Gluteus Medius

[Catrin]

Apparently my gluteus medius are quite weak, which is why I am starting to have pain while walking in one hip, and I guess it doesn't help that the piriformis muscles are tight (both sides). Thankfully neither bike nor spinning bike causes pain - and between my PT and trainer we will be able to reverse this.

What I don't understand is how this snuck up on me - it isn't like I haven't been very active for the last 1.5 years and have been doing a lot of walking and strength training :confused: :( Oh well, I guess that just means I am no longer 30, or even 49...

[OakLeaf]

very very common, especially in women. If you're not doing something with a lot of lateral movement, like board sports or yoga, pretty much everyone needs to target the hip stabilizers directly.

[Catrin]

very very common, especially in women. If you're not doing something with a lot of lateral movement, like board sports or yoga, pretty much everyone needs to target the hip stabilizers directly.

Thank you, I didn't know that and knowing that it is common really does help. I have started a Saturday morning mat pilates class - at least until riding season starts up. From what my new PT has told me, pretty much everything attached to my hips are weak. Guess it is just a case of our bodies letting us know that they need some attention!

[OakLeaf]

I like Pilates, but I think that it really overemphasizes spine flexion and movements in the sagittal plane. Not sure how much it will help your issues...

[Catrin]

I like Pilates, but I think that it really overemphasizes spine flexion and movements in the sagittal plane. Not sure how much it will help your issues...

I see what you mean - I don't know too much about Pilates so had not realized that. My new PT explained about the sagittal plane the other day so I've a better understanding. We DO have a power yoga class on Saturday mornings as well, it only costs $8 a session. I will check into it...

[indysteel]

I developed gluteal amnesia and weak glutes notwithstanding an active yoga practice. That's not to say yoga is a bad idea, but I'm not sure how much it will help you either. I'd just ask your PT for some exercises you can do at home as a good starting place.

[indysteel]

I should clarify that there are yoga poses that can be used to target any of the three gluteal muscles. If you knew how to do them on your own, they could be helpful. In a class setting, however, you might be unable to do the reps of the pose or hold the pose long enough to get what you need. Plus, some of the poses (like half moon) that could be helpful take a lot of practice to perfect to the point that you can truly focus on the glutes.

So, while I think you could benefit generally from yoga (although I cringe a the name "power yoga"), I think you might be better off just doing some exercises at home or with your personal trainer.

[KnottedYet]

I am starting to have pain while walking in one hip,

Did you ask your therapist why this new symptom appeared now?

Weak muscles do not suddenly arise. They are a gradual phenomenon.

My vote is still lumbar derangement. Ask your PT to rule out "anterior derangement." Tell him nothing less than full RFIL and RFIS for a minimum of 20 reps, make him earn his Cert. MDT. Then tell him if he rules out anterior, he must also rule out lateral relevant, both weighted and unweighted. (and no, women DO NOT need to show a lateral shift to be lateral relevant; and women do NOT always have classically centralizing/radicular symptoms. A woman can have massive hip symptoms and little to no low back and still be a lumbar derangement... and if he doesn't know that, it's about time he learned.)

Tell him I'm watching...

[Catrin]

The pain in the hip started when seeing the other physical therapist. My new therapist thinks it is from the weak muscles - and apparently one of the stretches the first one was having me do was not helping and may have actually made things worse :mad: It WAS hurting a lot more at night, but that has greatly improved over the past few weeks.

Last night I wanted to put some time in on the Arc Trainer after meeting with my trainer - and my hip only tolerated 15 minutes before it started hurting :(

Thankfully it doesn't seem to matter how long or how hard I work it on the spinning bike - no pain at all - which bodes well for that bike deposit I am putting down tomorrow. It is also true that I've no discomfort when I am strength training - if we do an exercise that causes the hip to complain, it stops immediately upon completion of the exercise (assuming it was an exercise focusing on my hips - if not the exercise stops as soon as pain presents itself).

Oakleaf and IndySteel, thank you for your comments on the classes. The point of Pilates, at least for me, is core work. I've been told that my lower abdominal muscles are weak as well - though the upper ab. muscles are fine - and my lower back where everything attaches is also weak. Would the mat Pilates class help with any of that?

