05/12/2022

Description

On the lateral aspect of the upper buttock, right below the iliac crest, lies a fan-shaped muscle called the gluteus medius. Now, what is the gluteus medius? You might ask, so basically, the gluteus medius is a highly functional muscle that aids in hip movement. The name of this muscle is pretty self-explanatory. Just as it seems, this muscle originates from the gluteal region. It sits along the outer surface of the ilium, near the pelvis, between the posterior and middle gluteal lines. This superior muscle is broad and gets narrow towards its insertional tendon resulting in a fan shape. Often this muscle is confused with the gluteus maximus. However, three gluteal muscles make up the buttocks and originate from the ilium and sacrum: the gluteus maximus, gluteus medius, and gluteus minimus. 

The Gluteus maximus covers all of the gluteal muscles except for the anterosuperior third of the Gluteus medius. This uncovered part of Gluteus medius is where buttocks Dorso gluteal intramuscular injections are applied.

Insertion

The gluteus medius muscle arises with a broad insertion from the gluteal surface of the ilium. The area of attachment is substantial and spans between the anterior and posterior gluteal lines. The muscle belly takes an anteroinferior course towards the proximal femur, gradually tapering in size and giving off a narrow tendon.

The tendon passes over the anterosuperior side of the greater trochanter. It then gets separated from it by the trochanteric bursa of the gluteus medius. Afterward, the muscle inserts to the lateral side of the greater trochanter of the femur.

Nerve Supply for the Gluteus Medius

The gluteus medius gets supplied by the superior gluteal nerve (root L4, L5, S1). Mainly, cutaneous supply is provided by L1 and 2.

Blood supply

The blood supply to the gluteus medius muscle comes from the profound part of the prevalent gluteal corridor. The ligament, in any case, is chiefly provided by the trochanteric anastomosis. This anastomosis is formed between the climbing part of the average circumflex femoral supply route and plunging parts of the unrivaled gluteal and sub-par gluteal conduits.

Movements of this muscle

Like we mentioned before, the gluteus medius is a highly functional muscle in our body, and it also serves a lot of functions. The gluteus medius muscle acts in synergy with gluteus minimus to perform these actions on the hip joint;

When the proximal attachment of the gluteus medius is fixed, the muscle can contract as a whole or contract with its anterior fibers only. In the former case, the axis of the movement goes through the hip joint and pulls the greater trochanter superiorly while abducting the thigh. In the latter case, as the axis of the movement tilts anteriorly, the muscle causes the internal rotation of the thigh.

The distal attachment of the gluteus medius is fixed, due to this the muscle pulls the ilium inferiorly, which results in the slight ipsilateral pelvic tilt and consequential raising of the pelvis on the opposite side. This action is vital during walking, as it allows the raised leg from the opposite side to be moved towards the next step. Moreover, the strong tension generated within the muscle contributes to the stabilization of the pelvis and trunk during the gait cycle.

Functions and How it Works

The gluteus medius is a significant muscle in maintaining the frontal plane stability of the pelvis. It forms with the ipsilateral tensor fascia lata and contralateral quadratus lumborum [a lateral fascial sling whose role is to provide frontal plane stability]

The gluteus medius is the prime mover of abduction at the hip joint. The anterior portion of the gluteus medius abducts and assists in flexion and medial rotation of the hip. Where else, the posterior portion of the gluteus medius abducts and assists in ext and lateral rotation of the hip.

In hip flexion, all portions internally rotate the hip and it has shown that at 90` of hip flexion, the leverage of medial rotation of gluteus medius is increased eight folds. 

Gluteus medius is an important muscle in walking, running, and single-leg weight-bearing because it prevents the opposite side of the pelvis from dropping during walking, running, and single-leg weight-bearing. When a limb is taken off the ground, the pelvis on that side will tend to drop, due to loss of support from below. Not only that but the gluteus medius also works to maintain the side of the pelvis that drops therefore allowing the other limb to swing forward for the next step.

 It also supports the pelvis during gait by producing rotation of the hip with assistance from gluteus minimus and tensor fascia lata. Conversely, the hip is supported during the stance phase by acting on the same side.

