The case of the missing glute

Over the past few months, I’ve been getting back into running. As a result, I’ve started to have some left knee pain after activity. This has been an on again, off again, annoyance for me over the past few years, but it has never increased to the point where it would affect my ability to do any of my activities. So, as many of my patients do, I’ve been mostly ignoring the discomfort and continuing with my workouts.

In my pre-physio days, I always blamed the discomfort on general tightness and lack of mobility. “I just don’t stretch enough” was what I’d tell myself. As I got into physio I started to bring stretching back into my life and unfortunately it didn’t quite seem to nip the knee pain in the bud. It would temporarily make things feel better after a run—I’d have less tension in my quads and my legs wouldn’t feel as heavy, but sure enough, that lingering knee pain kept sticking around.

On a related note, I’ve always had difficulty activating my left glute. I really started to notice it on the slackline over the past year. When standing on the line with my right leg, I could feel my glutes working from the get-go. I’d often feel some delayed muscle soreness (DOMS) the next day in that area. But with my left side, it was as if I couldn’t get that side of my butt to do its job. If I truly concentrated on squeezing that side I could generate some tension but it didn’t seem to help me on the line at all. And, as a day on the slackline would go on, I’d start to feel some left knee discomfort without fail.

Fast forward to the past few months of quarantine: I’ve been learning lots about glute and core co-activation from one of my mentors during our video sessions. The goal is essentially to make sure that you have good stability from your core and glutes when you’re doing activities so that other muscles don’t end up doing more work than they have to. You can train this with a bunch of different exercises. In learning how to teach these exercises, I continued to notice a lack of activation on my left side, until we started doing some work with single leg squats using an exercise ball. All of a sudden I started to feel my glute starting to pick up the slack, preventing my quads from holding on for dear life!

It’s taken some time to re-learn this faulty muscle pattern but now that I’ve found a way to do it, I’ve started to notice significant reductions in my knee pain. By incorporating a few corrective exercises into my running warm up, I’ve had much less discomfort afterwards! It turns out that the pain in my knee was less the fault of the knee itself and was caused by a lazy glute.

This happens all the time in physiotherapy. The painful area is not always at fault. By using a comprehensive assessment and addressing movement patterns rather than solely painful areas we can provide longer term solutions rather putting Band-Aids on painful spots!

#patientperspective