I've heard good things about the 90 minute "power" yoga class - but I don't know if those reporting know yoga outside of that class... They do tend to give creative names to classes at my club. Just to be safe, I will avoid the yoga class and focus on the exercises given by PT and trainer.

Knotted - thank you for your thoughts, I will take your suggestions to my PT when I see him tomorrow. I have asked him why this is all turning up now, when my over-use injuries are healed. He thinks at least part of the weakness came from the protracted healing period - while it is true that I went from REALLY working my lower body to only doing upper body work for almost 4 months, is that really long enough to create such weakness?

While I have been active for the last 1.5 years, it is also true that most of my life has been quite sedentary and I was much larger than currently.

Enough rambling, thanks!

[OakLeaf]

Here's my thoughts about Pilates, especially given Knott's opinion about your spine.

Not-very-expert Pilates instructors aren't well trained in recognizing when their participants are in neutral spine and when they aren't. They'll tend to put participants in imprint/C-curve more than they ought to, because when your legs are in the air, it's a lot easier to stabilize the spine if you flatten it against the mat, and you definitely don't want your spine flopping around when you're doing the movements. So rather than closely observe the participants and limit each one to what she can do in neutral, the instructors will put everyone in imprint and let them flail away.

Add the fact that classical Pilates has a lot more exercises in spine flexion than extension. Add in an aging pool of group fitness instructors :rolleyes: who mostly came from the aerobics boom of the 80s when everything was "suck and tuck." Add in that most people these days are sedentary outside of their "exercise" activities, sitting in chairs with their pelvises tilted posteriorly and their lumbar spines collapsed back. What you get (what *I* got) is a severely flattened lumbar spine. I see it in lots and lots of people now that I'm learning to know what I'm looking at.

That's why yoga has been so wonderfully exactly what I've needed. Seriously, I'm getting better, but I really have to use some muscle to get my spine into neutral, and it "feels" like I'm putting a huge arch in my back. But I really can't generalize from my experience, because just as I've pretty much only done Pilates with poorly trained teachers and/or from videos, I've pretty much only done yoga with amazingly good teachers. So I can't say that with equally trained teachers, one is better than the other.

But I do think that when you have a potential undiagnosed spine misalignment, a gym Pilates class is a bad idea. Find out what certifications the teachers have. Sometimes you do get a really well trained teacher in a gym - someone who doesn't need to get a return on their investment and just wants to spread the love. But it's pretty unusual.

[Catrin]

Oakleaf - thanks for your thoughts on this. I know that we have one Pilates teacher who also teaches at private studios. She subbed this last Saturday and she was constantly giving variations for beginners, intermediate and advanced students and she wasn't adverse to walking around and looking at everyone to make certain they had proper form. She is probably the most qualified, but her usual class is when I am at work :( Oddly enough, I avoid her spinning class as it is total chaos, but she was totally different in her Pilates class.

I digress, I will avoid our gym Pilates class for now and work with my PT to determine if I do have a misalignment in my spine. We certainly need to figure that out if I do, for sure, and then go from there.

I did send an email to my new PT where I copied/pasted Knotted's suggestions. It may be that he has already done as she suggested - but as I don't know what it is that she suggested I don't know :)

[NbyNW]

I completely agree with Oakleaf re large gym Pilates classes.

It is possible to get some gluteus medius work into your Pilates, but this may or may not be addressed in such a large class.

The next to last paragraph in this article (http://www.ultimatepilatesworkouts.com/blog-pilates-and-glues-workout.aspx) talks about working the gluteus medius with the side kick series. Your PT will likely give you some variations on these exercises, perhaps using Therabands or squeezing a ball between your knees.

Also, many of the exercises that will engage the gluteus medius are standing exercises or performed on apparatus, so you won't encounter them in a mat class. Here is an article by a Pilates instructor with a PT background -- in the last 3 paragraphs (http://www.ptproductsonline.com/issues/articles/2006-11_03.asp) she describes her approach to weak gluteus medius.

I really got into doing the standing exercises when I started doing Pilates after being discharged from PT. These were emphasized for me in the context of private sessions, which was what I needed at the time. Privates can be pricey, but if the instructor is good, it is well worth it.

[Catrin]

Out of curiosity - are there any Yoga DVDs for beginners that might be useful for me? I do not want to make matters worse, but if there is something I can do at home (during this delightful winter weather) that might help me to mix things up... I know there are a wide range of such things available, and I do not know how to separate the good from the mediocre from the bad.

