Lower Back Pain
I often hear lower back pain (LBP) being a common and repetitive problem reported by many that walk through the clinic doors. LBP has been well documented clinically as a cause of high pain levels and function loss. A major joint of the lower back is the sacroiliac joint (SIJ). This joint, if compromised, can result in debilitating pain for many humans today who lead either sedentary or active lifestyles. During weight-bearing activities, the SIJ provides the link between the trunk and lower limbs for ground reaction forces. Load transmission is normal across the lower back and pelvis when the abdominals, back and leg musculature are activated properly. One muscle, in particular, found to have abnormal recruitment levels during SIJ dysfunction and general LBP is the underrated gluteus maximus (GMax). If LBP is only found to be on one side of the posterior pelvis, it is likely there is a weakness of the GMax on the same side and if pain persists equally across the lower back, both sides of the GMax may have altered recruitment patterns.
Gluteus Maximus Strengthening
In those with persistent LBP, it is clinically supported to ensure the inclusion of GMax strengthening exercises to help stabilise the SIJ through dynamic muscle activity. Through proper strengthening of this major muscle, delayed onset of activation is reduced and function is increased, thereby playing a major role in ensuring proper load transfer between spine and pelvis to the lower limb (1). There are many exercise options for the GMax that elicit high electromyographic activity that are also safe for those who have not exercised before or lead active lifestyles. Beginner options include side-lying hip abduction, gluteal squeezes, glute bridges, and forward and lateral step-ups. Progressions for further strengthening include a front plank with hip extension, side plank with hip abduction, single leg deadlift and a single leg squat (2).
1. Added, M. A. N., de Freitas, D. G., Kasawara, K. T., Martin, R. L., & Fukuda, T. Y. (2018). STRENGTHENING THE GLUTEUS MAXIMUS IN SUBJECTS WITH SACROILIAC DYSFUNCTION. International journal of sports physical therapy, 13(1), 114.
2. Boren, Kristen; Conrey, Cara; Le Coguic, Jennifer; Paprocki, Lindsey; Voight, Michael; Robinson, T. Kevin, International Journal of Sports Physical Therapy Sep2011, Vol. 6 Issue 3, p206