What is ‘Gluteal Amnesia’?

Have you heard of the term ‘gluteal amnesia’? Decades ago, a renowned clinician named Vladimir Janda began to notice certain patterns in patients with back pain, specifically he noticed that these patients had signs of inhibited weak glutes. Now at the time, there was little research to back up his theories as to why this occurred, but in recent years this has changed. Research now shows that pain can often inhibit the activation of your glutes. 1-4  

In 2013 Dr. Stuart McGill and his team observed this happening in real time.1 They started by measuring glute activity by having study participants perform glute bridge exercises. They then performed a therapeutic procedure called capsular distension arthrogram (which instantly created a ton of pain in their hip joint). When immediately retesting the bridge they found the activity of the glute max on the side of the painful hip to be significantly reduced. This phenomenon has been termed by Dr. Stuart McGill as “gluteal amnesia.”5

It’s not that the glutes turned off completely, but instead ‘gluteal amnesia’ means the brain is diminishing neural drive and inhibiting the glute muscles from firing appropriately due to pain (a process called arthrogenic neuromuscular inhibition).

Here is a test to see if you may dealing with ‘gluteal amnesia.’ The goal is to see how your body coordinates the movement of hip extension (the same movement that occurs at your hip joint when you stand up from a squat, pull a barbell from the floor or propel your body forward during a sprint). For a back to remain healthy when lifting heavy, your hips must have the ability to generate the appropriate amount of force and fire at the appropriate time (called an optimal muscle recruitment pattern). This screen looks into just that and assesses how the muscles that surround your hips (primarily your glute max) work with the low back.

While lying on your back with your knees bent, straighten one leg and perform a single leg bridge. Hold your hips in the air for 10 seconds and feel for what muscles are working hard to keep you up and if this movement brings out any back pain.

Uni Bridge

What muscles were working hard to keep your hips up? If it was anything other than your glutes (butt muscles) as the primary muscle group, you have a coordination issue in how your body is producing hip extension (aka gluteal amnesia). 

Did this movement produce back pain? As you bridge on one leg, this pain is a response to the uneven forces that are being placed on your back. This is often due to the inability of the glutes to kick on appropriately and contribute to hip extension, which means the erectors of your low back have to pull double time. When this happens a ton of force is placed on the spine, which leads to the pain you felt.

If this was you, try to now perform a double leg bridge.

The Bridge

Step 1: Lie on your back with your knees bent as shown.

Step 2: Squeeze your butt muscles FIRST and THEN lift your hips from the ground. Squeeze your glutes as hard as you can for five seconds before coming back down.

Bridge.png

If your hamstrings start cramping, there are two modifications that can help. First, bring your heels closer to your hips. This shortens the length of the hamstrings and puts them at a disadvantage to contribute to the movement (a concept called active insufficiency).6

You can also jam your toes down into the ground and think about pushing your feet away from your hips. This will “turn on” your quads slightly which in turn will decrease hamstring activity (a concept called reciprocal inhibition). The only muscles left to create hip extension with the hamstrings out of the picture is, you guessed it, the glutes!

Recommended sets/reps: 2 sets of 20 for a 5 second hold. Eventually work your way up to 10-second hold.

If you still notice back pain when performing the bridge with the prior cues, try this modification. Position yourself with your head near a wall and push your hands into the wall prior to performing the bridge. Pushing into the wall engages the core thereby increasing efficiency of the bridge and hopefully decreasing pain.

If your pain decreases after performing a double leg bridge, this demonstrates that you need to incorporate glute exercises into your rehab program. Strengthening and re-coordinating the glutes to eventually be able to single leg bridge with proper glute activation will be an integral part of your rehab program to help re-establish a proper muscle recruitment pattern). I recommend using these exercises not only as a foundation for your rehabilitation from back pain but also as a part of your weekly training program to prevent future injury once your symptoms have resolved.

I hope this quick blog was able to help you better understand the idea of ‘gluteal amnesia’ and how you can take the first steps to restoring optimal muscle recruitment patterns in your body!

If you would like to listen to Dr. Stuart McGill speak on gluteal amnesia on the Squat University podcast, check out this link below…

Until next time,

Author Photo
Dr. Aaron Horschig, PT, DPT, CSCS, USAW

with

Kevin Photo
Dr. Kevin Sonthana, PT, DPT, CSCS

References

  1. Freeman S, Mascia A, McGill SM. Arthrogenic neuromuscular inhibition: a foundational investigation of existence in the hip joint. Clin Biomech. 2013; 28:171-77.
  2. Bullock-Saxton JE, Janda V, Bullock MI. Reflex activation of gluteal muscles in walking. An approach to restoration of muscle function for patients with low-back pain. Spine. 1993;18(6):704-8
  3. Leinonen V, Kankaanpaa M, Airaksinen O, Hannien O. Back and hip extensor activities during trunk flexion/extension: effects of low back pain and rehabilitation. Arch Phys Med Rehabil. 2000;81(1):32-7
  4. Nelson-Wong E, Alex B, Csepe D, Lancaster D, Callaghan JP. Altered muscle recruitment during extension from trunk flexion in low back pain developers. Clin Biomech. 2012;27(10):994-8
  5. McGill SM. Ultimate Back Fitness and Performance (4thed). Waterloo, Canada: Backfitpro Inc, 2009. (backfitpro.com)
  6. Olfat M, Perry J, Hislop H. Relationship between wire EMG activity, muscle length, and torque of the hamstrings. Clin Biomec. 2002;17(8):569-579

Published by

Dr. Aaron Horschig

Doctor of Physical Therapy, CSCS, USAW coach and athlete.

Leave a Reply