lower back pain

Fix Your Lower Back Pain by Strengthening the Gluteus Medius Muscle

  • stand up desk can solve frequent back problems miami boca raton

If you get frequent lower back pain that is not an underlying disease, the issue is likely due to a weak Gluteus Medius Muscle.

The Gluteus Medius is one of the three gluteus (butt) muscles that play a role in stabilizing the hips. The other two areas being the Gluteus Maximus and the Gluteus Minimus. The Medius muscle begins on the outer surface of the Illium, the hip bone, and attaches to the greater trochanter of the femur (a bony landmark at the top/outer side of the thigh bone). Its fibers run in a superior/inferior direction anchoring the pelvis to the femur. 

This matters the most when we remember that the spine rests upon the sacrum, a portion of the pelvis, specifically at the L5-S1 junction. Providing a foundation for the vertebral column can help in reducing back pain that is felt from prolonged standing and/or walking. Instability of the vertebrae can result in disproportionate compression of an intervertebral disc, causing nerve irritation prevalent in low back pain. 

More often than not, a patient will walk through our doors with reports of low back pain, and after some investigative work, we’ll learn that their job requires daily long hours of sitting. Jeong et. al1 demonstrate that the Gluteus Medius provides that stability to the pelvis when our body needs it. However, after sitting in a chair for many hours every day, these muscles will atrophy and no longer perform their designated job for months. This can result in vertebral instability, as mentioned above or worse, to leave a person susceptible to graver spinal cord injury when dealing with bigger movements such as deadlifting or squatting. 

How to Strengthen the Gluteus Medius Muscle

This article aims not to scare you from performing these movements; it is more the opposite. One of our strongest recommendations to those experiencing low back pain is to purchase a standing desk, which now creates a need yet again for those Gluteus muscles to stabilize the hip. We also frequently recommend performing exercises that target the Gluteus Medius, such as clamshells, bridges, sidestepping, side planks, as safe movements that re-introduce the patient to healthy activity while developing the musculature around the hip. 

To conclude, when treating low back pain, often a Physical Therapist elects to focus on establishing “core” strength by concentrating on the Transverse Abdominis and Abdominal Oblique muscles. Choosing to develop the Gluteus Medius is an alternative approach that many patients have experienced more relief than core work. If you’re someone who has no pain but is apprehensive about lifting, or if you are currently experiencing low back pain, the Gluteus Medius is a solid place to start. [1]

  [1] Jeong UC, Sim JH, Kim CY, Hwang-Bo G, Nam CW. The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients. J Phys Ther Sci. 2015;27(12):3813-3816. doi:10.1589/jpts.27.3813


Must Read If Your Are Considering Spinal Surgery

Are You Considering Surgery for Sping Pain?

In continuation of our last blog post on medical imaging in regards to spine pain, we continue with a look at using medication or considering surgical interventions for controlling symptoms.

Read the original blog post, click here.

So, what about medication to help with spine pain?

Because low back pain can be excruciating, many doctors prescribe opioids for pain relief. These are narcotics and include common brand names such as OxyContin and Vicodin. In the U.S., narcotics are currently the most commonly prescribed drug, and more than half of these prescriptions are for the treatment of low back pain.

Before deciding to use these prescription drugs, it is important to understand that they alter the chemistry within the brain and have the potential to become highly addictive. Opioid addiction is responsible for more than 14,000 death per year. In as little as two weeks, the body may develop tolerance requiring increased doses and leading to withdrawal symptoms once the medication is removed. Research does show that using opioids for a short time can provide modest pain relief (up to 30%).

However, opioids provide minimal to no improvement in function. In other words, these drugs have not been shown to expedite return to work or improve functional outcomes. Moreover, long-term use has been associated with worsening disability and increased sensitivity to pain (hyperalgesia). This is because long-term use causes a reduction in the ability to tolerate pain naturally, which may mean the pain is experienced long after the original cause has healed. Other side effects include constipation, nausea, sedation, increased fall risk, fractures, depression, and sexual dysfunction. Therefore, if you decide to use these medications, current recommendations include using the lowest possible dose for the shortest amount of time.

One viable alternative to opioids includes anti-inflammatory drugs (NSAIDS), as several high-quality studies have shown they are just as effective if not superior to opioids in reducing pain and improving function with much less risk or potential harm. 

Considering surgery?

Here’s why you should explore all options and consider physical therapy before making your decision:

Surgery is almost always a last resort. The preoccupation and misconceptions associated with disc herniation found on imaging have led to many unnecessary surgeries, sometimes resulting in even worse outcomes, particularly when the herniation is not the true source of pain. Surgery carries inherent risks of complications, including infection, bleeding, and the possibility of permanent nerve damage. Significant complications occur in approximately 20% of patients. Depending on the type of procedure, the surgeon may have to cut through bone, muscle, fascia, or ligaments. Even with successful procedures, these structures take time to heal and can potentially cause scar tissue leading to pain and restricting motion. Muscles may shut down temporarily and motion may be limited for a period, which may lead to additional pain and stiffness since healthy discs require the motion for proper nutrition. The stiffness and muscle guarding may also cause other compensations in motor patterns in an effort to protect the spine. This can cause undue stress to other tissues, ultimately leading to further pain and dysfunction. Likely, physical therapy will be prescribed post-surgery and it will generally take some time to regain full function.

What can conservative care offer me?

For all these reasons, surgery is generally recommended as a last option after all other conservative treatments have failed. Research has shown that long-term outcomes after an appropriate bout of physical therapy are generally equivalent to, if not superior to outcomes after surgery. In most cases, low back pain can be addressed and relieved via physical therapy, as research shows that that therapy leads to greater pain relief and decreased drug consumption. In fact, many insurance companies require a course of physical therapy and other more conservative measures before authorizing funds for surgery. This is because the evidence shows that addressing the issue with physical therapy is successful most the time, saving both patients and their insurance companies money and eliminating potentially expensive and debilitating complications. In addition, trying therapy first is never a waste because in cases where surgery is ultimately required patients who have completed “prehab” (therapy prior to surgery) ultimately have better outcomes and faster recoveries.

We hope this small series of imaging, medication, and surgery has cleared up some preconceived myths about low back pain.

At Fox Physical Therapy, our board-certified Doctors of Physical Therapy specialize in mechanical diagnosis and treatment of spine symptoms. Contact us today to find out how we can help you feel better.