When we graduated Physical Therapy school, we thought that strengthening the glutes was the answer to all of our problems. If in doubt, throw a band around the knees, and strengthen the glutes. However, once we began to understand the neurological strategies that humans use to move in a gravity driven world, and how these principles should guide our exercise prescription, things needed to change. A lot of therapists out there may find themselves strengthening the glutes of their clients without any quality assessment that guides this kind of rehabilitation. There are many outdated assessments that try to identify the “firing pattern” of the glutes in a prone position. However, this does not give us any insight into how the individual moves in the real world. If people walked down the street on their hips, it may have some relevance, but when we move in the real world, our foot is the first body part to hit the ground. The distribution of stress and load that travels from the foot, distal to proximal, guides what happens at the proximal tissues. If someone is experiencing knee pain, hip pain, or low back pain, are the glutes really inhibited? In fact, a lot of the research shows us quite the opposite. Many times, the glutes are doing TOO MUCH. This doesn’t mean going after the glutes is “wrong”, but we need to ask ourselves if they really deserve all the attention?
To appreciate this, we also have to also ask ourselves, how important are the glutes during everyday movement anyway? Not very. Many studies have shown that the glute muscles remain relatively quiet during walking, and even running. If we consider the neurological strategies that humans use when moving in a gravity driven world, a lot of those strategies unfold in a distal to proximal manner. When we’re babies lying on the ground, we haven’t yet mastered gravity, so we need to adapt by using a more proximal to distal strategy. We need to gain control over the movement of our eyes, our head, our spine, and then we slowly progress up onto two feet where things get a little crazy. Now you don’t have to wait for someone to give you that toy on the dining table. Now you can go and get it yourself. You begin to move and explore your environment in more complex ways. The strategies your nervous system uses to move shifts distal towards the movement direction of the hands and feet. As you build robustness, the proximal tissues/structures begin to take on more of a self-regulatory role, and respond to what the hands and feet are doing. This shift towards a distal to proximal strategy is an energy efficient strategy. Can you imagine having to consciously think about what your glutes are doing with every step you take? Unfortunately, many of our clients experiencing pain are told to do that. But, what if the solution doesn’t hinge entirely on strengthening the glutes? What if a large part of our approach shifted towards restoring that energy efficient distal to proximal strategy? What if our clients with back and hip pain are using too much of a proximal to distal strategy, and devoting too much conscious effort towards squeezing their glutes as they walk or get up from a chair?
Even if it was really worth considering the glutes as an “essential” component of gait, their role would be to decelerate our movement as we progress forward. The glutes are antigravity muscles, and from an IKN perspective, if we identify TOO MUCH activity in the glute muscles, the individual is probably not managing gravity well. They are fighting gravity. They may have lost the ability to allow the lower limb tissues and structures to cooperate well, and so we may see an increase in the protective tone around the hip. Many of us therapists see this, but is the solution to strengthen the glutes? Perhaps it’s a piece of the puzzle, but if we appreciate the complex nature of human movement, we need to allow for quality cooperation between many parts. We need to appreciate the role of the tissues and the neurological strategies used during locomotion.
We are certainly not saying that strengthening the glutes is a silly strategy, but we want to urge you to not blame only one muscle. The glutes have gotten enough limelight. It’s time for us to think about how the tissues and systems of our body are cooperating when helping someone restore pain-free and robust movement, instead of blaming isolated muscles. The nervous system organizes our movement around strategies, not what individual muscles are doing.