Glute amnesia and lower back pain: what it is and how to fix it

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. Hey everyone, it's Sebastian, your host with the Restoring Human Movement podcast. I'm just one of the hosts of the show. Again, as you've probably seen, we've done short format podcasts recently, and this is going to be one of those until we actually design and able to spend a little bit of time in the studio and get some long format out there. But let's get you some information right now. We're going to cover lower back pain today, and a common phenomenon that happens with lower back pain is something called glute amnesia.

I will dissect that down a little bit because I did need to speak to someone about it today, and as it tends to go with everybody with their first bout of the condition, it's also their first time experiencing even some of the most, I don't want to say most common things that you'll read about it, but there's a lot of different articles on the phenomena of glute amnesia. There's a reason why people are suggesting so many glute exercises when they are dealing with hip conditions or low back ones at physical therapy offices. There's a reason if you go onto YouTube and you look up best low back pain exercises, you're going to find a bunch of glute ones.

There's a reason for that is because the glute inactivity is so common associated to lower back pain of various different types and sciatica. So I'll tell you first my personal experience with it and then tell you what I hear a lot of people talk about, and then I'll cover a little bit of what some of the research tends to lean towards, and then I'll talk about maybe some ways to resolve it. Now, I've had back pain on and off for a lot of years. I'm not going to say I suffer from back pain because I've had 20 years of no back pain from the age of 15 to the age of 35, and then I spent a good six, seven years having no back pain, and then I had a little bit, and then I have some back stiffness periodically.

I'm low 40s right now, so I'm as active as I want to be. I sprint. I hit baseballs. I lift weights. I don't really have any disabilities, and as we said in the last podcast or one of the last podcasts, the type of back that you want is the back that you don't have to think about, and I don't really think about my back, although I have had problems. So I can share my experience with glute amnesia with you, which is basically glute amnesia is kind of where the glute forgets to contract, they say. It doesn't really not contract. It does contract, but what you'll notice, and this is what I noticed, is that when you're doing like a glute activity, like say a bridge, on one side you may feel like, man, I feel like my glute getting a pump.

It feels good. It feels normal. On the other side, you do as many reps as you want to, and it's like, what is going on? I just don't feel, I feel like my hamstring's just working extra. I don't feel like I can do anything to get my glute to actually do work, and I've experienced this with side bridge exercises, which are designed to be more glute dominant. I've had the experience with single leg bridges, I've had the experience with banded bridges, I've had it with clamshells, I've had it with even more advanced exercises that are a little bit more nuance-y for rehab scenarios, diagonal sits or high oblique sits, single leg hinges.

I've had problems with all of them with not getting glute activity, and during that period of time, I was dealing with a little bit of back pain, and I noticed that other types of single leg hinges, such as single leg RDLs of various different knee bend types, such as stiff-legged or Romanian style, did not feel good. I just felt like my hamstring and my back got lit up the whole time. Even deadlifting with a hex bar or a chop bar, I didn't feel super good with, and I avoided it for a little bit of time, I didn't feel great doing kettlebell swings, I feel like my hamstrings are always lit up afterwards, and I haven't really gone back to barbell deadlifting in a long time, so I can't really speak for that, and there's various different reasons why for that.

So, I've had other people tell me that it feels like their glute is just not working, it feels like it's just not there, but you can see it's contracting, you can see the glute max is contracting, so those are very common phenomenons with it, they happen often times with people with low back pain and hip pain, like I said, or a past history with it. You may even notice it when you don't actually have any pain whatsoever. I can tell you a full certainty that my back pain was pretty much gone, but I was still having problems activating my glute, and I know from working with a lot of people with this, that that's kind of, I don't want to call it a problem, but it's a risk factor, I think.

And so, I fully know that the effect of glute exercises weren't getting my glute to work, which tells me that maybe that's something I should be keen on and try to address, especially when I'm not in a stage of really having any back pain. So, I actually asked some of my interns to help me with it, some did better than others. One intern actually got it really good, and at that point, once they got it rocking and rolling, I actually had a better chance of getting the glute activity with my home exercises. If you listen to my other podcasts where I've hosted, I talk about how some people need corrective exercises, but I also am pretty concerned about how I kind of hate them. Like, I don't want to do them. I don't want to do all these bridges and side planks and clamshells. I don't want to do any of these things. I just kind of want to feel good, and I'm okay with doing light warm-ups with activity or exercise. Go to the baseball field. I'll jog around. I'll do a little bit of, like, stretching and so on. I'll do my leg swings. I'll do the sprinting. I'll do all stuff. But I kind of don't want to show up 15 minutes early to do all these bird dogs and side planks and glute things. I don't want to do it. But I think I've learned over the years that if you actually get something, what we call is more protective stiffness or encouraging the air to become stiff, you don't need to do it quite as much. And so, when I say you got it rocking and rolling, you should start hammering it. All right? And that's what we have our clients do here is we may have to, may take a little bit of coercing to get the glute to come back online, or the glute max to come back online, which, by the way, gets all the glute muscles, not just the glute max. So, you get the glute max to come back online, and all of a sudden, you start hammering that thing. Like, you work it. You work it with whatever exercise you want to, and you challenge that thing, and you're going to be sore and stiff there the next day. I remember the first time that I really got this productive stiffness. It was, I was sore there for quite a few days, and I got up thinking, man, this is going to be a mistake tomorrow. But I actually felt way better. I felt way better right after. I felt way better the next few days. And as I said, I hate doing corrective exercises. I actually didn't do any of my corrective exercises for three to four weeks after that, because I felt so good. And I talked to somebody about this before. I talked to somebody who knows more than myself about this type of scenario. And I said, so what are we doing? Like, why is, why did doing it to that intensity have such a lasting effect? And so they said, basically, you're training to create some stiffness in an area, or we're changing what we call the attractor state. I have other podcasts where I've talked about the attractor state models, which I'm not going to go into this one. But for the most part, the stiffness, learning to train the stiffness is enough to understand the basic concept. So the way I like to explain to people and the way I kind of learned it from them was the, if you are, do so much arm work, so you do, do, do so many bicep curls that the next day you're so sore, you can't extend your elbows.

