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Table 2 Included studies per outcome measurement

From: Gluteus medius muscle function in people with and without low back pain: a systematic review

Study Measurement equipment Method Result Major Conclusions
Notzel et al. 2011 [28] Modified Posturomed, Biovision Participants stood barefoot in a static weight bearing position on the posturomed plate for 10 s while it that vibrated. Activity level Fatigability Time to onset Time of peak Patients with LBP demonstrated statistically significant less gluteus medius muscle activity compared to controls. This could be associated with reduced hip stability.
LBP: 56.29 μV (±39.63) nLBP: 96.42 μV (±64.77), p < .05 Normalisation: not performed, raw EMG values used Not measured Not measured Not measured
Farahpour et al. 2018 [17] BTS FREE EMG300 Participants walked for 8 steps in standardised shoes. RMS LBP: 111.8% (±48.6%) nLBP: 48.4% (±27.3%), p < .05 Normalisation: % of MVIC in single leg stance while maintaining the pelvis level Not measured Not measured Not measured Participants with LBP showed statistically significant more gluteus medius muscle activity compared to controls.
Larsen et al. 2018 [38] Noraxon EMG Participants performed 10 ascent and 10 descent step tasks at self-selected speed, separated by 3 min of rest. RMS Specific values not reported, p > .05 Normalisation: % of sub maximum voluntary contraction during standing hip abduction with manual external resistance Not measured Not measured Not measured No statistically significant differences in gluteus medius activity during ascent and descent between those with and without LBP.
Penney et al. 2014 [29] Biopac EMG system Participants stood in a single leg stance position for 30 s, with the non-weight bearing limb flexed between 60 and 90 degrees at the hip. One minute rest between each of the 3 reps per side, with a 5 min rest between sides. RMS LBP: 5.8% (± 2.6%) nLBP: 4.2% (± 2.3%), p = .05 iEMG LBP: 122% (± 55%) nLBP: 87.8% (± 49%), p = .03 Normalisation: % of MVIC in side-lying hip abduction with manual resistance Not measured LBP: 461.7 ms (±286.5) nLBP: 493.4 ms (±292.8), p = .73 Not measured There was no statistically significant difference in onset time of the gluteus medius when moving to unipedal stance between the groups. However, the LBP group demonstrated statistically significant more gluteus medius activation.
Santos et al. 2013 [18] EMG810C, EMG System do Brasil® Participants started kneeling and then were asked to flex their R hip and extend their R knee until the R foot contacted the ground (the L knee remained on the ground). The same process was then repeated on the L limb. R peak amplitude, MED (IQR1–3) LBP: 1.25 (1.00–2.16) nLBP: 1.60 (1.00–2.10), p = .007 L peak amplitude, MED (IQR1–3) LBP: 1.19 (1.04–2.31) nLBP: 1.81 (1.02–2.11), p < .001 R iEMG, MED (IQR1–3) LBP: 0.66 (0.17–1.00) nLBP 1.00 (0.35–1.48), p = .004 L iEMG, MED (IQR1–3) LBP: 1.00 (0.57–1.00) nLBP 1.00 (0.87–2.00), p = .001 Normalisation: % of average activity during the kneeling task. Not measured Not measured R, % of duration of task, MED (IQR1–3) LBP: 0.68 (0.11–0.94) nLBP: 0.44 (0.07–0.74), p = .001 L, % of duration of task, MED (IQR1–3) LBP: 0.86 (0.13–1.00) nLBP: 0.21 (0.05–0.83), p < .001 Participants with LBP demonstrated statistically significant lower amounts of glutues medius muscle activity, and later times of peak activation compared to those without LBP.
Ringheim et al. 2015 [31] EMG TeleMyo 2400 (Noraxon) Participants stood barefoot for 15 min. Start RMS (%Max) LBP: 10.4 (6.3–36.5) nLBP 8.3 (4.9–11.6), p = .19 Slope RMS (%Max) LBP: − 1.5 (− 9.1–7.7) nLBP: − 0.6 (− 1.7–3.5), p = .66 Normalisation: % of maximum voluntary contraction during standing hip flexion and extension in an isokinetic device. Coefficient of variation LBP: 27.4 (23.4–48.5) nLBP: 31 (17.5–39.7), p = .62 Slope MDF (Hz/min) LBP: 12.9 (− 9.0–21.3) nLBP: 2.5 (− 8.0–21.3), p = .28 Not measured Not measured No statistically significant differences in the amount of gluteus medius muscle activity or variability of muscle activity over time between those with and without LBP.
