Gluteal Amnesia V - Prevention Practices and Exercises
Updated: Feb 5, 2021
Hey Readers! I am so thankful you are here! This is the fifth, and final, part of my gluteal amnesia series. In this installment, I will go over various ways to try to prevent the onset of gluteal amnesia. I will warn ya, this post is a little long, but the info is super helpful, so try to hang on with me until the end. As stated many times throughout this series, none of this information is intended to replace the advice of a licensed doctor. If you think you have gluteal amnesia, you really should see a physical therapist, orthopedist, or sports medicine doctor, as those professionals can diagnose and treat active cases of gluteal amnesia. The information presented in this blog post is meant to serve as a prevention, not as a cure or treatment.
In this series we have discussed gluteal amnesia in depth. Part I (click here) explored the anatomy of the gluteal complex. Part II (click here) explained gluteal amnesia in greater depth along with the potential neuromuscular implications therein. Part III (click here) discussed the muscular biology of gluteal amnesia as it relates to muscle atrophy. Part IV (click here) reviewed the neurobiology of gluteal amnesia. In this blog post, I will go over various lifestyle changes, strengthening exercises, and stretches that you should do regularly in order to hopefully prevent gluteal amnesia from occurring in your body. In general, there are four areas that should be targeted for optimal glute functioning:
Changes to daily movement habits
Direct strengthening exercises for the glutes
Core stabilization and strengthening exercises
Stretches for the hip flexors
Change Your Daily Movement Habits
One of the best, and easiest, ways to prevent gluteal amnesia is to simply move your body more throughout the day. This is especially important if you sit a lot during the day for work or other lifestyle-related reasons. As we have discussed quite a bit in this series, your neuromuscular system is very efficient, and it will generally only maintain connections that it “thinks” you use regularly. Thus, if you sit for most of your day, your body will adapt by becoming really good at sitting. However, if you incorporate more movement into your day, your body will adapt accordingly by getting better at movement. Humans are not biologically wired to be sedentary. Rather, we are genetically programmed to move our bodies for most of the day.
So, what are some simple ways to get in a little extra movement during the day? Take short walks throughout your day. It is generally accepted that getting up every 20 minutes to move around is really helpful for the functioning of your glutes (and to be honest, the rest of your body as well). Instead of using “downtime” at work to get lost on social media, take those few free minutes and move around. Do a few jumping jacks. Walk around your place of work or the parking lot where you work. When you are out running errands, park a little further from the entrance so you have to walk a little more. You could take the stairs instead of the elevator or escalator. It doesn’t have to be fancy or planned out; just get up and move. As the saying goes, “movement is medicine.”
Also, consider doing your dedicated workout at the beginning of the day. Oftentimes, by the end of the day, we are fatigued and exhausted from work, driving kids around, running errands, etc. And that can make it really challenging to find the time, and energy, to workout in the evening. Doing your workout in the morning can really help you to have more energy and better focus during the work day. Additionally, research has shown that physical activity prior to prolonged periods of muscle unloading or disuse (e.g. sitting for a while) might protect your skeletal muscles from atrophy. And, if that isn’t enough to convince you, research has shown that early morning workouts tend to lead to higher metabolic rates during the day, which is great for weight loss.
In addition to potentially preventing gluteal amnesia, movement helps to circulate your lymphatic fluid (i.e. the fluid portion of your immune system). Indeed, the only way lymph moves around your body is via skeletal muscle contraction. When you contract your skeletal muscles, it literally pushes lymph around your body. This helps to circulate immune cells (old and new) to the right places in your body. Also, the extra movement gives you a little extra cardiorespiratory work (click here to read more about cardiorespiratory training). And, the increased work from the heart helps to circulate more blood around your body, bringing fresh nutrients to your working cells and retrieving waste products from those same cells.
Direct Strengthening Exercises for the Glutes
In addition to moving your body regularly throughout the day, there are direct exercises you can do that specifically target the gluteal musculature. These exercises can be broken into non-weight bearing exercises (NWB) and weight-bearing exercises (WB).
