Do Weak Glutes Cause Knee or Back Pain?

Say your knee or lower back starts hurting and you, sensibly, see a physiotherapist. They do a bunch of tests and declare you have a 'weak' or 'lazy' Glute muscle.

You're prescribed some Glute strengthening exercises and, hey presto, your pain disappears.

Except that many people get re-injured or pick up another, different injury, and end up having their physiotherapist on speed dial. They may end up hopping from specialist to specialist, hoping for a solution but never finding it.

So if strengthening weak Glutes doesn't provide a long-term resolution to pain, what would help relieve knee and lower back pain?

Let's dive into 2 real life case studies of members who reported getting knee and lower back pain when exercising and training.

MEMBER 1

Member 1 has been training for a half marathon in February.  Unfortunately her left knee has started to hurt whilst running.

Sensibly she's seen a physiotherapist, who declared she had a 'weak' left Glute, and prescribed some strengthening exercises.

This is pretty standard industry advice, right?

Now I'm NOT saying this is incorrect, or that strengthening the left Glute won't improve the knee pain, BUT....

Let's ask another question:

WHY is the left glute behaving differently to the right glute?

Now, stay with me!

Physiotherapists are trained to perform a bunch of tests to find out if a muscle is 'weak' (or dysfunctional).

But all these muscle tests are actually showing is that the left glute is behaving differently to the right glute for this person.

WHY would the left glute behave differently to the right glute??

The left glute doesn't just wake up one morning and decide to be useless!

And this is the question you should be asking your physiotherapist - WHY is the left glute behaving differently to the right glute?

Because if whatever is causing the difference between the 2 Glutes isn't resolved, strengthening the muscle is pointless. 

The pain will either recur or resurface as a different injury elsewhere, which is why so many people can't get off the treatment table.

So what did I speak to Member 1 about first?

Her feet! And as we chatted, she revealed that she has a mild bunion toe on her left foot.....BOOM!

Ok, so why did I start discussing her feet, when she has knee pain and the physio has diagnosed a 'weak' left glute?

1) The pelvis sits on top of the hip joints. The hip joint is the top of the leg:

At the bottom of the leg is the foot and ankle. Therefore if the foot isn't optimally orientated or balanced, it's extremely difficult for the pelvis to function as Nature designed.

The role of the pelvis is to act as the master controller of load and movement in the body.

2) If the pelvis isn't balanced or stable, the muscles that attach onto the pelvis won't function as designed either. The Glutes are just one of over 50 muscles that attach to the pelvis.

3) The big toe propels the body forwards when walking or running. Therefore any changes to the big toe WILL alter your gait - how you stand and move.

4) The big toe also supports the pubic bone of the pelvis. The pubic bone is the front attachment for the pelvic floor. The pelvic floor muscle is involved in how the pelvis and sacrum (part of the lower spine) work to create movement,. 

A bunion toe alters how the foot interacts with ground, and the support given to the pelvis, sacrum and pelvic floor. This can also alter gait.

5) The orientation (direction) of the feet talks directly with the glutes - whether they're switched 'on' or 'off'. I have a cool movement exploration that neatly demonstrated this line of communication between the feet, ankles and glute muscles. It's literally like a light switch - on/off!

We could go on, but hopefully you're beginning to see the bigger picture, beyond just a 'weak' left glute.

Along with the glute strengthening exercises prescribed by the physio, this member could work on reducing the bunion toe by reorganising the toe lines.

The toe lines are the longitudinal arches of the feet - a chain of bones that connect the toes (metatarsals) to the heel bone. Their role is to support specific areas of the hip joint and pelvis for stability, balance and efficient movement.

Now one more thing to consider.......What if the left glute ISN'T actually weak?!? 

What if this left glute is in a state of permanent low level contraction, perhaps to compensate for the bunion toe not supporting the pelvis as effectively?

If the left glute is in a constant low level contraction it will have less maximal voluntary contraction (MVC) available, so it will appear weaker in the physio's tests.

This is called Sensory Motor Amnesia (SMA). 

Member 1 could also work on her sensory-motor awareness and control of her glutes - working on feeling the communication between the feet and glutes is one exercise she could do to improve this.

Can you see how we've moved beyond blaming the left glute and labelling it as 'weak'?

We're now looking at the body as a whole, exploring systems and how they interact, rather than getting hung up in individual body parts or muscles.

