Member Case Study: Gluteus Medius and ITB Syndrome

author : AMSSM

comments : 1

How can gluteus medius weakness/problems be involved in iliotibial band syndrome? What specific exercises should be used in building gluteus medius strength in post-ITB syndrome treatment?

Member Question from KSB:

I have a 3-part question relating to the Role of the Gluteus Medius muscle

1) What is the exact location, role and function of the gluteus medius including angle of leg joint flexion/extension where it kicks into action and examples of activities where it is used (e.g. hiking uphill);

2) How can gluteus medius weakness/problems be involved in iliotibial band syndrome;

3) What specific exercises (e.g. rear lunges) and general activities (e.g. skating or soccer) should be used / are helpful in building gluteus medius strength in post-ITB syndrome treatment?

Question 1:

What is the exact location, role and function of the gluteus medius, including angle of leg joint flexion/extension where it kicks into action and examples of activities where it is used (e.g. hiking uphill)?

Answer:

Gluteus Medius Anatomy
The gluteus medius is an upper anterior buttock muscle with some of its posterior fibers situated beneath the gluteus maximus. It originates from the part of the pelvic bone beneath the crests known as the ilium, and inserts onto the side of the thigh bone, or femur, at the greater trochanter.

Gluteus Medius Function
The main function of the gluteus medius is abduction, or moving the leg away from the body. This is a function rarely performed alone in most sports. The more important role of the gluteus medius is that of pelvic stabilization during single leg stances such as when walking or running. This means that a strong gluteus medius can stabilize the pelvis and prevent it from sagging when the opposite side is not supported by that side’s leg. While this function is obviously important to maintaining good form while running, it can also impact triathletes during the bike portion of their training.

Strong gluteus medius muscles keep the hips stable on the bike, promoting good posture and helping to sustain power and force while riding. If an athlete has weak gluteus medius muscles, the pelvis will be more likely to move out and upwards out of the saddle during cycling which will lead to diminished power and more chance of manifesting problems with such areas as the iliotibial band, knees and/or back. The gluteus medius also assists with the early portion of hip flexion, as well as rotation of the femur about the hip.

Training the Gluteus Medius
The best hip abductor exercise is single leg standing. Each time the other leg/hip moves it challenges the ability of the standing leg to stabilize itself. If side-lying position is preferred, isometrics should be performed, with the leg held at hip level. Resistance bands can be utilized with either method for added difficulty.

Carrie A. Jaworski, M.D., F.A.C.S.M.
Director
Resurrection Sports Medicine Center and Fellowship Program
Chicago, IL
Member AMSSM

Question 2:

How can gluteus medius weakness/problems be involved in iliotibial band syndrome?

Answer:
Iliotibial band syndrome is considered by most to be an overuse injury most commonly seen in runners and cyclists. Many individuals have no symptoms except for an annoying “snapping” of the hip when the knee flexes and extends during the running motion. However, others can experience significant lateral knee pain. The iliotibial band is a thick fascia that crosses the hip joint and inserts on the patella and tibia. The common theory has been that this band becomes inflamed from the friction of rolling over the lateral femoral epicondyle. Recent MRI studies and biopsy analysis of the distal insertion of the iliotibial band suggest the pathology may involve a compression rather than a rubbing of this band of tissue.

The multitude of different management strategies highlights the lack of agreement on a specific cause for this syndrome. Use of orthotics, stretching, massage, steroid injections, rest, strengthening of gluteus medius and other muscles and tendons in the functional kinetic chain, analysis and change in biomechanical function and footwear, and in rare cases surgical release of the band have all been reported to be successful therapy for this common knee pain. Imbalance between muscle groups such as hamstrings and quadriceps, or hip abductors (including gluteus medius) and hip adductors, is a prevalent theory of etiology. Weakness of any of these muscles in the hip, pelvic, and knee area certainly may play a role in this syndrome. Type of exercise, biomechanics, equipment, and anatomical structure also appear to be involved.

A multi-disciplinary team of sports medicine professionals may provide the best analysis and treatment regimen for the individual with iliotibial band syndrome, especially for those stubborn cases that don’t respond to the most traditional and conservative measures of ice, rest, anti-inflammatory medications, and adjustments in equipment and training.

Vito Perriello, Member AMSSM

Question 3:

What specific exercises and general activities should be used / are helpful in building gluteus medius strength in post-ITB syndrome treatment?

Answer:

ITB syndrome is a common cause of lateral knee pain in athletes. Usually athletes are told to cut back on their running mileage, use ice, and take non-steroidal anti-inflammatory medications to reduce pain and inflammation. Although stretching of the ITB is helpful, one must also advance the strength of the muscles that are associated with the ITB in order to make the ITB resistant to future injury.

The primary action of the ITB is to abduct the thigh (move it away from the body’s midline). The ITB is constantly being stressed when running by acting to prevent too much adduction (movement towards the body’s midline) of the upper thigh. One of the muscles that assists with this action is the gluteus medius muscle. The gluteus medius is often neglected in running and cycling, which heavily work the quadriceps and involve forward movement in a straight line. It is important the keep the glute muscles strong in order to prevent ITB syndrome from occurring or recurring. Two specific exercises that will accomplish this are the Hip Hike and the Forward Straight Leg Raise. A brief description of these is as follows:

Hip Hike - Stand in front of a mirror on a platform surface that is at least 4” off the ground, with one leg held free over the edge. Keep your shoulders level and both hips squared forward. Keeping your standing leg (the one on the platform) straight, raise your other hip (the free leg) directly upward and then drop the leg down. You should be able to see your beltline alternately tilt up and down. You can increase the difficulty of the exercise by adding ankle weights.

Forward Straight Leg Raise - Lay down on your side with your bottom leg (the one on the floor) bent, and your top leg extended out at a 90 degree angle to the rest of the body. Keep a slight bend in the top knee. Now raise the top leg from the floor to about twelve inches off the floor. Try and keep your heel higher than the toe on this top leg in order to maximally recruit the gluteus medius. Again, you can add ankle weights to increase the difficulty.

Two of the best activities to stay in shape during a flare up of ITBS are swimming and aqua-running. These will keep you fit without further aggravating things. Sports involving running, cycling, and stair climbing are going to likely worsen the condition because they can cause rubbing of an inflamed IT band on the outer edge of the femur and therefore delay recovery.

Peter Marshall, MD, Member AMSSM

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date: June 5, 2006