Non-Weight Bearing Exercises (NWB). NWB exercises are exercises in which you are not supporting your own body weight. Typically, these exercises are performed on the ground, from a side-lying, prone (i.e. face down), or supine (i.e. face up) position, and they are generally considered to be a little easier than WB exercise since the challenge of being upright is removed. NWB exercises are great for anyone, and they are especially good for people who are in pain, are brand new to exercise, and/or have limited strength capacity. NWB exercises are very effective in improving gluteal muscle activity and strength, without needing additional tools, devices, or equipment. The most common NWB for the gluteal muscles include bridge lifts and side-lying leg abduction.
Bridge lifts are one of the most common NWB exercise that targets the gluteal muscles. In fact, many rehab professionals often recommend supine bridge lifts to target weakened GMax muscles. The main movement happening at the hip during the bridge exercise is hip extension, in which the GMax is the main muscle responsible for that action. The bilateral bridge lift is probably the most common variety of the bridging exercise, but the single-leg bridge is also used to strengthen the glutes. Another variety of the bridge exercise is to lift one, or both, heels off the ground when your hips reach the top. Electromyographic (EMG) studies have shown that GMax activation is greater when lifting your heels at the top of the bridge lift compared to leaving your heels flat on the ground.
Side-lying leg abduction exercises are another common NWB exercise that targets the gluteal muscles. These NWB exercises are great at helping to also target the GMed and GMin since these muscles are partly responsible for hip abduction (i.e. moving your hip away from the midline of your body). To perform this exercise, lie on your side and either lift your top leg from a straight-leg position, or bend your knees, and lift the top knee up (this is sometimes referred to as the “clam” exercise). I actually really like these exercises a lot, and to be honest, these exercises sort of remind me of the old exercise VHS tapes that my mom used to use (Buns of Steel, anyone? Haha!). Even though they may look a little silly, they are fabulous for targeting the glute muscles, especially GMed and GMin.
Weight Bearing Exercises (WB). WB exercises involve movements in which you are supporting your body weight in some way. Typically WB exercises are performed from a kneeling or standing position. In general, WB exercises are a little more challenging than NWB exercises. WB exercises are typically appropriate for people who are not experiencing pain, are more familiar with exercise, and/or have an adequate foundation of strength. Common WB exercises that target the gluteal muscles include single-leg balance exercises, squats, deadlifts, lunges, step-ups, and plyometric exercises. You can use your own body weight as the resistance in the aforementioned exercises, or you can add external resistance via free weights, ankle weights, etc. If you add external resistance to these exercises, make sure you add the “just right” load. If you add too much weight, your body might compensate by recruiting the wrong muscles to achieve the motor pattern, and that is contrary to the whole point of these exercises.
Single-leg balance exercises include a huge variety of exemplars. All balancing yoga poses (e.g. dancer’s pose, eagle pose, tree pose, etc.) are great for building strength and stability in your glute muscles. Recall, one of the jobs of the glutes is to stabilize your pelvis when standing, walking, and balancing. Thus, pretty much any exercise where you balance on one leg is good for strengthening the glutes. In the image below, the glutes on my standing leg are contracting to help stabilize my pelvis, and the glutes of my lifted leg are working to help extend my hip.
In a squat (see image below), your glute muscles quite literally work the entire span of the exercise. The glutes eccentrically contract (i.e. create tension as they lengthen) as you lower your hips, and they concentrically contract (i.e. create tension as they shorten) to extend your hips as you rise to standing. There are like a gazillion variations to the traditional squat, way more than I can describe here. For example, you can lift your arms over head, interlace your fingers behind your head, OR keep your hands together at your heart-center. Additionally, you can do a single-leg squat (which is typically much harder than a bilateral squat), add little pulses up/down at the bottom of your squat, OR play with balance by lifting one leg up as you rise up from the squat.