Exercises that activate this muscle

Learning so much about this muscle causes us to think about the times it helped us function. Listed down are some of the exercises in which this muscle of yours is activated. So the next time you try one of these, you will know the muscle, that is helping you out.

Moderate-level activation 

  • Prone bridge plank 
  • Bridging on a stable surface 
  • Lunge-neutral trunk position
  • Unilateral mini-squat 
  • Retro step-up 
  • Clam with 60° hip flexion 
  • Sideways lunge 
  • Clam with 30° hip flexion 

High-level activation

  • Lateral step-up
  • Quadruped with contralateral arm and leg lift 
  • Forward step-up 
  • Unilateral bridge 
  • Transverse lunge 
  • Wall squat 
  • Side-lying hip abduction 
  • Pelvic drop
  • Single-limb deadlift

Very high-level activation

  • Single-limb squat 
  • Side-bridge to neutral spine position 

Complications that can arise (The Gluteus Medius Tear)

A gluteus medius tear is a condition characterized by severe strain on the gluteus medius muscle that results in partial or complete rupture of the muscle. Gluteus medius tears often occur at the tendonous attachment to the greater trochanter of the femur bone.

Causes

The tear or rupture of the gluteus medius muscle is commonly found in runners and athletes involved in high-impact sports such as soccer or basketball. It can occur from sudden bursts of activity and poor flexibility of the gluteus muscle. Any traumatic or overuse injury or degenerative changes can also lead to a partial or complete tear of the gluteus muscle.

Symptoms

The symptoms of a gluteus medius tear involve pain and tenderness over the lateral aspect of the hip which may be aggravated with activities such as running, climbing stairs, prolonged sitting or walking, and lying on the affected side of the hip. One of the main symptoms of a gluteus medius tear is the presence of the Trendelenburg sign, evidenced by the dropping of the pelvis towards the unaffected side during ambulation from being unable to properly bear weight on the affected limb.

Diagnosis

The diagnosis of a torn gluteus medius muscle starts with a physical examination of the patient comprising palpation of the affected muscle, testing muscle strength, and assessing the walking pattern or gait of the patient. Special tests such as single-leg squat test or positive Trendelenburg sign confirm the diagnosis of a gluteus medius tear. MRI or ultrasound may be helpful to view the pathological changes of the muscle.

Palpation

You saw the word palpation mentioned earlier and you must be thinking what’s that. Palpation is a method of feeling with the fingers or hands during a physical examination. The health care provider touches and feels your body to examine the size, consistency, texture, location, and tenderness of an organ or body part. The palpation to cure the gluteus medius tear is done in this way:

Find the middle of the iliac crest which is located above the greater trochanter. Two fingers below are the bulk of gluteus medius. The contraction of the muscle can be felt by alternate single-leg stands.

Treatment

The aim of the treatment is to restore the normal function of the gluteus medius muscle. Immediately following the rupture, RICE therapy is initiated and involves:

  • Rest
  • Ice
  • Compression and
  • Elevation

Medications such as non-steroidal anti-inflammatory drugs or NSAIDs and steroid injections may be given to reduce the pain and inflammation. You should use a pillow between your legs when sleeping and avoid positions that overstretch the muscle. Assistive devices such as a cane or crutches may be used temporarily to facilitate pain-free ambulation.

Surgical treatment may be recommended to repair a complete, full-thickness gluteus medius tear. The surgery can be performed endoscopically through tiny incisions to reattach the torn tendon back onto the greater trochanter with stitches. This helps to restore strength and function to the gluteus medius muscle.

Gluteus Medius Release

Various stretches can be done to release this muscle of yours. These stretches result in getting relief from tight hips, hip pain, knee pain, and sometimes even lower back pain!

  •  Cross-legged glute stretch
  •  Z-sit
  •  Figure 4 stretch
  • Standing side bend
  • Massage your glutes

When the glutes aren’t activated due to prolonged inactivity or being overworked, other areas may take on the job of the glutes of stabilizing the hips.

Since tight hips can make certain yoga poses quite difficult, this will also help you in your yoga practice.