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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

StudyMeasurement equipmentMethodResultMajor Conclusions
Notzel et al. 2011 [28]Modified Posturomed, BiovisionParticipants stood barefoot in a static weight bearing position on the posturomed plate for 10 s while it that vibrated.Activity levelFatigabilityTime to onsetTime of peakPatients 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 measuredNot measuredNot measured
Farahpour et al. 2018 [17]BTS FREE EMG300Participants 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 measuredNot measuredNot measuredParticipants with LBP showed statistically significant more gluteus medius muscle activity compared to controls.
Larsen et al. 2018 [38]Noraxon EMGParticipants 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 measuredNot measuredNot measuredNo statistically significant differences in gluteus medius activity during ascent and descent between those with and without LBP.
Penney et al. 2014 [29]Biopac EMG systemParticipants 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 measuredLBP: 461.7 ms (±286.5) nLBP: 493.4 ms (±292.8), p = .73Not measuredThere 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 measuredNot measuredR, % 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 measuredNot measuredNo 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 SystemParticipant stood shod for 30 min.Not measuredR 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 measuredNot measuredParticipants 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 EMGParticipants 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 measuredSpecific values (in ms) for gluteus medius not reported, p > .05Not measuredNo 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 BiopacParticipants 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 measuredNot measuredNo 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 MP150Participants 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 measuredNot measuredREO-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 measuredDuring 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 EMGParticipants 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 measuredNot measuredLBP: 1629 ms (±1715) nLBP: 648 ms (±150), p = .115Not measuredNo 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 dynamometerParticipants 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.StrengthThose 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 testerThe 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 performedLBP: 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 meterSide 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 dynamometerThree standing concentric muscle contractions (torque) measured with leg secured to dynamometerMale 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 TesterParticipants 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 meterSide lying hip abduction test. Three maximal voluntary isometric contractions, held for 5 sLBP: 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 dynamometerSide 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 MeasureGluteus 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 observationWhile 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 ViconSubjects 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 algometerLying 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 pointsParticipants 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]PalpationGluteus 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]PalpationThe 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]PalpationLying 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 transducerSide-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 thicknessParticipants 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 SonataMRLying 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 supineNo 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