Deadlifts are considered a more advanced strengthening exercise for the glutes. In a deadlift, you hinge from the hip (so go into hip flexion) and reach for the ground (you could reach for a weighted object if adding external resistance). Then, you stand back up, extending through the hips by contracting your glute muscles. Do NOT use your lower back to lift your torso up. Deadlifts are primarily a glute exercise. If you feel discomfort in your low back, regress the exercise in some way (e.g. lose the external resistance, do not bend as far over, etc.).
Lunges are also great for building strength in the glute muscles. As with any exercise, there are many ways that you can vary up the traditional lunge. For instance, you can add variety to your lunges by moving in different planes of motion, such as lunging forward or backward, sideways, or even rotating into the lunge. You can even add variety to your lunge by stepping your back leg up to balance. You could even add a little twist with your core muscles while in the lunge (as pictured below).
The step-up exercise uses some type of a platform or step that you step-up to, hence the name. In general, the step-up exercise, and all of its variations, have shown to be great at eliciting high levels of GMax activation. During a step-up exercise, the GMax is responsible for extending the hip joint while simultaneously maintaining the pelvis level, controlling for excessive hip adduction and internal rotation. These exercises can be difficult to perform and require a lot of stabilization from the lumbo-pelvic hip complex (LPHC). The step-up exercises may not be advised for beginning exercisers.
Plyometric exercises and agility drills can also train the gluteal muscles, and include sprint running, jumping, ladder drills, and cone drills. However, these exercises are definitely more advanced forms of exercise and should only be completed if the glutes have sufficient strength and neuromuscular efficiency.
Strengthen and Stabilize Core Muscles
Your core is your center of gravity and the foundation from which all movements in the body originate. When your core is strong and stable, the rest of your body can move safely and efficiently. However, when your core is weak and/or unstable, it can cause dysfunctional movement elsewhere in the body, including the glutes. Thus, to ensure the best possible activity of the gluteal muscles, it is highly recommended to regularly engage in exercises that stabilize and strengthen the core musculature (e.g. abdominals, low back, etc.).
Core stability exercises are numerous, far more than I could list here. Some core exercises that I really like are stability ball core work, planks, and spinal balance.
Doing core work from a stability ball adds a good deal of instability to the exercises, causing you to engage your deep, core stabilizing muscles (e.g. transverse abdominis) to keep you on the ball. You could pretty much adapt any floor exercise to a stability ball to increase the stabilization function of your core muscles. For example, you could do abdominal crunches on the stability ball. You could do a prone cobra or locust pose on a stability ball. Even just sitting on a stability ball while watching TV or working on your computer is great for improving the stability of your core muscles. If you do not own a stability ball, I highly recommend that you get one for your home use, as this tool is an excellent one to have for your workouts.
Plank poses are also fabulous for building stability and strength in your core muscles. There are many variations to the plank pose. You can do a traditional plank either from straight arms (which is generally easier on the core, but more challenging for the wrists and shoulders) or on your forearms (which is generally harder for the core, but less challenging for wrists and shoulders). You can modify the plank and put your knees down or place your hands on a bench or the wall. You can turn your plank to the side, taking a side-plank pose. Here again, you can do a straight-arm side-plank or a forearm side-plank. You can also play with hip abduction from a side-plank position, which gives your glute muscles, especially GMed and GMin, a little extra bonus work. I’ll be honest, planks, in any variety, are TOUGH! But, they are also really effective at helping to stabilize your core and spine.
Spinal balance, sometimes referred to as “bird dog,” is performed from hands-and-knees position and involves reaching one arm straight forward and the contralateral (i.e. opposite side) leg straight back behind you. From this position, you can simply just hold your arm and opposite leg reaching in opposite directions. Or, you could add some movement, such as bringing your elbow and opposite knee to tap under your belly. You could also play with lifting the back leg up, and lowering it down, to build some strength in the glute muscles.