Embaby et al. 2013 [24] Myomonitor® Wireless EMG System Participant stood shod for 30 min. Not measured R first 5 min, MDF LBP: 172.40 (±48.96) nLBP: 171.41 (±38.87), p > .05 R Last 5 min, MDF LBP: 158.91 (±49.03) nLBP: 195.19 (±34.74), p < .05 L First 5 min, MDF LBP: 159.29 (±48.81) nLBP: 173.12 (±41.36), p > .05 L Last 5 min, MDF LBP: 177.18 (±53.95) nLBP: 185.04 (±48.04), p > .05 Not measured Not measured Participants with LBP demonstrated statistically significant less gluteus medius muscle activity on the R during the last 5 min compared to those without LBP (indicating greater fatigue). Differences in the first 5 min on both sides, and the last 5 min on the L side, were not statistically significant.
Hungerfor-d et al. 2003 [26] Noraxon Telemyo 8 EMG Participants stood on one leg then flexed the contralateral hip and knee to 90 degrees. Five trials per side were conducted. Peak amplitude Specific values for gluteus medius not reported, p > .05 Normalisation: % of maximal activity during the single leg standing task. Not measured Specific values (in ms) for gluteus medius not reported, p > .05 Not measured No statistically significant differences in the amount of activity or time of onset of the gluteus medius muscle in those with and without LBP.
Sutherin et al. 2015b [34] EMG100C Biopac Participants performed 5 consecutive isometric hip abduction contractions, in a side-lying position at zero degrees of hip abduction, each lasting 30 s. This was done on both sides, separated by 15 min of rest. RMS No specific values reported, p > .05 Normalisation: % of MVIC during side-lying hip abduction with manual resistance. MDF No specific values reported, p > .05 Not measured Not measured No statistically significant differences in the amount or duration of gluteus medius muscle activity between those with and without LBP.
Nelson-Wong et al. 2013 [6] Biopac MP150 Participants performed the active hip abduction (AHAbd) test in a side-lying position. Note: A positive value indicates the first listed muscle activates first and a negative value indicates the second listed muscle activates first. Not measured Not measured REO-RGMd LBP: − 0.18 s (±0.28) nLBP: 0.10s (±0.31), p = .015 LEO-RGMd LBP: − 0.03 s (±0.37) nLBP: 0.03 s (±0.37), p = .65 RIO-RGMd LBP: − 0.11 s (±0.33) nLBP: 0.14 s (±0.33), p = .033 LIO-RGMd LBP: 0.02 s (±0.37) nLBP: 0.08 s (±0.40), p = .62 RES-RGMd LBP: 0.05 s (±0.34) nLBP: 0.06 s (±0.33), p = .94 LES-RGMd LBP: − 0.11 s (±0.29) nLBP: 0.07 s (±0.36), p = .15 REO-LGMd LBP: 0.17 s (±0.38) nLBP: 0.05 s (±0.30), p = .35 LEO-LGMd LBP: 0.04 s (±0.39) nLBP: 0.12 s (±0.35), p = .55 RIO-LGMd LBP 0.01 s (±0.42) nLBP: 0.19 s (±0.28), p = .15 LIO-LGMd LBP: − 0.04 s (±0.32) nLBP: 0.17 s (±0.35), p = .049 RES-LGMd LBP: − 0.24 s (±0.33) nLBP: 0.09 s (±0.39), p = .014 LES-LGMd LBP: 0.01 s (±0.34) nLBP 0.10 s (±0.38), p = .44 Not measured During the R AHAbd test, participants with LBP demonstrated statistically significant earlier activation of the R gluteus medius muscle relative to the ipsilateral trunk flexors (RIO and REO), compared to controls. During the L AHAbd test, participants with LBP statistically significantly activated the LGMd prior to the contralateral trunk extensors (RES) and ipsilateral IO, compared to controls.
Rabel et al. 2013 [30] Noraxon Telemyo 2400 T EMG Participants performed the active hip abduction (AHAbd) test in a side-lying position. Note: the larger the number, the longer it took for that muscle to activate. Not measured Not measured LBP: 1629 ms (±1715) nLBP: 648 ms (±150), p = .115 Not measured No statistically significant differences in time to onset for the gluteus medius muscle in those with and without LBP.
Hides et al. 2016 [25] Power Trak II handheld dynamometer Participants were positioned supine with hip in neutral. A strap was used to stabilise pelvis. Participants abducted their hip against the dynamometer at a maximal effort for 5 s with examiner resistance applied. Three trials with a 15 s rest between each trial. Strength Those with LBP had statistically significantly less gluteus medius muscle strength on the stance limb, but significantly more on the kicking limb.