Now we may call this like a mistake. Like maybe that's not, we shouldn't have done that many, but we can't refute the fact that it changes the way you move without you having to think about it. And that change lasts for days and days until you think, gosh, it's already, finally, it's been a week and I'm not so sore anymore. That's what I wanted. But then your elbows start to extend. Now, does it stop extension forever? No, it doesn't. But you can recognize that actually, if you train to get stiffness in the appropriate tissue, it can actually last longer. So when I first did it, I trained to create stiffness in the glute tissue. And so by doing that, it changed the way I was walking and lifting and running without me thinking about it. Now, a big mistake that people make is that when they get that productive stiffness, it's, they think that they need to stretch it out. And that's, it's not what I would suggest. You have to embrace the stiffness because the stiffness in this scenario has gotten, it's protective, it's helpful, and it changes the way you move. But if you stretch it out, you'll reverse engineer kind of what the whole purpose of the exercises were. Now, this is the way we try to train our people if it's safe to do. And we do testing ahead of time to make sure that it is safe to do. And we found better results by doing this than by doing the standard reps and sets and so on, because everybody's a little bit different in what they can do. So when I, when I talked to somebody about the stiffness model, by the way, stiffness gets a bad name. So it's productive to have it in certain areas that you're lacking stiffness. We, I said, how come I was able to feel better for like three to four weeks, and I didn't need to do any exercises again. And they said, well, it's different for everybody. The stiffness remains in the tissue for certain, like say, a couple hours for some person, some people, and a couple weeks, a couple months for others. And he said, there's really no way to know. But what they observed is that the more trained the individual is, the longer the effect can last. So you may have someone who's like a professional athlete where you do a lot of stiffness work with that person, and the effect lasts for months, while you have someone who is not as conditioned, doesn't have a good history of exercise, and they have more bad habits, they may only last a couple hours. And so a part of our job is to read what the trend is towards. And so if we know we have a deconditioned individual, and we do the exercises, and it makes them sore, and they say they only feel good for like a couple hours or a day, and it goes back to normal, that's okay. We just have to increase the dosage, increase the stiffness, and get the person more trained. And so these aren't bad things, but this is just the differences between people and the differences in management. In another video, I talked about how exercises are helpful, or in another podcast, I talked about how exercises are helpful, but the coaching of it and the management of the person is also equally as important. So the way the person coaches it to get the effect of glute stiffness, but also letting the person know what to expect and to continue or to stop doing that is also equally important. Okay, I remember there was somebody that I worked with before that they they had a hip problem. It was like a TFL IT band type of problem in their leg. They were a runner, they were track runner, and so they had a big track workout later that day. And so they came in, and I did a test, and a few tests, and I deemed that their glute was kind of, as we say offline, it's being a lazy glute, glute amnesia. And so we did a few exercises to really encourage that baby to start working, and it did. And they looked at me, and they said, they're really hesitant. And they said, I don't know if I should be doing this. And I said, how come? And they said, because I have a big track workout later, and I think I'm going to do poorly for it. I said, well, you have an option here is you, if you do it, I believe you'll feel physically better, and you may not hurt when you're doing the workout, leading to a better workout, or there's a chance you're so sore that you're not able to do a workout, but hopefully you don't hurt, right? They texted me later, and they said that they had one of the best track workouts that they had in a long time, and their knee and thigh didn't hurt.

So the stiffness for that scenario, yeah, it can tank the glute, but it actually had a performance effect with them, okay? So now let's talk about what research has leaned towards with this. I say lean towards because I feel like everybody that I've talked to about this have said that there's not really any proof that low back pain leads to the glutes turning off, but it's been observed multiple times in labs and working with subjects. And I would say, at least from Yanda's work, Vladimir Yanda, with postural types of syndromes, the lower cross syndrome, it kind of leans to that same thing too, hyperactive tissue, less active tissue. We tend to notice that people's hamstrings get tight. They never tend to get looser when they're having problems. We see their hip flexors get tight. They never tend to get looser. They always get way more active. And then we see the opposite with some of the abdominal muscles or the gluteal muscles. We see they just get kind of underworked, underserved, and less ready to do work. But again, truth be told, the glutes never really stop working. They're always working, but I like to think that they're late to the game. They're late to the party. They're more latent.

