Chronic Low Back Pain and Glute Weakness

Chronic low back pain has been frequently linked to weak or inactive glute muscles, but the latest research suggests the relationship is more complicated than it appears. Some patients with chronic low back pain may actually be over-engaging their glute muscles as a compensation strategy. Research shows that individuals with chronic low back pain may exhibit differences in gluteus medius muscle strength, activation, and movement strategies, but weakness alone does not account for every case.

A consistent finding in the literature is that the gluteus medius muscle tends to be weaker in those with chronic low back pain compared to pain-free controls. However, it's unclear whether that weakness is a cause of chronic low back pain or a consequence. Individuals with chronic low back pain often become deconditioned over time, whether through reduced activity, protective guarding behaviors, or simply moving less due to the fear of pain, and current evidence can't tell us whether this deconditioning precedes the pain or follows it.

The relationship between the gluteus medius muscle and chronic low back pain is more complex than the oversimplified view that "weak glutes cause back pain." While strengthening the glute muscles can play an important role in rehabilitation, current evidence suggests that chiropractors should avoid assuming that every patient with chronic low back pain requires increased gluteal muscle activation. Instead, treatment should be guided by the individual's presentation, movement strategy, and functional demands. The goal isn't simply to increase muscle activity, but to restore efficient, confident movement with the right amount of muscular effort.

REFERENCES

Sadler S, Cassidy S, Peterson B, Spink M, Chuter V. Gluteus medius muscle function in people with and without low back pain: a systematic review. BMC Musculoskelet Disord. 2019;20:463.

Sornkaew K, Punyaphing K, Wongonta T, Phinthong S, Kiewsiri N. Increased gluteus medius activation during sustained walking in chronic low back pain: a compensatory strategy for mediolateral postural control. Gait Posture. 2026;129:110218.

Marshall PWM, Patel H, Callaghan JP. Gluteus medius strength, endurance, and co-activation in the development of low back pain during prolonged standing. Hum Mov Sci. 2011;30(1):63-73.

Ceballos-Laita L, Estébanez-de-Miguel E, Jiménez-Rejano JJ, Bueno-Gracia E, Jiménez-Del-Barrio S. The effectiveness of hip interventions in patients with low-back pain: a systematic review and meta-analysis. Braz J Phys Ther. 2023;27(2):100502.

Dr. Michael Braccio. Glute Weakness and Chronic Low Back Pain: What the Latest Research Really Says. Chiro-Up blog. 07/29/2026