Gluteus Medius
The Main Hip Abductor
| Muscle | Origin | Insertion | Innervation | Action |
|---|---|---|---|---|
| Gluteus medius | Ilium | Greater trochanter (lateral surface) | Superior gluteal n. L4 - S1 |
Entire mm.: Abduction, Frontal stabilization Anterior fibers: Flexion, IR Posterior fibers: Extension, ER (when <60° HF), IR (when >60° HF) |
Origin
Ilium (gluteal surface below the iliac crest between the anterior and posterior gluteal line)6
Insertion
Greater trochanter of the femur (lateral surface)6
Innervation
The gluteus maximus muscle is innervated by nerve roots L4, L5, and S1, via the Superior gluteal nerve6
Action
- Entire muscle: abducts the hip, stabilizes the pelvis in the coronal plane6
- Anterior fibers: flexion and internal rotation6
- Posterior fibers: extension and external rotation6
- At ≥60° hip flexion, the posterior fibers of the gluteus minimus switch and produce an internal rotation torque4.
The Glute med is the “main hip abductor” due to its efficiency and strength. The Glute med is efficient since it is almost perpendicular to its lever arm7.
The glute med and glute min are both oriented mostly in the frontal plane, but the glute med is a greater abductor since it can produce ~16kg of force, which is more than 3x that of the gluteus minimus7.
The glute med’s insertional angle on the greater trochanter varies with degree of hip abduction7. At neutral, the angle is not perpendicular, thus the force generate by the glute med results in a hip abduction moment and joint compression which increases articular contact7.
As the hip moves into abduction, the insertional angle becomes more perpendicular, resulting in a greater hip abduction moment and decreased hip joint approximation force7. This trend continues until the hip reaches 35° abduction, which is exactly perpendicular7.
Overview
Palpation
- Position the patient in sidelying8
- Much of the glute medius and minimus overlap, but you can isolate the gluteus medius by palpating the most superior part of the iliac crest8.
- The glute med’s proximal origin extends from the PSIS almost to the ASIS8.
- The fibers of the glute med and min are fanned across the iliac crest then converge distally at the greater trochanter of the femur8.
- To palpate the gluteus minimus, dive deep to the the gluteus medius
- Having the patient actively abduct the top leg will help confirm that you are palpating the correct muscle8.
Tests & Measures
- External Derotation Test (gluteus medius tendinopathy)
Exercise
A wedge forcing the foot into hyper-dorsiflexion will cause the client to prevent excessive anterior knee translation and force more hip hinge, which will activate the glutes.
- Single leg bridge (with 90° knee flexion and pushing through the hindfoot)
- Wall triple extension
- Bridge (toes up)
- S/L Hip abduction to high knee