L1: What to prescribe them for part 1

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Summary text

What to prescribe them for

Overactive tensor fascia latae

Excessive activation of the tensor fascia latae during exercises may be detrimental in patients with excessive hip internal rotation.1 The tensor fascia latae is both a hip abductor and internal rotator. It can also exert a lateral force on the patella through its connections with the iliotibial band.4-6 A small study found that “patients with abductor tendon tears showed hypertrophy of the tensor fascia latae muscle when compared to the contralateral healthy side and to patients without a tear.”7

Hip pain

Tears of the gluteus medius and minimis have been associated with hip pain8 although evidence relating to hip abduction exercises and hip pain reduction are lacking.

Degenerative hip joint pathology

Atrophy of the gluteus maximus relative to the tensor fascia latae has been observed in patients with advanced degenerative hip joint pathology.1,9 These patients also demonstrate increased gluteus medius activation during stepping activities which is considered a compensation for weakness.10 Interestingly, in the early stages of hip joint pathology hypertrophy of the hip abductor muscles may be present and this should be considered when prescribing gluteal exercises.11

Lower back pain

Gluteus medius weakness and gluteal muscle tenderness are common symptoms in people with chronic non-specific lower back pain.12-14 There is some association between gluteus medius and maximus weakness and lower back pain.15-19 While limited information regarding the effectiveness of hip strengthening exercises for lower back pain exists there is some indication they may be beneficial.20

Sacroiliac joint pain

Shear in the sacroiliac joint according to one model is prevented by two factors: 

1. Form closure – joint anatomical features that increase the friction coefficient21-23

2. Force closure – Tension of muscles and ligaments crossing the joint that lead to higher friction and therefore stiffness22,24 

Muscles that could increase force closure include gluteus maximus and biceps femoris25-27 (due to their attachments to the sacrotuberous ligament), latissimus dorsi28 (due to its partial coupling with gluteus maximus by the posterior layer of the thoracolumbar fascia, creating a compressive force acting perpendicular to the sacroiliac joint) and the erector spinae29 (which are closely linked to the sacrum and posterior superficial sacroiliac ligaments). 

The erector spinae, biceps femoris and gluteus maximus muscles have been shown to have a significant effect on sacroiliac joint stiffness.22 Both the sacroiliac ligament30-33 and the long dorsal sacroiliac joint34-38 can be significant pain generators in those with pelvic girdle pain. Patients with sacroiliac joint pain have been shown to display a delayed onset of gluteus maximus on the stance leg during standing hip flexion compared with healthy subjects.39 Due to a lack of investigation it is unclear if exercises for the gluteals improve sacroiliac joint pain. 

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