By Dr Chris Ellis
First off, there are several reasons why weak glutes can cause back pain. This article will cover just one compensation that is probably the most common dysfunction that I see in the clinic: weak hip abductors and quadratus lumborum compensation.
These are neighboring muscles and have very similar roles. The hip abductors (gluteus medius and minimus) attaches the pelvis to the femur. The QL attaches the pelvis to the side of the spine and the bottom ribs. They both have an effect on lateral movements. Muscles can move in two directions; they can move the origin closer to the insertion or vice versa. In other words, the hip abductors can lift the leg laterally on a fixed pelvis, or the pelvis can lift on a fixed leg. If you have heard the terms opened chain and closed chain, it refers to exactly this concept. In standing (leg fixed/closed chain), the QL side bends the torso. Laying on your side (spine fixed/open chain), the QL lifts the pelvis towards your ear. By the way, the exercise where you grab a dumbbell and side bend to one side, works the QL muscle, not the obliques or love handles.
Let’s look at the relationship of these two muscles on the pelvis. The hip abductors lift the pelvis from a dropped position to neutral. The QL lifts the pelvis from a neutral position towards your ear.
These are subtle differences so it is very easy for the QL to take over where there might be a weak hip abductor. So why does this matter? Walking. For most of the gait cycle, walking is just a series of being on one leg. That means that the hip abductors role is to keep the pelvis level in every step you take. If they are not strong enough to support your torso, your hip will drop. There is a name for this, it’s called a trendelenberg sign. Think of the way runway models walk - this is nothing but a bilateral trendelenberg. This can also happen if you are fatigued, and that’s why longer walks can cause pain.
Notice the angle of the pelvis, easily
visible by the difference in the height
difference of her hands
So what causes pain? There are two culprits that we typically see. One affects the hip, one affects the back. It all comes down to your habit. You either do the runway model walk, or you use back muscles for compensation. If you do the runway walk and have pain in the hip, it’s probably bursitis. The weak hip abductor allows the hip to drop and then the pelvis pushes laterally into the bursa. On the other side of the bursa is the dense and fibrous IT band. The repetitive compression causes the bursa to inflame.
If the back is painful, it is probably due to the QL taking over for weak hip abductors. Either you use the opposite QL to lift your pelvis up as it begins to drop. Or you use the same side QL and lean away (think of a waddling gait). The QL’s primary role is spinal extension when both sides are activated. In other words, they are on when standing erect. If you give them another role when walking, they easily get overworked.
What’s the fix? Strengthen your hip abductors and be conscious of how you walk. Watch yourself walk in the mirror and make sure your belt line stays parallel to the ground. You can take a long ruler and lace it through your belt loops in the front and watch it as you walk. Or video tape yourself and watch it in slow motion.
To strengthen your gluteus medius and minimus, you can start off with hip abduction. It’s easier in standing, so start there and work on technique. Make sure your pelvis stays parallel to the ground. When you get the technique, you can lay on your side and do lateral leg lifts. It’s harder on your side because gravity now has more of an affect on your leg. Then you can easily load the leg with ankle weights or bands. As the strength improves, it should take less effort to keep your hips parallel when you walk.
The picture on the left is correct, the picture on the right is with QL compensation and to be avoided
Learn how to mobilize the hip joint and stretch the surrounding muscles. If you are feeling stiff and feel like your hips are limiting your movement, this is the class for you. You'll need a foam roller, a lacrosse ball, and a mobility band. Plan on 30 minutes for class.