The Critical Role of Hip and Gluteal Function in Lower Limb Health

As a podiatrist, most patients present with a range of foot and lower leg issues. Heel pain, Achilles Tendinopathy, Medial Tibial Stress Syndrome, Shin Splints and Patellofemoral Joint Pain are all common presentations to our clinic. Given these injuries and issues affect the foot and lower leg, both referrers and patients alike assume that the cause of these issues are located primarily in the foot. This assumption is simply not true. Of those people experiencing the injuries mentioned above, the vast majority have issues at the level of the hip and pelvis and in particular the glutes.

Understanding the Gluteal Complex

The gluteal complex is an extremely important group of muscles comprising the gluteus maximus, gluteus medius, and gluteus minimus. These muscles not only drive you forward when walking, running and jumping, but they are also incredibly important in stabilising the pelvis when supporting the entire body weight on one leg, otherwise known as single support phase in running or midstance when walking.

During running activities, the glutes hold our pelvis level and steady, extend our hip, propel us forward, and keep our legs, pelvis, and torso aligned. It then follows that if there is substantial weakness or poor recruitment/inhibition of the glutes, the knock-on effect to the entire kinetic chain is substantial and potentially a real source of injury.

Impact on Lower Limb Biomechanics

The relationship between gluteal function and lower limb mechanics is complex and interconnected. Your glutes prevent your femur (thigh) from rotating inwards. If this doesn’t occur, it will result in an increase in both the valgus (knock knee) and rotational forces through the knee joint, increasing the risk of injury.

Another potential effect of gluteal inhibition is reduced ankle joint motion. If the gluteals can’t extend the hip due to inhibition, the brain will act to limit hip extension. One way to restrict hip extension is to reduce ankle motion, which, if present, can contribute to lower limb injuries. There are numerous studies linking glute weakness/inhibition to pathologies such as:

• Achilles tendinopathy and its relationship to altered landing mechanics and reduced shock absorption
• Medial tibial stress syndrome (shin pain) due to altered lower limb loading patterns
• Patellofemoral pain and its connection to poor hip control during weight-bearing activities
• Plantar heel pain, particularly in cases where altered gait mechanics increase load through the plantar fascia
• Iliotibial-band syndrome resulting from poor hip stabilisation during running

Common Issues with Gluteal Function

The gluteal complex presents particular challenges for most athletes (recreational or otherwise), but particularly runners and walkers, for several reasons:

1. While their role in stabilising the pelvis is critical, they don’t receive adequate strength training during regular running activities. This can lead to disproportionate strength in the hamstrings, quadriceps, and calves.
2. Most general strength-training routines don’t effectively isolate the glutes. When an exercise requires several muscles to perform a movement, the strongest muscles typically dominate, potentially leaving the glutes under-trained.
3. Tight muscles, specifically the hip flexors, can inhibit the glutes and prevent their muscle fibres from firing efficiently. This is particularly common in people who spend long periods sitting.

Assessment and Treatment Approaches

When assessing lower limb injuries, our clinic takes a comprehensive approach that includes:

• Detailed biomechanical assessment of the entire lower limb kinetic chain
• Specific muscle strength and activation testing
• Gait analysis during walking and running when appropriate
• Assessment of functional movement patterns
• Evaluation of current training practices and footwear

Prevention and Management Strategies

To maintain healthy gluteal function and reduce injury risk, consider the following approaches:

1. Begin with a simple activation programme focusing on proper muscle recruitment
2. Progress gradually to more challenging exercises as technique and strength improve
3. Incorporate specific gluteal strengthening exercises into your regular training routine
4. Address any underlying flexibility issues, particularly in the hip flexors
5. Ensure proper warm-up routines that include gluteal activation exercises

Professional Guidance

If you are experiencing lower limb pain or wish to improve your gluteal function to enhance performance and reduce injury risk, seeking professional advice is crucial. A thorough assessment can identify specific areas requiring attention and guide the development of an appropriate management plan.

Remember, investing time in gluteal strength and activation will not only reduce your risk of injury but can also lead to improved performance in your chosen activities. Our clinic can provide specific guidance tailored to your individual needs and goals.