Thanks for the links!

[OakLeaf]

As a newbie yogini, here's one that I like a lot:

http://www.anusara.com/index.php?page=shop.product_details&flypage=flypage.tpl&product_id=2549&category_id=24&option=com_virtuemart&Itemid=142

Doing the whole thing in one session would be pretty difficult for a beginner. Best to choose a few poses and skip through.

[NbyNW]

I find the various exercise card decks out there to be very helpful. There must be a couple out there for yoga. I like that you can pull out the cards that focus on things you want to work on and just do those.

I've got a deck for my Swiss ball and another for Pilates. I made up my own PT deck when I was doing PT. Somehow for me, working through a deck of cards was a little easier than a list.

[Becky]

I like Zyrka Landwijt's style, and most of her stuff is well suited to beginners.

Esther Ekhart (yogatic.com) is another favorite.

[Catrin]

I've a friend who went to the 90 minute "power yoga" class this past weekend to check it out, and she does know yoga. She really liked the instructor. He paid close attention to everyone, and he corrected her position a few times. The reason the class is so long as that it also includes meditation (perhaps this is usual?) and apparently they stayed in some of the positions for 10 minutes. Is this common? She really liked the class, but I don't know how to process what I hear because I do not know anything about it...

[indysteel]

I've a friend who went to the 90 minute "power yoga" class this past weekend to check it out, and she does know yoga. She really liked the instructor. He paid close attention to everyone, and he corrected her position a few times. The reason the class is so long as that it also includes meditation (perhaps this is usual?) and apparently they stayed in some of the positions for 10 minutes. Is this common? She really liked the class, but I don't know how to process what I hear because I do not know anything about it...

Ten minutes? Depending on the pose, this is not typical, but there are types of yoga where you do hold the poses for a long time. IME, it's not easy, and it's not very everyone (it's not for me).

Try the class. Just don't expect it to necessarily address your glute issues. Just go easy. The last thing you need is to injure yourself in some other way.

[Becky]

OMG, I couldn't hold a pose for 10 minutes if I tried. I just don't have the mental focus to do anything for 10 minutes.

I will say....I don't think of 10 minute poses when I think of "power yoga"....

[Melalvai]

I was having hip pain when I walk, and someone told me it might be because I slouch over a bike or keyboard all day. I made a conscious effort to straighten up, and my hip never hurts now. I discovered that it's all in my head position. If I tuck my chin in because there's snow in my face, my hip hurts, when I put my head high, the hip is better and my face stings with snow (so I wear a balaclava for walking)!

[indysteel]

OMG, I couldn't hold a pose for 10 minutes if I tried. I just don't have the mental focus to do anything for 10 minutes.

I will say....I don't think of 10 minute poses when I think of "power yoga"....

If I held a pose for 10 minutes, it would be "weak and defeated" yoga. I've been to classes where poses are held for a few minutes each, and it's friggin' hard. Think of holding your arms in Warrior II. It hurts.

[OakLeaf]

I'd tend not to believe it either. I've never done yin yoga, so I started looking around on the internets, and I couldn't find anything that talked about holding a pose longer than 5 minutes in a class setting. There were a couple of teachers who talked about staying in some poses longer, in their home practice, but that was it. Outside of yin practice, I've never heard of holding a posture anywhere near that long. Seriously, in a 90-minute class, that would mean eight asana plus a little warmup and shavasana. I don't think so.

Different teachers include different amounts of standalone meditation. AFAIK a practice should always finish in corpse pose (shavasana), which is a meditation.

In other news ... this ties in here and also with shootingstar's thread - I think I'll crosslink ...

I've been making great progress with my headstands in the past week, not least because I've been doing them when the class is doing another pose that my wrist isn't ready for.

It's really become clear to me that neutral spine is key to inversions. When we're right ways up, we can use all the muscles that we've developed over time to hold us cattywampus. Not so much when we're upside down - especially for a newbie who probably doesn't have too many upside-down-holding muscles. :p I have to rely quite a bit on balance, and if the column of my body isn't vertical, I'll go right over.

