TABLE OF CONTENTS:
Common phrases
What does Google have to say?
What is gluteal amnesia
History of gluteal amnesia and proposed hypothesis
low back pain and gluteal inactivation
Causes of gluteal amnesia
how to check if your glutes are activated
Conclusion
As health and exercise professionals, we should become more mindful of our language and how patients interpret what we say. Patients frequently report that they’ve been told their glutes don’t work, which can be understandably concerning, and in some cases becomes a single-minded focus for the patient – reactivating their ‘turned off’ musculature.
I’m sure most of us reading this blog must have heard or read somewhere that :
And sometimes these things are told to healthy individuals with no pain, that’s messed up!
On a quick google search, this is what google has to say:
Things wrong with the above definition:
Our body doesn’t just ‘forget’ to turn on our muscles.
Yes, the gluteus muscle is important, but no more than any other muscle.
And well…gluteal tendinopathy is not the same as gluteal amnesia.
With so much information around us, it can surely be difficult to find out what is correct, especially when everyone is claiming to be a guru.
Through this blog, I will attempt to make the topic of inactivated glutes/ gluteal amnesia more coherent.
Let’s start with what are the gluteal muscles and gluteal amnesia.
The gluteal muscle group, known as the “glutes” for short, is actually composed of three muscles, the gluteus maximus, gluteus minimus, and gluteus medius. These muscles make up our buttocks region and are responsible for hip extension, abduction, internal and external rotation.
Gluteal amnesia is a “condition” where the individual is believed to have lost the ability to contract their gluteal muscles – generally, the gluteus maximus, though some report it as the gluteus medius. This can take many different names, such as “dead butt”, “sleeping glutes”, or glutes that are “turned off” or inactivated.
Coming to the origin of this condition and the history of this concept
This concept of the lower cross syndrome was birthed by Vladimir Janda years ago and was picked up by Stuart McGill, a biomechanist and eventually he coined the term called gluteal amnesia.
The lower cross syndrome is a postural condition in which the patients have an increased lumbar lordosis and anterior pelvic tilt, secondary to the pattern of muscle “imbalances i.e. the person has “tight” hip flexors, tight erector spinae, “long” and weak abdominal muscles and weak Gluteus Maximus muscles (which people consider to be “inactivated”).
The concept of lower cross syndrome is rampant across various platforms and is used extensively as the reason behind various other pains and disorders. However, the research available doesn’t support it.
various hypotheses are proposed so as to what could be the cause of gluteal inactivation, I have discussed below three of the most common reasonings:
Duration of time spent sitting
It was said that an increased amount of sitting leads to poor blood flow ultimately causing the muscle to atrophy and also that it leads to gluteal amnesia aka your glutes forgetting to “turn on”.
There is no evidence currently which demonstrates that there is a link between reduced perfusion of blood and gluteal contractility.
Given that most people change positions often, which would accommodate a capillary refill if perfusion was reduced i.e. restored blood supply, it is unlikely that this is a potential scenario.
You needn’t worry unless you have a highly sedentary lifestyle and you sit for long hours with no movement at all, which is unlikely because we have the ability to naturally shift and change our positions to ease any discomfort, we naturally do not sit perfectly still unless we have a pre-existing condition that forces us to do so.
And if you have a highly sedentary lifestyle then you already know what to do!
Tight hip flexors
This idea argues that tight or shortened hip flexors (as happens in a person with anterior pelvic tilt or due to consistent sitting) cause the glutes to lengthen therefore leading to an inability to contract properly giving rise to a dysfunction
The term tightness is ambiguous and most of the time is just a feeling, therefore it can be said that it is a non-specific term, building a little more on it, tightness here is synonymous with shortened muscle, specifically the hip flexors. It is said that tight hip flexors (present anteriorly) cause the glutes (present posteriorly) to lengthen therefore leading to gluteal inactivation. But there is no evidence to back up this claim.
How often do we move any of our other joints like the shoulder or our neck through their full range or even put it into varied positions throughout the day, not quite often I think, if you are someone who sits for most of the day, I would assume that your shoulder/arm would be by your side most of the time with your neck in neutral or slightly flexed which would make the case very similar to the position of hip in sitting but the same idea of inactivation isn’t applied there.
Furthermore, posture is determined by things like our lifestyle, habits, and mood and it is not always the same and therefore isn’t always a result of muscle imbalances, especially when you have no pain.
Inactivated glutes cause low back pain
It is believed that the glutes forget to get activated which causes the low back muscles to compensate leading to pain.
