The term “glute amnesia,” originally coined by Dr. Stuart McGill, has been around for years, and a newer term “dead butt syndrome” has recently joined the ranks, but they basically mean the same thing: the glutes have forgotten how to work or “turn on.” But is it that they’ve forgotten how to work, or is it that they can’t get into a specific position in order to work? It’s a little bit of both. When you walk or run, your hip needs to go into extension in order for you to push off and propel you forward. This is an important job of the glutes. If you aren’t able to achieve hip extension, the glutes won’t activate. It’s like trying to do math on a calculator that doesn’t have batteries. It’s not broken, you simply need to give it what it needs in order to function.

We’ve collectively become a quad-dominant society because we lack hip extension. Is it from sitting too much? Possibly. Is it from not moving enough? Maybe.

Regardless of the reason, if we lack hip extension, the body will compensate and find alternative ways to achieve it. The body often recruits the lumbar spine, or lower back, for a lack of hip extension. When we can’t get our leg behind us during push off in the gait cycle, the lumbar spine extends or arches to compensate, which puts a lot of strain and compression on the lumbar spine.

The body can also recruit the adductor magnus, a muscle whose primary job is to adduct and internally rotate the hip, but it also helps to flex and extend the hip. You may hear of runners getting groin strains or what seem like hamstring pulls, but it may be the adductor magnus overworking. Yes, it is a hip extender, but it’s not its primary job. The hamstrings are also hip extenders, but again, it’s not their primary job. They’re also working much harder without the help of the glutes and may be susceptible to strains and injuries. The quadriceps can also compensate for a lack of hip extension, which may already be overworked leading to a myriad of other lower body and trunk issues. And lastly, the calves can be extremely overworked due to a lack of hip extension. That “push off” phase of the gait cycle will now rely heavily on plantar flexion of the ankle (pointing the foot) creating a “tightness” of the calf muscles and a lack of dorsiflexion (pulling the toes back). This can create plantar fasciitis, Achilles tendinopathy, and even specific knee issues.

So, what can we do about our lack of hip extension? It’s not enough to just strengthen the glutes, you have to re-introduce the body into hip extension and then strengthen and re-educate the glutes on a neuromuscular level in that new range. Otherwise you’re just strengthening the glutes in a limited range. You can squat 300 lbs. and have strong glutes, but it doesn’t necessarily mean you can get into, or utilize hip extension when walking or running.

We have to first develop mobility in the hip, IF NEEDED, in order for it to get into extension, and then we RE-EDUCATE the glutes and strengthen them in the new range.  Sometimes people have the available range of hip extension, but for whatever reason they don’t use it. These people don’t need mobility, just re-education. Start with prescribed stretches, IF NEEDED, and then exercises starting in side-lying, and then progress into prone, and finally standing for a more functional activity or task.

This week we’ll begin with some stretches to open up the front of the hip, specifically the iliopsoas and the rectus femoris, and then some side-lying exercises with progressions to re-educate the glutes into their new range.

At Beacon Physical Therapy, we support our patients in leading a healthy life and establishing a healthy lifestyle. We’d love to meet you and get you back to doing what you love.