Turn around Idris…
There’s a number of reasons why the likes of Idris Elba and Rachel Riley are amazing – but their awesome acting skills and mathematical genius aren’t the only reason they’re getting attention from the press and physios alike.
They were both winners in 2017’s ‘Rear of the Year’ competition. And although the competition is supposed to be a bit of fun, there’s a very serious reason why working on your behind is really important for your health to prevent conditions such as lower back pain, sciatica and knee pain.
Through my eyes as a physio, the Gluteal Muscles (your buttock muscles) are winners year after year. They are one of the most important features of the human body and their strength and control has enabled us from moving around on all fours to having the bipedal athletic prowess that separates humans from the rest of the ape species.
If we look back to the newborn child, the gluteal muscles start to develop straight away. Babies start to work the gluteals by kicking their legs out. They develop by pushing down with the heels to try to roll over and lifting the bottom off the floor. It’s the first sign that they’re trying to initiate movement and I can remember all of my kids getting frustrated as they arched their back away from the bed, desperate to roll over or look over their head to see what’s going on. It feeds their curiosity.
‘Tummy time’ is another important stage that helps gluteal development. Placing a baby on their front helps to develop strength in the legs, arms and tummy muscles. Once there, pushing up onto all fours should be encouraged to improve shoulder and hip strength.
The gluteals provide the power to maintain a position on all fours and start to crawl at what can often be described at lightning speed. For the majority of children, crawling develops the connection between the hips and shoulders to promote a strong link between the upper and lower body through the posterolateral sling system – a connection between the back of the shoulder via the latissimus dorsi, across the spine and into the gluteals on the opposite side.
Developing the posterolateral sling is an important feature of good shoulder and hip stability, especially when it comes to quality of movement and biomechanical pain later on in life.
As a parent, I was so keen to get our first child through the early stages of development. I thought it would be easier once they moved to the next stage – but with each small amount of progress, the chaos grew! They could reach more, grab more, pull more and stopped only to sleep!
So don’t be too keen to develop babies into toddlers. Starting to walk is not the only way a baby’s development should be praised. Enjoy the time they’re on their tummy and crawling. Encourage it often and they’ll develop much better strength and control that will provide great foundations for movement in later life.
Moving on to walking, the hip and the gluteal muscles play an important role in transferring the stability of the core into the lower limb to propel the body forwards. Without effective hip extension, driven by the gluteus maximus, the ability to progress walking into running is hindered.
And as we run, cycle, climb and crouch, the gluteal muscles enable us to generate power and force to propel the body and any load that we carry with it forwards and upwards, lifting us to greater levels of endurance and speed.
Gluteal Anatomy and Function
The Gluteal muscles are made up of 3 individual muscles that work together as a unit. Along with the other muscles around the lower back, hip, lower limb and shoulder girdle they generate power, provide control, promote endurance and improve posture.
The 3 muscles are:
- Gluteus Maximus
- Gluteus Medius
- Gluteus Minimus
Gluteus Maximus – The powerhouse of human movement
The outermost muscle is the Gluteus Maximus. (I know, it sounds like it should be from the Gladiator movie - remember Maximus Decimus Aurelius Gluteus Maximus???!!!)
It’s the largest muscle in the human body and plays a role in 3 of the 6 movements around the hip – the upper part abducts and laterally rotates the thigh, and the lower part extends and laterally rotates the thigh. It is supplied by the inferior gluteal nerve and from the nerve roots exiting the spine at the L5, S1 and S2 levels.
It is a muscle that is only used in forceful movements, such as running, climbing or standing up from a chair. But interestingly, it is not normally used in walking on a level surface.
This brings a host of problems when people try to progress from walking to running during a fitness programme.
If the gluteal muscles aren’t strong enough when you start to undertake more vigorous exercise routines, you might just find you develop pain and stiffness for a couple of days afterwards.
Gluteus Medius – Keeping your pelvis level
Moving down a layer beneath the gluteus maximus, lies the gluteus medius. It’s supplied by the superior gluteal nerve via the L4, L5 and S1 nerve roots in the spine and works to lift the thigh out to the side and turn the hip out – abduction and external rotation.
But it’s not actually working most efficiently when it lifts the leg to the side. The gluteus medius shows us a superb display of how a muscle controls movement, rather than generates it. It lengthens and shortens to keep the pelvis level when you stand onto your leg, rather than lifting the leg up to the side when you take the weight off it.
And here lies it’s main function – keeping the pelvis level when you’re walking and running.
And when you lose control of the pelvis, you can struggle with keeping the pelvis balanced and secure during both high and low levels of exertion.
Gluteus Minimus – the little sibling, but definitely no slouch
The deepest layer of the glutes and the smallest of the three muscles is the gluteus minimus. But it doesn’t mean it’s not a major player in hip activity.
It’s supplied by the same nerve and spinal nerve roots as gluteus medius – the superior gluteal nerve and L4, L5 and S1 nerve roots and has the same abduction action on the hip.
In many cases of lateral hip pain, runner’s knee and trochanteric bursitis, the gluteus minimus is tight and painful. We commonly call these areas trigger points, but they may also be known as knots, muscle spasm or myofascial trigger points.
Trigger points usually arises as a result of weakness, fatigue, overload or reduced control of a muscle. When the muscle struggles to keep the pelvis level, other structures star to become overloaded and can develop pain or inflammation to try and compensate.
Why focus on the glutes?
Hip pain can often start to when the gluteals are put under stress. If you’re reasonably active, stress could include an extra run a week, or a particularly hard legs day at the gym.
But for people not so active, extra load could be an uphill walk, or sitting on a wobbly chair at work for 8 hours a day.
If you’re suffering from osteoarthritis of the hip, exercise has consistently been shown to be the most effective form of treatment in managing symptoms of pain, stiffness and weakness. And the gluteals are the muscles that most commonly need attention.
Hip pain that’s associated with inflammation around the outside of the hip (trochanteric bursitis) can be really painful. Getting things back under control can be a major undertaking and take some time. But consistently working on the strength and flexibility of the hips can make significant improvements to your pain and function.
So what can I do to improve things?
Working on your glutes strength regularly will avoid problems when your hips get put under stress.
Your posture will also see a remarkable benefit. Combined with other postural exercises you can achieve a straighter spine and stronger abdominals.
Joint and muscle flexibility is also important to maintain good back, hip and knee health. Creaks and groans often won’t bring about any pain. But if the joint moves freely, your muscles won’t have to work so hard to generate the same movement as a stiff one.
Any good functional exercise, and the majority of sports, will involve the gluteals in some way.
Lunges, squats, rowing or climbing steps or stairs will give you a great workout. But if exercise is associated with pain, you should seek professional advice earlier rather than later to avoid any compensation strategies.
Depending on your activity levels, hobbies, sports and working positions, you’ll need a tailored programme that targets key areas at the right intensity. Too much load and you could aggravate symptoms, too little and you won’t notice any change.