Stance leg LBP: 154.1 Nm (±10.0) nLBP: 161.5 Nm (±6.6), p < .05 Kicking Leg LBP: 165.1 Nm (±11.8) nLBP: 143.9 Nm(±7.8) p < .05
Kendall et al. 2010 [5] Lafayette manual muscle tester The test limb was positioned parallel to the treatment table, directly in line with the hip. 3 maximal voluntary isometric strength contractions with a 30s rest period between trials was performed LBP: 6.6 (N/kg) (5.4 to 7.7) nLBP: 9.5 (N/kg) (7.2 to 11.9) p = .03 LBP participants had statistically significantly less gluteus medius muscle strength compared to those without LBP.
Arab et al. 2010 [4] Pressure meter Side lying hip abduction test. Three maximal voluntary isometric contractions, held for 5 s with 15 s rest between trials. LBP: 27.87 kPa (± 7.95) nLBP: 33.51 kPa (± 7.29), p < .001 LBP participants had statistically significantly less gluteus medius muscle strength compared with subjects without LBP.
Cai et al. 2015 [23] Isokinetic dynamometer Three standing concentric muscle contractions (torque) measured with leg secured to dynamometer Male LBP: 1.49 (Nm/kg) (±0.39) Male nLBP: 1.52 (Nm/kg) (±0.41) Female LBP 1.05 (Nm/kg) (±0.39) Female nLBP: 1.17 (Nm/kg) (±0.35) p = .596 (Gp) p = .743 (Gp by Sex) No statistically significant differences in gluteus medius strength between those with and without LBP.
Penney et al. 2014 [29] Lafayette Manual Muscle Tester Participants were laid on their side and abducted their hip whilst the examiner resisted with their hand just superior to the ankle. Two maximal resisted voluntary contractions for a 3s max voluntary contraction with 1 min rest in-between. Right LBP: 1.04 (N/Kg) (± 0.32) Right NLBP: 1.36 (N/Kg) (±0.33) Left LBP: 1.05 (N/Kg) (± 0.26) Left nLBP: 1.23 (N/Kg) (±0.30) p = .04 (right) p = .002 (left) LBP participants had statistically significantly less gluteus medius muscle strength on both sides compared to those without LBP.
Nourbakh-sh et al. 2002 [3] Pressure meter Side lying hip abduction test. Three maximal voluntary isometric contractions, held for 5 s LBP: 26 kPa (±8) nLBP: 32 kPa (±7), p < .01 LBP participants had statistically significantly less gluteus medius muscle strength compared to those without LBP.
Sutherlin et al. 2015a [33] Isokinetic dynamometer Side lying hip abduction, three maximal voluntary isometric contraction (torque). Hip-abduction trials lasting 5 s were recorded, with 30 s of rest between trials. LBP: 1.64 (Nm/Kg) (±0.44) nLBP: 1.65 (Nm/Kg) (± 0.28), p = .944 No statistically significant differences in gluteus medius strength between those with and without LBP.
Cooper et al. 2016 [16] Subjective Measure Gluteus medius strength was tested by placing subject in side-lying and having the subject abduct and slightly extend the hip while keeping the pelvis rotated slightly forward. Resistance was applied at the ankle. Graded 1–5. LBP: 3.35 (±0.73) nLBP: 4.46 (±0.50), p < .001 LBP participants had statistically significantly less gluteus medius muscle strength compared to those without LBP.
Cooper et al. 2016 [16] Subjective observation While standing one hip is flexed. Trendelenburg sign considered present if the subject was unable to maintain the pelvis level or had to shift the trunk to keep the pelvis level. Presence of Trendelenburg sign occurred 54.2% of the time in those with LBP compared to 9.7% of the time for those in the no LBP group p < .001 LBP participants were statistically significantly more likely to demonstrate a trendelenburg sign, indicating gluteus medius muscle weakness.
Kendall et al. 2010 [5] Treadmill and Vicon Subjects performed a baseline standing trial, 2 static Trendelenburg trials, and a 30s walking trial on a treadmill at a speed of 1.34 m/s. LBP right: − 1.9 deg (− 7.0 to 1.7) nLBP right: − 2 deg (− 4.8 to 1.2) LBP left: − 1.6 deg (− 1.6 to 2.6) nLBP left: − 2.2 deg (− 4.3 to 0.7) Negative values indicate hip hike; positive values indicate pelvic drop. No significant differences. No statistically significant differences in presence of Trendelenburg sign between those with and without LBP, indicating no difference in dynamic strength provided by the gluteus medius.
