Gluteal Muscle Strength and Activation, and the Relation to Knee Pain

by Joseph J. Swinfen
TSAC Report April 2019

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This article focuses on exercises that strengthen the gluteal muscles for abduction to help reduce knee pain in full range of motion and promote proper movement in the primary knee joints.

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Patellofemoral pain syndrome (PFPS) is a chronic condition described as generalized anterior knee pain that occurs during a multitude of activities, typically becoming worse with prolonged activity (14). Activities such as walking, jogging, squatting, lunging, kneeling, and walking up and down the stairs, along with many others can induce or exacerbate pain. A 2008 retrospective study found that due to PFPS, as many as 74% of adults cease their activity at some level or stop because of this pain (3). Musculoskeletal disorders can unfortunately be a major issue in the military setting. Military personnel encounter a myriad of activities (e.g., physical training, recreational sport and work) that may result in some form of musculoskeletal disorder.

This article originally appeared in TSAC Report, the NSCA’s quarterly, online-only publication geared toward the training of tactical athletes, operators, and facilitators. It provides research-based articles, performance drills, and conditioning techniques for operational, tactical athletes. The TSAC Report is only available for NSCA Members. Read more articles from TSAC Report 



1. Barton, CJ, Lack, S, Malliaras, P, and Morrissey, D. Gluteal muscle activity and patellofemoral pain syndrome: A systematic review. British Journal of Sports Medicine 47(4): 207-214, 2013.

 2. Belmont, PJ, Owens, BD, and Schoenfeld, AJ. Musculoskeletal injuries in Iraq and Afghanistan: Epidemiology and outcomes following a decade of war. Journal of the American Academy of Orthopaedic Surgeons 24(6): 341-348, 2016. 3. Blond, L, and Hansen, L. Patellofemoral pain syndrome in athletes: A 5.7 year retrospective follow-up study of 250 athletes. Acta Ortho Belg 64: 393-400, 1998.

 4. Boren, K, Conrey, C, Le Coguic, J, et al. Electromyographic analysis of gluteus medius and gluteus maximus during rehabilitation exercises. International Journal of Physical Therapy 6(3): 206-223, 2011.

5. Crossley, K, Zhang, WJ, Schache, AG, Bryant, A, and Cowan, SM. Performance on the single-leg squat task indicates hip abductor muscle function. The American Journal of Sports Medicine 39(4): 866-873, 2011.

6. Dierks, TA, Manal, KT, Hamill, J, and Davis, I. Lower extremity kinematics in runners with PFP during a prolonged run. Medicine and Science in Sports and Exercise 43(4): 693-700, 2011.

7. Dierks, TA, Manal, KT, Hamill, J, and Davis, I. Proximal and distal influences on hip and knee kinematic in runners with patellofemoral pain during a run. Journal of Orthopaedic Sports Physical Therapy 38(8): 448-456, 2008.

 8. Hauret, KG, Jones, BH, Bullock, SH, et al. Musculoskeletal injuries: Description of an under-recognized injury problem among military personnel. American Journal of Preventive Medicine 38(suppl 1): S61-70, 2010.

9. Ireland, ML, Wilson, JD, Ballantyne, BT, and Davis, IM. Hip strength in females with and without patellofemoral pain. The Journal of Orthopaedic and Sports Physical Therapy 33(11): 671-676, 2003.

10. McBeth, JM, Earl-Boehm, JE, Cobb, SC, and Huddleston, WE. Hip muscle activity during 3 side-lying hip-strengthening exercises in distance runners. Journal of Athletic Training 47(1): 15-23, 2012.

 11. Prins, MS, and van der Wurff, P. Females with patellofemoral pain syndrome have weak hip muscles: A systematic review. Australian Journal of Physiotherapy 55(1): 9-15, 2009.

12. Pollock, ML, Gettman, LR, Milesis, CA, Bah, MD, Durstine, L, and Johnson, RB. Effects of frequency and duration of training on attrition and incidence of injury. Medicine and Sciecnce in Sports 9(1): 31-36, 1977.

13. Tyler, TF, Nicholas, SJ, Mullaney, MJ, and McHugh, MP. The role of hip muscle function in the treatment of patellofemoral pain syndrome. American Journal of Sports Medicine 34(4): 630-636. 2006.

14. Waryasz, G, and McDermott, A. Patellofemoral pain syndrome (PFPS): A systematic review of anatomy and potential risk factors. Dynamic Medicine 7(9): 2008.

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Joseph J. Swinfen

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