Aerial Glutes: Could they be the Culprit of your Back, Knee, or Ankle Pain? Part 1

Do you have Back Pain? Knee Pain? Ankle Pain? : Let’s Have an Open Discussion about those Aerial Glutes. A lot of patients come to our clinic complaining of knee/ankle/back issues and are surprised when we start examining the hip muscles. Remember that catchy children’s song “the hip bone’s connected to the ankle bone?” Well, a guiding principle here at SPARK is the idea that body parts do not exist in isolation and dysfunction in one part can cause symptoms in another part. To get a little bit more technical, the literature has connected patellofemoral syndrome (a type of knee pain), ankle sprains, plantar fasciitis, and low back pain with weakness in the hip musculature, particularly the gluteus medius. [i],[ii],[iii],[iv]

In anatomical lingo, the gluteus medius is responsible for hip abduction (moving the leg out to the side) and for stabilizing the pelvis in the horizontal plane. When you are standing on one leg the gluteus medius fires to prevent the pelvis from dropping on the other side. Weakness in the gluteus medius can lead to knee valgus (“knocked knees”), overpronation at the foot (aka : a “collapsed arch”), and problems with pelvic alignment. (As a side note, we also have a gluteus maximus and a gluteus minimus – but that’s a topic for another day).

For the gymnast and acrobat, strong glutes translate to improved jumping/landing mechanics, cleaner vaulting, and smoother front and back handsprings. For the aerialist, it means improved inversions, straddles, front balances, windmills, and fan kicks (just to name a few things). Strong hips translate to more efficient mechanics, better performance, and decreased risk of injury.

So how does one go about strengthening the gluteus medius? If you type in “gluteus medius strengthening exercises” in your browser, Dr. Google will give you a variety of exercises to target this area. The most popular exercises include side-lying leg raises and clamshells. Sure, these moves are great “primers” and according to EMG studies ask for the right muscle to “turn on”[v] — but are they very “functional?” It’s great that your gluteus medius can fire when you’re lying on the ground and lifting your leg — but can it fire in cooperation with other muscles when you are in the air hanging from a silk or trying to nail a clean round-off in gymnastics? This is where the eye of a trained professional such as a physical therapist can come in handy to assess individual patterns of weakness, provide interventions that carry over to the demands of our unique art form, and improve efficiency for the aerial/acro mover.

Hungry for how you can maximize your aerial performance? Tune in to my next blog post where I will share some of my favorite functional glute exercises to challenge those glutes in different planes and under specific demands.

[i] Meira EP, Brumitt J. Influence of the Hip on Patients With Patellofemoral Pain Syndrome: A Systematic Review. Sports Health. 2011;3(5):455-465. doi:10.1177/1941738111415006.

[ii] Friel K, McLean N, Myers C, Caceres M. Ipsilateral Hip Abductor Weakness After Inversion Ankle Sprain. Journal of Athletic Training. 2006;41(1):74-78.

[iii] Bolgla LA, Malone TR. Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice. Journal of Athletic Training. 2004;39(1):77-82.

[iv] Cooper, N.A., Scavo, K.M., Strickland, K.J. et al. Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls.  Eur Spine J (2016) 25: 1258. https://doi.org/10.1007/s00586-015-4027-6

[v] Macadam P, Cronin J, Contreras B.  An examination of the gluteal muscle activity associated with dynamic hip abduction and hip external rotation exercise: a systematic review.  International Journal of Sports Physical Therapy. 2015;10(5):573-591.

Dr. Natalia M. Sleziak, PT, DPT

Performance Physical Therapist/Aerial Performance Specialist

Dr. Sleziak received her Doctorate of Physical Therapy from Thomas Jefferson University in Philadelphia, PA and her Bachelor’s in Psychology from Muhlenberg College in Allentown, PA. She obtained her dry needling certification through the Spinal Manipulation Institute and is fully certified in the Graston Technique. Natalia has a strong interest in working with the aerialist, acrobatic, gymnastic, and dance populations. She herself is an avid aerialist and actively practices silks and aerial lyra. Natalia enjoys keeping her exercise routine varied and stimulating through weight lifting, tumbling, and parkour. She places a strong emphasis on individualized treatment/fitness plans that cater to each client’s goals, interests, and lifestyle.