Train your buttocks to fix your knee pain
At first glance the influence of the gluteal muscles on knee health is everything but obvious. However, if you scrutinize the function of the gluteals closely, there will be a big aha-moment. In short, the gluteus maximus and posterior fibers of the gluteus medius are responsible for producing hip external rotation and abduction (moving the leg to the outside as in side-lying leg raise). Both are vital for knee health and here is why.
How your gluteals fix your knee pain
Since the gluteals can produce external rotation and abduction they can also resist internal rotation and adduction of the hip. Remember the picture on the right from our brief look into internally rotated femurs? If you look at rendering (B), you can see exactly the kind of situation good gluteal function (i.e. a healthy butt) can prevent you from getting into.
By preventing the knees from collapsing inward the gluteals also help to minimize the risk of ACL-injuries, since the inward collapsed knee puts the ACL at a high risk. In other words: the gluteals help you maintain high quality of movement, for example when landing or running and high movement quality will always reduce undue stress on the joints.
Causes for weak gluteals
Unfortunately our gluteals take a lot of beatings these days, metaphorically speaking. By sitting a lot, you subject yourself to what Kelly Starrett calls “butt lamination”: the fascia and muscle quality of your gluteals and hamstrings is negatively impacted through the constant pressure of sitting. Ultimately this leads to “gluteal amnesia”, the inability to control your gluteal muscles, manifesting itself in weak and inactive gluteals. The term was coined by Dr. Stuart McGill, who did extensive research into back pain, but it’s just as important for knee health as it is for a healthy back.
Another reason for weak and inhibited gluteals are tight hip flexors. The hip flexors (psoas, rectus femoris) are the antagonists of the hip extensors (gluteals, hamstrings) and if one group is overly tight, the other group will be inhibited in strength output. As we have already discussed in the post on anterior pelvic tilt and how to fix it, tight hip flexors are a by-product of sitting a lot. The question that remains is how to get back to normal.
How to retrain your gluteals
To retrain your gluteals you first have to get rid of excessive tension in your anterior hip by stretching your hip flexors. This will allow your gluteals to work without being negatively impacted by the tight hip flexors. Several authors (e.g. Tsatsouline, Starrett) refer to the hip flexors as the handbrake of the human body and before you’re able to excel in athletics you will need to undo it. If you have already been working on the drills from “anterior pelvic tilt and how to fix it”, your first steps have already been done. Just keep practicing these drills and your hip flexor tightness will be a lot better soon.
There is also a lot of overlap from the corrective drills I laid out in the article on “internal rotation of the femur”, so just go back and keep on practicing these little exercises. However, I’m not letting you off without additional homework. The following drill will help you activate your gluteals before a workout, but you can also just do them to generally retrain your CNS to fire your gluteals properly.
For example you could do 4 sets of 8 steps in each direction. Between the sets you just do 30 seconds of this adductor mobilization drill:
In this drill keep your back straight and move gently back and forth to get rid of excessive tightness in your adductors. By performing these two drills for better gluteal function back to back you make good use of your time.
Building super-strong gluteals
Rather than reinvent the wheel, I will just point you to the man whose work on gluteals has earned him the nickname “glute guy” in the strength and conditioning industry. Bret Contreras has obsessed over glutes like Steve Jobs has obsessed over the design of his products and the end result in both cases is without equal in their respective industries. For a nice introduction into gluteal training for strength and hypertrophy, please refer to the following article of his on T-Nation: Dispelling the glute myth.
For healthy knees you have to have a healthy butt. Stretch your anterior hip and train your butt to decrease chances of ACL-injury and knee pain. It’s that easy and the result will look good no matter if you’re male or female.