Farasyn et al. 2005 [35] Fischer pressure algometer Lying prone the rate of pressure increase was maintained at a constant rate of on average 1Kg/sec. Three short consecutive PPT measurements with 10 s in between were performed. Trigger points Participants with LBP had a statistically significant lower threshold for pain than those without LBP.
LBP: 6.1 kg/cm2 (±1.6) nLBP: 7.2 kg/cm2 (± 1.5), p < .001
Cooper et al. 2016 [16] Palpation Gluteus medius was palpated from its insertion, muscle belly and origin. Tenderness was defined as pain reported by patient and when using enough pressure to blanch the examiner’s nail. LBP (affected side): Tenderness associated with triggers points was more prevalent (68.10%) on the side of the body affected by LBP nLBP: Tenderness associated with triggers points occurred in 11.20% of the gluteus medius muscles of those without LBP p < .001 LBP (affected side): Tenderness associated with triggers points was more prevalent (68.10%) on the side of the body affected by LBP LBP (unaffected side): Tenderness associated with trigger points was less prevalent (4.80%) on the side of the body that was not affected by LBP. p < .001 Participants with LBP had a statistically significant greater number of trigger points in the gluteus medius muscle compared to those without LBP, as well as, more on the affect side compared to the unaffected side (for unilateral LBP suffers).
Iglesias-Gonzalez et al. 2013 [27] Palpation The gluteus medius was palpated by an experience clinician. No other details reported. Latent TrP LBP (painful side), n (% of LBP participants): n = 5 (12%) nLBP, n (% of nLBP participants): n = 2 (5%), p < .001 Latent TrP LBP (less painful side), n (% of LBP participants): n = 7 (17%) nLBP, n (% of nLBP participants): n = 2 (5%) p < .001 Active TrP LBP (more painful side), n (% of LBP participants): n = 15 (35%) LBP (less painful side), n (% of LBP participants): n = 16 (38%) p > .05 Participant with LBP had a statistically significant greater number of latent trigger points in both the painful and less painful sides compared to those without LBP. The number of active trigger points on either side in those with LBP was not statistically significant.
Njoo et al. 1994 [36] Palpation Lying prone the gluteus medius was palpated and number of trigger graded as present or absent. LBP, n (% of LBP participants): n = 21 (34%) nLBP, n (% of nLBP participants): n = 4 (6%), p < .05 Participants with LBP had a statistically significant greater number of trigger points in the gluteus medius muscle compared to those without LBP.
Aboufazeli et al. 2018 [39] Ultrasound (GE, Model GE LOGIQ S6, MA, USA), 5.0 MHz curvilinear transducer Side-lying at rest and during resisted hip abduction (0.5Kg weightused for resistance). Only painful side measured in LBP group. In the control group, the thicknesses of both sides were measured and then averaged. Thickness was measured as the distance between the superior and inferior hyperechoic muscle fascias, at the middle of each image. Cross-sectional area and muscle thickness Participants with LBP demonstrated a statistically significant smaller change in gluteus medius muscle thickness, from rest to during resisted hip abduction, compared to those without LBP.
Resting thickness LBP: 16.75 mm (0.33) nLBP: 22.00 mm (0.11) Contracted thickness LBP: 26.15 mm (0.90) nLBP: 33.90 mm (0.10) Thickness change LBP: 9.40 mm nLBP: 11.90 mm, p = .025* *Only reported for change between groups
Mendis et al. 2016 [37] 1.5 T Siemens Magnetom SonataMR Lying supine on the imaging table with knees and hips supported in neutral position. LBP: 35.8 cm2 (±1.5) nLBP: 37.3 cm2 (±0.9), Specific statistical values not reported No statistically significant differences between the thickness of the gluteus medius muscle between those with and without LBP.
Skorupska et al. 2016 [32] 1.5 Tesla Signa HDe system (GE) Lying supine No specific values for the gluteus medius muscle were reported (mm3). No statistically significant differences between each side. Note: No comparisons made between groups.
  1. LBP low back pain, nLBP no low back pain, SD standard deviation, EMG electromyography, Mins, RMS root mean squared, MVIC maximum voluntary isometric contraction, MED median, Q1-Q3 interquartile range, COV coefficient of variation, MDF median frequency, iEMG integrated electromyography, REO and LEO right and left external oblique, s second, RGMd and LGMd right and left gluteus medius, RIO and LIO right and left internal oblique, RES and LES right and left erector spinae, TrP Trigger points, n number