They're just not doing the work readily enough. And then the other groups that are there sooner to the party say, you know what, I'll do that work for you, which tends to lend to them working a little bit harder and becoming overactive, which is why we see a lot of people with more hamstring overactivity problems, hyperactive hip flexors. And then some of the smaller musculature of the hip, like the piriformis and the TFL and things like that. And this happens all throughout the body with different areas. And I know the glutes are the only ones we're talking about with lower back pain today. But we see them in other parts of the body as well. There's other tissues that become a little bit more dormant and less ready to work after injuries. Now, I think part of the injury cycle is that we focus more so on pain than actual function nowadays, which I think is very unfortunate.

And if you work with a good physical therapist or sports chiropractor or a personal trainer, athletic trainer, they kind of know the difference between the two things. They know that the person will get out of pain usually very quickly. If they can't get them out of pain, then it's a different scenario, more of a chronic pain model possibly or inflammatory. And then we have to manage a different way. But either way, the pain eventually typically goes away. After it goes away, we have to, we have to consider, do we want to release this person and say, hey, everything's rosy and good. Or do we want to try to nip and butt possible collateral that's associated to it or other things that are risk factors with it too. We know that people with knee pain tend to use their knees a lot. We also know people with knee pain tend to have knee cave when they squat down or when they're stepping upstairs and stuff like that. You can see it. They may not always have knee pain, but that movement pattern or deficiency or weakness remains for a while despite pain levels. And we know people with back pain tend to have similar cross, lower cross type of scenario. So function is really what we're after when we're trying to do more of a preventative model.

And as I discussed with someone today, I said, you're probably going to notice over the years that you are feeling pretty good. But when you do your bridges, as you notice this time, you do your bridges and you don't feel your glute working anymore. And it's odd because you have been feeling it working for months to years now. That should be a sign to you that something possibly could be lurking, not to be scared, but think preparedness. Now you know that the glute is not online. And just think reasonably, if the glute's not online, where is the work going? So don't be surprised if you have some hamstring or hip flexor stuff or groin things pop up or lower back, but it'd be in your best interest to see if you can encourage that thing to come back on. And a lot of times a similar workflow that you turned it back on in the first place can also work again. So for an example, and I'm not saying it's going to be this simple, but let's just say it is. If you knew that clamshells got your glutes to come back online every time. And the last time you had back pain, you went to the therapy office and you worked with someone who helped you get your glutes back online. All you did was a massive amount of clamshells. And all of a sudden, right as rain, you're good for like three to five years. And then you notice again that your glutes are offline. It would be a good idea to go back to the clamshells again because that helped you the first time. Not to say it will every time, but there's a very good chance that what worked for you in the past is probably going to work for you in the future if you are diligent and catch it super early. So just to recap on some things so far is glute amnesia is basically where the glute becomes latent or unwilling to do the work that it typically does. And the glute is a massive work horse in the lower extremity, a massive one. It has a ton to do with spinal stability. It has a ton to do with core stability, hip extension strength, leg strength.

It has a ton to do with all of it. And if it's offline, your other tissues are working harder. It's very common to feel it after chronic or acute lower back pain. And part of the injury cycle is when people are out of pain, they don't worry about those other things. But remember, if the glute's not working, ask yourself what other tissues will, especially when challenged. It's going to be the other ones that aren't designed really to do that purpose. And breaking that injury cycle comes down to recognizing if you're in pain, you'll settle it down really quickly. Number two is if there's any deficiencies of strength or mobility, they should be addressed. And I think normally the things that work best for me to help reduce the amount of glute amnesia that I have is an exercise called a single leg hinge.

So, um, on our YouTube channel, we have, uh, let's see, what is the best way for you to look for it? There's actually, um, we have a, huh, let's see what actually, you know, what's probably going to be the best is going into our YouTube channel and searching, uh, single leg deadlift. Our YouTube channel is performance place sports care. Just search single leg deadlift. When you get into there and you'll find, uh, you'll find that, or you'll find something called like a lateral squat. These are exercises, which are a little bit more focused on glute facilitation. And if done right, they're not so regressed that you will have to go all the way down to the floor. It kind of still looks like a gym workout.

So you can still use it and not look weird at the gym or look weird at the baseball field. And that's kind of like a double-edged sword. That's a win right there. I'll tell you what I'll do is I'll look to see through our YouTube channel. I'll see if I can put a video in our link description as well, uh, for this, for this podcast and see if I can get you guys more of a direct link to that. Also too, if you've been dealing with lower back pain, just know that we do have consultations as well. They're $29 for 30 minutes. And we try to make it really affordable just to make sure that you do have someone to talk to and take advantage of our low back webinar, which is completely free.

It'll be in the link description as well. And it covers some of these other aspects with symptom generating structures that you may not be aware of. Again, if you've liked the show, please thumbs up and share it with a friend and leave us a comment in a review on your podcast player. I'll see you next time.