Stretch/Lengthen the Hip Flexors
As discussed throughout the course of this series, your hip flexor muscles (e.g. Psoas, TFL, Rectus femoris, etc.) often become overactive and shortened, while your glute muscles becoming underactive and lengthened. This is true for most people, regardless of the presence of gluteal amnesia or not. It's really important that you include some type of stretching for your hip flexors in your movement practice. If you only take time to build strength in the gluteal musculature while neglecting your hip flexors, your hip joints will still be prone to misalignment, and your body prone to injury. So, please please please, include stretches and even self-myofascial release (e.g. foam rolling, Roll Model Method, etc.) for your hip flexors. This will help to restore stability and balance to your LPHC.
There are many types of stretches that target the hip flexors, but my favorite is a kneeling hip flexor stretch, which is also referred to as Anjaneyasana in yoga. In this hip flexor stretch, you step one foot behind you, and then lower the back knee to the mat, and untuck the back toes (you could keep the back toes tucked if that feels better to your body). The front knee should be bent at 90 degrees, with your knee over the ankle. In this stretch, you are actually lengthening the hip flexors on the back leg (the leg with the knee down). Breathe in and reach your arms overhead. To add a little more lengthening to the hip flexors of the back leg, side bend towards the front, bent, knee. Hold in this position and at the same time, gently engage the glutes on your back leg. Engaging the glutes of the back leg helps to relax the hip flexors on the front of the hip of the back leg. Hold in this stretch for at least 30 seconds. Then, switch sides.
There are also many different self-myofasical release techniques that can be used to restore length to the hip flexors. Do a Google search for “SMR” or “self-myofascial release for hip flexors,” and you should find some good resources, especially for foam-rolling. I am trained in, and prefer, the therapy balls used in The Roll Model Method (RMM). The RMM is a type of self-myofascial release that uses various sized therapy balls to improve sensation and mobility of muscles. Check out the RMM website (click here) and follow Jill Miller on social media (click here) to find some ideas for hip flexor releases.
See a Doctor
All of the exercises and techniques described in this post are fabulous ways to try to prevent gluteal amnesia from occurring. However, if you need more individualized care and education for your body, follow up with your doctor. A sports medicine specialist, orthopedist, or physical therapist may be able to diagnose gluteal amnesia and prescribe exercises specific to your needs. Thus, none of the information presented in this section is meant to replace the advice from a licensed doctor. Please see a doctor if you think this is an issue you might have.
Wow! That was a lot of information presented over the course of this series. I am so thankful that you joined me for all, or even part, of this series. I truly believe that knowledge is power, and knowing about your body helps you to make choices that better align with what your body needs day-to-day. Gluteal Amnesia is a real condition in which the gluteal muscles become weakened and/or underactivated by the nervous system. Gluteal Amnesia often causes your body to use other muscles to perform the job of the weakened glutes (i.e. synergistic dominance), and that can cause many issues in the rest of the body, especially in the hips, low back, knees, and ankles. Muscle atrophy and denervation have also been documented in some patients with Gluteal Amnesia. One of the best ways to prevent Gluteal Amnesia from occurring in your body is to move your body more AND actively strengthen your gluteal muscles. Stretching the hip flexors and building more stability in your core muscles can also help to ward off Gluteal Amnesia. Your gluteal muscles are so incredibly important to the functioning of your entire body, and when these muscles are weakened or underactive, it really puts your entire movement system at a mechanical disadvantage. People with Gluteal Amnesia often have higher rates of low back, hip, knee, and ankle pain. And, people who actively work on strengthening their gluteal muscles typically report very little low back, hip, knee, and ankle pain. Thus, take good care of your gluteal muscles! Thanks again for reading!
Please note, the information presented in this blog series is not meant to diagnose gluteal amnesia or treat active cases of gluteal amnesia. After reading this series, if you have concerns about your gluteal muscles, please follow up with your physician, physical therapist, or sports medicine doctor. If you have been diagnosed with gluteal amnesia, please continue to heed the advice of the medical professional that evaluated you. Also, please keep in mind that I have simplified some anatomical and biological information, so I can keep the focus on gluteal amnesia as best I can. If you feel like you need more thorough descriptions and explanations, please refer to my reference list at the end of each installment in this series.