Is your Low Back, Hip or Knee pain caused by Gluteal Amnesia?
If you suffer from lower back, hip, knee or shoulder injuries, you could have Gluteal Amnesia.
Gluteal Amnesia occurs when your body forgets how to properly activate the gluteal muscles. As a result, you lose the ability to move your hips through their full range of motion and compensatory recruitment of other muscles, such as the hamstrings and erector spinae (lower back) occurs.
The hamstrings and erector spinae muscles are considered synergists to the gluteus maximus and are not well suited as primary extensors. Over time, these muscles can become over active and faulty movement pattern result leading to injuries, or impaired performance if you are an athlete.
Common injuries associated with gluteal amnesia can include patella-femoral (knee) syndrome, Iliotibial Band Syndrome, Disc Herniation, recurrent low back strains and Piriformis Syndrome.
The gluteal muscles include the gluteus maximus, gluteus minimus, and the gluteus medius. These muscles control movement at the hip and knee as well as influencing ankle motion.
The gluteus maximus is involved in hip extension and external rotation. It decelerates hip flexion and internal rotation. It also assists in maintaining an upright torso.
Some causes of gluteal amnesia include:
- Overworking or isolating the quadriceps when working out, e.g. leg press, leg extension
- Improper abdominal training.
- Soft tissue adhesions
- Articular (joint) fixations.
- Improper training or exercise mechanics, e.g. Landing improperly from jumps
- Prolonged sitting or static posture.
Prolonged sitting results in gluteal amnesia by causing over activity of the hip flexors (TFL, Sartorius, Iliacus and Psoas), and altered reciprocal inhibition of the gluteals (i.e. overactive hip flexors “turn off” the gluteus maximus).
How do You Know If You Suffer from Gluteal Amnesia?
One sign is a feeling of tension in your hamstrings after you do gluteal dominant exercises such as dead lifts and step-ups. This is especially true if you have normal flexibility in your hamstrings.
If you suffer from recurrent lower back, hip, knee or shoulder injuries an assessment is warranted (see below).
Many people with low back pain actually have strong backs, due to the over activity of low back muscles that are compensating for the gluteal under activity. Low back pain is more often an issue of muscle imbalance.
People attempt to correct back and knee pain by stretching the hamstrings and strengthening the low back muscles. Because the hamstrings are often “stretched tight” or “locked long” and the lower back erectors are already working hard, one can see that this is not the best strategy and in fact this approach can exacerbate the condition. Correcting the underlying muscle imbalances as described below is the ultimate solution.
Gluteal amnesia affects Core (spinal, abdominal and pelvic) stability. A stable core is essential for a healthy body.
You can test the stability of your core by doing a few overhead squats in front of a mirror. Face the mirror with your feet hip width apart. As you squat down, observe what happens at the kinetic chain check points (feet and ankles, knees, lumbar spine and hips, shoulders/arms and neck).
Some movement compensations that can indicate Gluteal Amnesia include:
- Feet turn out
- Knee’s cave in
- Low back arches
- Excessive forward lean
- Low back rounds
- Asymmetrical weight shift
Posture plays an important factor in gluteal activation. A common postural flaw that can lead to gluteal amnesia is known as anterior pelvic tilt. This occurs when the pelvis tilts forward and the stomach protrudes. The forward tilt of the pelvis stretches your gluteals into a relaxed state which decreases your ability to properly activate them (remember, muscles work best at optimum length and tension).
You can increase pelvic stability while simultaneously decreasing knee and back pain with the right exercises. Increasing pelvic stability means that you are re-training your muscles to pull the pelvis back into a neutral position so that your gluteal muscles can be activated efficiently. Gluteal Bridges are effective exercises to accomplish this.
Lie on your back on the floor with your knees bent and feet on the floor. Lift your pelvis until it forms a straight line with your back hold this position for 2-4 seconds and then drop down to the floor and lift again for 10-12 reps. Other great gluteal activation exercises to include are clam shells and birddogs (quadruped opposite arm/leg lifts).
Tight hip flexors are characteristic of anterior pelvic tilt. If your hip flexors become too tight, they rotate your pelvis forward, overstretching your abdominal and gluteal muscles. Using self-myofascial release techniques and stretching the hip flexors can help you to better activate the gluteals.
The abdominals are also affected by an anterior pelvic tilt posture. The abdominals, specifically the rectus abdominis and external oblique, prevent anterior pelvic tilt. However, they are unable to do their job if they are in a relaxed state. Properly strengthening the abdominals will help to bring the pelvis into a neutral position so that you are better able to use your gluteals.
Planks and side planks are good abdominal exercises for reversing anterior pelvic lift. Pushups and dead bug variations are also effective choices for increasing pelvic stability and reversing gluteal amnesia. Conventional sit-ups and crunches are actually poor choices to strengthen the abdomen for two reasons. Firstly they flex the spine and can increase the pressure around discs and secondly, they often shorten the hip flexors which as you know, can reciprocally inhibit the gluteal muscles, thereby perpetuating the very problem that you are trying to correct.
After performing gluteal activation exercises, it’s important to incorporate integration exercises, i.e. you need to learn how to use them during functional (i.e. intermuscluar) movements. Ball squats, lateral tube walking, single leg balance, single leg squat, lunges and single leg dead lifts are good functional exercises.
If you have back, hip or knee pain or want to prevent these problems. Identifying dysfunction through a movement screen (e.g. Overhead squat, range of motion and strength assessments) and performing corrective exercises based on your specific deficiencies is the key.
A corrective exercise program for gluteal Amnesia should consist of:
- Inhibiting tight muscles through self-myofascial release e.g. Hip flexors (TFL, Psoas)
- Lengthening tight muscles e.g. Stretching the hip flexors
- Activating weak or inhibited muscles e.g. Gluteal bridge, Bird-dog
- Integrating functional movements e.g. Squat, tube walking, planks