Lower Back Pain Hip Pain Gluteus Medius

A person with lower back pain or hip pain often will limp with a lurch over to the side of the weight supporting limb every time he/she takes a step. This sign called the Trendelenburg sign is due either to pain and or weakness of the gluteus medius muscle. This duck waddle type of gait is characteristic of this muscle's inability to function well.

Gluteus medius arises from the outer surface of the pelvic bone called the iliac bone and attaches to the outer part of the hip. Its function is to spread the thigh outward away from the midline (abduction). This muscle receives very strong nerve supply from the L5 nerve root via the superior gluteal nerve. Since L5 nerve root is the most commonly injured nerve root, weakness and/or pain in the gluteus medius is common.

Usually, muscles that become weak and are prone to injury are those subjected to constant lengthening contractions rather than shortening contractions. Gluteus medius however does shortening contractions but is one of the muscles that easily become weak. Nerve related weakness of this muscle is common and is due to L5 spinal nerve root involvement from irritation related to presence of degenerative arthritis of the spine, slipped disc, bulging disc, etc.
A person with tightness of this muscle may sometimes hear a click as he/she walks and there can be significant hip pain. Treatment of nerve related muscle pain of the gluteus medius cannot be isolated to treating this muscle alone. The adjacent tensor fascia lata muscle supplied by the L5 nerve root whose function is exactly similar to that of the gluteus medius must be treated.
Pain and/or weakness of gluteus medius and the adjacent tensor fascia lata muscle is made more difficult to treat from the overpowering action of the hip muscles that bring the thigh inward such as the adductor magnus muscle in the inner thigh and the buttock muscle (gluteus maximus). Therefore at a minimum these two huge muscles as well as the lower back muscles must be included in the treatment.
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