Nothing has made it more clear to me how flattened my lumbar curve was, than headstands (and handstands at the wall, when I was doing them, and it won't be long before I can do them again). To keep in balance, I've got to do what at first felt to me like really arching my back. But the way my spinal column supports my whole body, and my pelvis supports my legs, makes it very clear that that is neutral. I'm getting some better flexibility, starting to feel more natural, learning to keep it in my body when I'm right ways up.

This is really huge for me, and it's making me very happy right now. :)

[Becky]

Oh absolutely! There's not much in yoga that I could do for 10 minutes (maybe shavasana ;)), but my brain gives in even sooner than my body.

I wonder if I could even hold tadasana (correctly) for that long...

[Catrin]

She may only have meant the final pose at the end of class...and it might have just FELT like 10 minutes :) Anyway, I will give it a shot at some point soon. I see my PT today so hopefully we can figure some of this out. Had lumbar stiffness during spinning class last night - my tail bone was aching. It has done that before, but not often.

Melalvai, I do catch myself slouching more than I realize, so will work on this as well. Everything is connected, for sure.

I have been told that my spine doesn't have as much curve in it as "normal" by one of the other personal trainers when I first joined my sports club. Indeed he was surprised that I didn't have back pain...

[OakLeaf]

You probably remember this, but here this past spring and summer I was having pain and spasm in one glute medius. Knott thought it was coming from my spine, and taught me a quick fix to try, which helped about 85%.

Y'know what the fix was? Hip and lumbar extensions, repeated every two hours. Restoring that normal lumbar lordosis, getting my pelvis out of posterior tilt.

The other 15% got fixed with half moon pose (ardha chandrasana).

I'm just sayin'...

[Catrin]

You probably remember this, but here this past spring and summer I was having pain and spasm in one glute medius. Knott thought it was coming from my spine, and taught me a quick fix to try, which helped about 85%.

Y'know what the fix was? Hip and lumbar extensions, repeated every two hours. Restoring that normal lumbar lordosis, getting my pelvis out of posterior tilt.

The other 15% got fixed with half moon pose (ardha chandrasana).

I'm just sayin'...

I don't remember this, but if'en it worked for you.....hmmm. I have tried to figure out what "lumbar lordosis" might be but am unsure what it is. Is it something like alignment? I will look for that thread from the summer, thanks for the reminder!

[OakLeaf]

I don't remember this, but if'en it worked for you.....hmmm. I have tried to figure out what "lumbar lordosis" might be but am unsure what it is. Is it something like alignment? I will look for that thread from the summer, thanks for the reminder!


Lordosis just means curvature with an anterior apex ... a normal spine has lumbar and cervical lordosis, a swayback is hyperlordotic. What I'm working on with mine is hypOlordosis, a flattened curve.

The opposite is kyphosis, curvature with a posterior apex. A normal thoracic spine has a curve in that direction, but you don't usually hear it called kyphotic unless it's abnormally exaggerated, like a dowager's hump.


What Mel said about the neck curvature is good, it is all connected. Visualizing that you're hanging from the ceiling by a string through the crown of your head helps align your spinal column. It's basically feeling your balance and letting the bones come into alignment by themselves, just as I've been doing upside down.



ETA - I guess it would be more correct to say ventral and dorsal, not anterior and posterior, since many four-legged critters have the same spine curvature, and it's not unusual for dogs and horses to get hyperlordosis.

[bluebug32]

As someone who tends to overdo it, looking for a quick fix to a problem, I would just advise you to take some caution when starting something new, like yoga. Yoga is strangely deceptive. Most people think it's "just stretching," but I know a lot of people who are injured in a yoga class because they decide to push a little further. And if you're competitive, it's very hard to sit back while others go into the advanced form of a pose or hold something longer than you're comfortable with.

Are there any classes for beginners? Or any beginner dvds you could try?

[OakLeaf]

That's very very very true.

One thing I would be hyper-attentive to is instruction that *starts* gently, and then shows more advanced yogi how to progress - not a teacher who starts with a classical pose and *then* gives modifications to beginners or people with injuries, less flexibility, etc.

There was one teacher in particular at my studio that I learned I just could not do his class. He would give lip service to only doing what you can and not getting hurt, but he would START in a fairly tough place and invite people to back off if they needed to. I never felt I needed to ... until I came out of the pose with a muscle strain. :rolleyes: Like, every single time I did his class.