MEMBER 2

Member 2 came up at the end of a Pilates class and mentioned that she was getting lower back pain during a Hip Bridge. Here's our lovely Bridge exercise:

We were using a band around the lower thigh during class, similar to this stock image.

Member 2 reported that her lower back muscles were tensing up, causing soreness during the Bridge sequence in class. She pointed to the area of Quadratus lumborum (QL) and the erector spinae (spinal extensor) muscles.

You can see from this image how QL originates on the ilium of the pelvis, attaches on the lumbar vertebrae and inserts onto the lower ribs. The erector spinae group of muscles attach onto every vertebrae in the spine and then onto the pelvis.

So why would these muscles tense up during a Hip Bridge exercise for member 2?

1) How the feet interact with the ground. Yes, we're back to this again!

Now, member 2 also mentioned that her toes tended to shorten and claw the mat during a previous standing exercise we did at the beginning of the class. 

She also found it hard to control and keep her ankles stable during this standing section of the class.

Remember, if the feet don't stay orientated, balanced and level it could shift the pelvis forwards, backwards or sideways on the hip joints.

If her feet, ankles and pelvis aren't stable structures a Hip Bridge exercise will amplify this dysfunction because the pelvis is elevated off the ground. 

The lower back muscles could then be recruited to try and bring the pelvis back into equilibrium. This is hard work for them. A Hip Bridge exercise could make them work so hard it becomes painful.

2) Thorax - QL and erector spinae attach to the thoracic vertebrae and ribs.

If the thorax (thoracic vertebrae, ribs and shoulder blades) are not functioning as Nature designed this can also alter how QL and erector spinae behave.

There are direct muscular connections between the pelvis and ribs via the External Oblique muscles. The shoulder blades link with the pelvis indirectly through Serratus Anterior and then the External Obliques.

I suggested to member 2 that she pay attention to how she uses her feet - being aware of whether they're orientated, balanced and level.

She could also work on releasing held tension around her ribs, so that her thorax can move freely. This creates a healthier spine that can twist and bend with ease.

Can you see that for member 2, Hip Bridges might reinforce the compensatory patterns that are creating muscle tension and pain in her body.

This is why it's important to understand what's triggering muscle tension and the pain response in your body, rather than simply picking generic exercises because you've heard they're meant to be good for strengthening glutes or relieving back pain.

I encourage you to be advocate for your body. Always look for the WHY - Why is the body responding in this way? Why is this muscle behaving like this?

It's rarely ever as simple as a 'weak' or 'lazy' glute.

Muscles don't just choose to be 'weak' or 'tight'. They're being driven into this behaviour as a compensation, maladaptation or protective pattern. 

This philosophy of looking beyond standard industry dogma is at the heart of The Befriend Your Body (BYB) Method.

The BYB Method is a 4 pillar system which reduces pain and muscle tension long-term, putting you back in the driving seat and in control of your body and pain again.

I'll be helping a small group of people unlock the triggers of their pain and create a home programme that will reduce pain and muscle tension effectively in less than 15 minutes a day.

We start in February. Want to join them?

NEXT STEPS

1) If you want to make the next 12 months the year you find freedom from persistent or recurring pain or muscle tension get yourself onto the early bird interest list for The BYB Method Workshop Retreat : EARLY BIRD LIST 

8.5 hours of live tuition + 30 days of 1:1 coaching support to help you implement what you learn from the weekend into a regular home care routine. 

No myths or industry dogma, just simple, safe movements that WILL help you release pain and tension from your body.

Get on the early bird interest list here to receive all the details first:

EARLY BIRD LIST 

2) You can also:

• Book into a Stretch, Yoga or Pilates class with me - these are a good introduction to The BYB Method and take the first steps to your pain-free body.
• Attend a mind-body retreat - these are deeply relaxing, fun, social small group experiences typically held in various locations within easy reach of Worthing, West Sussex. The next retreat is  on Sunday 24th March. Click HERE for all the details.
• Subscribe HERE to receive "The Movement Chronicle", a weekly e-newsletter delivering mobility and pain reduction tips directly into your inbox every Monday morning,

If you would like support with managing pain or an injury please reach out to me on any of these channels:

• Email at norma.pearson1@ntlworld.com
• DM me on Facebook Messenger 
• WhatsApp message to 07801 867361.