Pilates and Chronic Low Back Pain - Part V: The Role of the Glutes
This last article in the series focuses on the role of the gluteal muscles in proper movement, their relationship to chronic low back pain and Pilates’ strategies to improve proper neuromuscular control of the glutes.
The gluteal muscles are muscles around our hip and buttocks. Gluteus maximus is a muscle that extends our leg or brings our leg backwards. Gluteus medius and minimus abduct our leg or move our leg sideways. All 3 muscles also have jobs in maintaining stability of our spine and pelvis in an upright standing posture.
Studies have shown that patients with chronic low back pain have dysfunction in one or more of the gluteal muscles. Cooper and colleagues showed weakness in the gluteus medius muscle; Kankaanpaa and colleagues showed the gluteus maximus fatigued quicker compared to subjects without low back pain and Leinonen and colleagues showed a difference in the timing of the gluteus maximus muscle during a forward bend and return to stand activity compared to subjects without low back pain. Often we see other muscles such as the low back muscles and the hamstrings trying to compensate for the dysfunctional glutes creating poor neuromuscular control (as discussed in previous articles).
In Pilates, we can use the equipment to help re-train the neuromuscular control of the glutes to do their “job”. For example, in this bridging exercise, the gluteus maximus muscle should be the main muscle lifting the hips off of the mat. In people with gluteal weakness, the hamstrings will compensate and become the main muscle working. On this equipment, we can set the springs such that the hamstrings have 1 job (to control the movement of the carriage) while the gluteal muscles have a different job (to lift the hips from the mat). If the client tries to use the hamstrings to do both jobs, the hamstrings will cramp and give the exerciser immediate feedback.
In this standing exercise, the gluteus medius and minimus hold the pelvis level and maintain the alignment of the standing leg while the gluteus maximus helps hold the upright posture. The gluteus maximus of the other leg pushes the carriage back. This exercise also is a great balance challenge.
1. Cooper N, Scavo K, Sluka K, et al. Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. European Spine Journal: Official Publication of the European Spine Society, The European Spinal Deformity Society, and The European Section of the Cervical Sine Research Society [serial online]. May 26, 2015; Available from : MEDLINE, Ipswich, MA. Accessed Feb 2, 2016.
2. Kankaanpaa M, Taimela S, Laaksonen D, Hanninen O, Airaksinen O. Back and hip extensor fatigability in chronic low back pain patients and controls. Archives of Physical Medicine and Rehabilitation [serial online]. April 1998;79(4):412-417. Available from: MEDLINE, Ipswich, MA. Accessed Feb 2, 2016.
3. Leinonen V, Kankaanpaa M, Airaksinen O, Hanninen O. Back and hip extensor activities during trunk flexion/extension: effects of low back pain and rehabilitation. Archives of Physical Medicine and Rehabilitation [serial online]. January 2000; 81(1):32-37. Available from: MEDLINE, Ipswich, MA. Accessed Feb 2, 2016.