[indysteel]

Catrin,

I just took a look at your gym's yoga/pilates schedule. I saw an "Andrea B" on there for reformer. I have to wonder if that's the Andrea Bergeman that head's up my yoga/pilates studio's reformer program. If so, I've heard really good things about her (although I have no direct experience with her other than in passing). Some of the other names make me wonder, too. Granted, it could be nothing but a coincidence, but there is some overlap in teachers in Indy because no one studio or gym offers enough to employ them full time. In any event, if Andrea B is Andrea Bergeman, you might reach out to her for some suggestions as to what pilates or yoga classes, if any, might be suitable for you given your current issues.

But I also tend to agree with Bluebug to some extent. I'm not sure adding something new right now is a great idea, unless you get your PT to sign off on it with some specific instructions.

[Catrin]

Ahhhh, pain free for now, delightful :) Saw both trainer and PT today, and one might think that I would be sore considering what they do to me, but I feel ever so much better! My trainer had been able to incorporate some of my PT suggestions.

As it turns out, on our initial evaluation visit he was able to rule out spinal derangement of any kind. I had sent him an email with Knotted's suggestions and he took some time when we started today to explain what he had already done, he took my question quite seriously. I also found that he is involved in a national McKenzie research project and is being published this month, interesting.

In the course of our session today my hamstrings started hurting again when I bent over, and we tried an experiment. When I bent over normally it did get my hamstrings attention. When I did the same thing but carefully kept as straight a back as I could - there was not the slightest bit of pain :) 5 hours later I still don't have any pain, any where :) Apparently my life-long habit of bad posture is having at least part of this...

Both he and my trainer have given me more exercises, and I will keep it up. PT things that Yoga would be more helpful over Pilates right now, but he thinks it is fine for me to start up either of them.

[KnottedYet]

In the course of our session today my hamstrings started hurting again when I bent over, and we tried an experiment. When I bent over normally it did get my hamstrings attention. When I did the same thing but carefully kept as straight a back as I could - there was not the slightest bit of pain :)

Posterior lumbar derangement.

Excellent, keep the good posture FOREVER!

With this very clear indication of a posterior derangement, I assume the PT is having you do the exercise Oakleaf described (backward bending). Keep doing that every 2 hours and as needed until you've been painfree for a week. Even if you get bored!

Keep the good posture forever and for always!

(I'm sure the PT explained to you that if you can control the pain by the way you manage your BACK during movement, then the issue is clearly not your hip nor your gluteus medius nor your hamstring.)


ETA: don't get too excited about this: "I also found that he is involved in a national McKenzie research project and is being published this month, interesting." They published my research too, and it even got presented at the big McKenzie shin-dig in Rio de Janiero. If they'll publish me... they'll publish anyone...

[Catrin]

Yes, he did explain that my current pain isn't in my hamstring - he also said that my core strength/stability is quite weak and is a contributing factor - he then proceeded to prove it :o He is using more than McKenzie to treat me as he thinks that there are multiple things going on and that he needs more than one tool to treat me. It is only the hamstring pain that is controlled by the way I manage my back - the OTHER pain (hip) is predictable and doesn't change with the position of my back when it comes. The hamstring never was predictable once the over-use injury healed.

He did recommend the backwards bending - and other exercises as well. The two abdominal surgeries that I have had certainly has a role in the core strength issue, and decades of horrible slouching posture can't have helped :o I am encouraged by how I feel after our sessions - regardless of whatever torture he may have applied during that hour. Second session today and I still feel better 12 hours later.

I will certainly take your recommendation about doing the exercise every 2 hours until I am without the pain for a week - and I greatly appreciate your input!

Edited:
I should note that the pain in the left hip is there when I rise in the morning (most of the time) or (half of the time) when I start walking. It does go away when I start doing more - however it really dislikes the Arc Trainer (stride is probably too long). It does seem centered on the gluteus medius and doesn't hurt elsewhere in the leg.

I should further note that the exact location of the hamstring pain yesterday at the PT was only at the exact spot where it attaches at the top - no further down. As you noted, the fact that bending over with a very straight back and spread out arms (eventually bring my hands down to touch the ground - proves it isn't really the hamstring. Have already started the recommended lumbar extensions...and am going to check out my beginner yoga options as well.