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Aquatic Therapy implications and treatment approaches for GLUTEAL AMNESIA.
Beth Scalone, PT, DPT, OCS, ATRIC
 
The gluteal muscles are usually strong and functionally important. Inhibition or delayed onset of these muscles is the root cause of many injuries and pain in the back, hips, knees and ankles. Functional rehabilitation of the spine and lower extremity includes interventions to strengthen these essential muscles.


The role the muscles around the hip play depends on the activity being performed. The “text book” definition is primary muscle action and describes the muscle in isolation and in a non-weight bearing position. For example the gluteus maximus performs hip extension with the gluteus medius being a hip abductor and external rotator. 


In function, especially closed chain activities, these muscles work together with other muscles to stabilize, control and move the body in all three planes. The gluteus maximus eccentrically decelerates hip flexion in the sagittal plane and controls internal rotation of the femur along with the gluteal medius in the transverse plane. The gluteus medius plays a primary role in controlling lateral translation of the hip and pelvis in the frontal plane to the same side of the body.  When these muscles fail and the pelvis drops on the opposite side during single leg stance it is often described as a positive trendelenberg. Lack of femoral rotational control translates down the lower extremity chain resulting in internal rotation of the femur, valgus stress at the knee and pronation at the foot and ankle.


These muscles are often inhibited or chronically weak, with associated tightness in the hip flexor from prolonged sitting postures, injury and pain.  The term “gluteal amnesia” applies when the glut muscles do not turn on automatically having “forgotten” their role. Without the stabilizing effects of these muscles, faulty movement patterns overtime lead to injury and pain. Common diagnoses linked to gluteal weakness include sacroiliac dysfunction, lower back pain, anterior hip pain, bursitis, patellar femoral pain, ACL injury, ankle sprain and Achilles tendonitis.


What are the best treatment strategies to address “dead butt syndrome”?
Stretch the antagonist.
In order for the muscles to be able to work effectively the antagonist muscles, mainly hip flexor group and adductor muscles need to have adequate flexibility otherwise it is impossible for the weak extensors and abductors to fight the habitual tightness on the opposite side of the joint.  


Specific Strengthening
Strengthening should focus on the weaker, posterior portion of the glut medius and gluteal maximus with stabilized control of the other joints, especially the knee and lumbar spine.  In open chain exercise, hip abduction is performed with the hip in 5-10 degrees of extension and neutral rotation, making sure the movement is strictly coming from the hip without excessive pelvic side bending.  When working hip extension watch for lumbar spine extension as the compensatory movement.  To prevent the pelvis from anteriorly rotating and thus extending the lumbar spine, cue abdominal activation prior to the initiation of the hip movement. 

 The gluteus medius on the standing leg is weak which causes the opposite hip to drop below a level position which can lead to hip, SI joint and low back pain. 

The gluteus medius on the standing leg is weak which causes the opposite hip to drop below a level position which can lead to hip, SI joint and low back pain.