This study measured gluteus medius strength and endurance before and after a 2 h prolonged standing task in previously asymptomatic individuals, to compare between individuals who did and did not report pain in the low back. 24 participants without a history of low back pain stood in a constrained area for 2 h. Before and after the standing protocol, participants’ maximal hip abduction strength and side-bridge endurance were measured. Continuous surface EMG was collected from GM during the 2-h protocol for analysis of bilateral co-activation.
Pain in the low back was rated every 15 min with a visual analog scale (VAS). Seventeen of 24 (71%) previously asymptomatic participants developed pain in the low back during the standing protocol. These participants had lower side-bridge endurance, and higher gluteus medius co-activation compared to participants who did not develop pain in the low back.
Low back pain is a complex and multifactorial condition and it is incorrect to oversimplify even when the research disagrees with the idea.
In most conditions, your gluteal muscles jump in to help you out and are not ‘sleeping’ or ‘inactivated’.
Those with hip OA show increased Glute Medius activity.
Increased Gluteus Medius activity is associated with increased pain during standing.
No difference in glute max activity in those with low back pain.
Any muscle ‘inhibition’ seems to resolve quite quickly after injury.
Increased Glute Max activity in those with hamstring strains.
Onset times of those with Low Back Pain are not delayed in the Glute Max.
This study shows that Glute Max is always delayed during the prone leg lift (a test done to examine spinal dysfunction).The authors of the paper quote:
“While Janda and Singer both advocate the assessment of muscle firing order during active prone leg extension as part of the examination of spinal dysfunction, the timing of activation of 3 muscles appear to be within 30 ms of each other which questions whether one can assess these activation patterns without surface EMG. Even if a delay of approximately 200 ms in the gluteus maximus is indicative of pathology can this delay be detected without functional testing that incorporates EMG i.e. muscle palpation?Functional testing procedures should be validated further before dysfunctional recruitment patterns in symptomatic individuals can truly be identified. The inconsistencies in the firing pattern during the prone leg extension suggest the need to create and evaluate other methods to objectively assess neuromuscular functional control.”
Muscle firing/ activation cannot be analyzed accurately visually or through palpation by your therapist or trainer, unless they have laser eyes or magic hands. It is checked using a proper method called EMG (Electromyography).
It is not possible to check for muscle activation just by seeing someone at rest and when someone uses a different movement pattern that doesn’t necessarily tell us about the strength or activation of their muscles involved, it just could be their preferred strategy and not necessarily an incorrect one.
So next time be vary when someone tells you that your glutes are inhibited.
Unless someone has suffered a severe injury that leads to nerve damage or tendon detachment or is under anesthesia (to name a few), we do not lose the ability to contract or activate our gluteus muscles.
In Fact, in an EMG study of running, it is seen that in the terminal swing phase of running, before the foot contacts the ground, there is an increased activity of the glutes even before the foot strikes the ground (which requires the extension of the hip, fulfilled primarily by the glutes) seen on the right side of the graph.
The runner doesn’t stop mid-running to stand and activate their muscles for their coming task, it happens automatically. Hence we don’t need to specifically turn these muscles on, they work on their own and they start working even before they are needed.
On the left side of the graph, there is an increase in activity during the loading phase of running followed by the graph going flat (decrease muscle activity), which is the propulsive phase of running when we are propelling ourselves forward, the muscles don’t need to be active there. The muscles work as a spring, they store and release energy to help us propel forward, and no muscle activation is needed to do this.
Therefore the muscles not only work before they are needed they also know when they are not needed.
Our body is a very sophisticated system, when we try to consciously take over, we interfere with the working of this system.
That being said, there is no problem with strengthening your glutes. Many times it can be helpful while dealing with certain disorders, pains, and aches. The recruitment of the muscle fibers can be increased by modifying and optimizing movements according to the individual but does that mean your glutes are switched off or do you need to activate them through a warm-up before proceeding for the main workout? NO.
Oftentimes, words like ‘inactivated’ can be confusing and nocebo evoking for people in pain giving them the notion that their bodies are defective in some way.
A simple way to check if your glutes are working:
Sit on a chair
Stand up
Walk
If you can do the above, then viola! Your glutes are awake.
In conclusion:
As clinicians, we should be mindful of what we say and should avoid using polarising statements that may be confusing and fear-inducing.
As consumers/ patients, we should be more aware and selective of what we believe in.
Don’t try to fix something that is not broken.
Keep moving!
For more go to Physio Explored Blogs
Disclaimer: In the presence of low back pain all the structures and context must be clinically assessed, this blog is in no way a substitute for a clinical assessment and all must consult a physiotherapist or a physician in such conditions.
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