip muscles! While patients may even test strong in the gluteal muscles with traditional testing, functional movements, such as a squat, often demonstrate that the muscles do not turn on or activate when needed most. The two main muscles of the hip are the gluteus maximus and gluteus medius, and both of the gluteal muscles play an important role in preventing injuries to the legs and the low back. In regards to walking or running, weak or inactive gluteal muscles can eventually lead to patellofemoral pain syndrome (PFPS), a general term for knee pain.1 Likewise, weak or inactive gluteal muscles can predispose patients to ankle injuries due to decreased force absorption and redistribution by the muscles around the hip.2 Researchers even determined that inactive gluteal muscles are associated with increased hamstring muscle group cramping.3 Low back pain can also develop when the muscles around the hips are not strong and stable because of the overcompensation that must occur from the low back muscles.
Research shows that a reflex mechanism resulting from tightness in the ligaments that surround the hip sends a signal that causes the gluteal muscles to shut down.4,5 This tightness commonly occurs when patients are not moving as much or change their normal movement patterns due to pain. While physical therapists can prescribe exercises intended to train the activation of the gluteal muscles, researchers demonstrated that a manual pressure down into the hip can actually reverse the reflex mechanism and additionally assist in activating the muscle group.4,5 Yerys et al. determined that the use of a hands-on mobilization to the front of the hip joint could increase the maximal force output of hip extension by 14% in patients immediately after receiving treatment.4 Makofsky et al. similarly determined that the use of a hands-on mobilization to the bottom of the hip joint could increase the maximal force output of hip abduction by 17% in patients 15 minutes after receiving treatment.5 If you are scheduled for a physical therapy examination for pain anywhere from your low back down to your feet, you should expect a physical therapist to assess gluteal muscle strength and activation due to all of the potential benefits associated with hip strength and stability. Treatment will likely include mobilizations to get the hip muscles active again, showing the benefit of hands-on treatment from your PT. The glutes hold the key to less pain!
References:
- Fukuda T, Rossetto F, Magalhã E, Bryk F, Lucareli P, Carvalho N. Short-term effects of hip abductors and lateral rotators strengthening in females with patellofemoral pain syndrome: A randomized controlled clinical trial. J Orthop Sports Phys Ther. 2010;40(11):736-742. doi:10.2519/jospt.2010.3246.
- Hughes P, Hsu Jim, Matava M. Hip anatomy and biomechanics in the athlete. Sports Med Arthro Rev. 2002;10(2):103.114. doi:10.1097/01.JSA.0000017305.66476.DA.
- Wagner T, Behnia N, Ancheta W, Shen R, Farrokhi S, Powers C. Strengthening and neuromuscular reeducation of the gluteus maximus in a tirathlete with exercise-associated cramping of the hamstrings. J Orthop Sports Phys Ther. 2010;40(2):112-119. doi:10.2159/jospt.2010.3110.
- Yerys S, Makofsky H, Byrd C, Pennachio J, Cinkay J. Effect of mobilization of the anterior hip capsule on gluteus maximus strength. J Manual Manipulative Ther. 2002;10(4):218-224 7p. pmid:19066650.
- Makofsky H, Panicker S, Sileo R, et al. Immediate Effect of Grade IV Inferior Hip Joint Mobilization on Hip Abductor Torque: A Pilot Study. J Manual Manipulative Ther. 2007;15(2):103-110. an:106704406.