What are the best exercises for the gluteus medius?

Best Gluteus Medius Exercises

For optimal gluteus medius strengthening, side-lying hip abduction is the single most effective exercise, producing 81% of maximal voluntary isometric contraction (MVIC), significantly outperforming all other exercises studied. 1

Exercise Progression Framework

Phase I: Initial Strengthening (Weeks 1-4)

For beginners or those with hip pathology, start with exercises producing 20-40% MVIC:

• Resisted terminal knee extension - Minimal gluteus medius activation while avoiding hip flexor irritation 2
• Double-leg bridges - Safe foundational exercise with bilateral support 2
• Lateral band walks - Produces 27% MVIC in gluteus maximus, appropriate for early strengthening 1
• Hip clam exercise (neutral hip position) - Generates 38-40% MVIC but use cautiously if hip flexor tendinitis is present 1, 2

Training parameters for Phase I: Perform 10-15 repetitions at 40% of 1-repetition maximum (1-RM), 2-3 days per week, allowing 48 hours between sessions 3

Phase II: Moderate Loading (Weeks 5-8)

Progress to exercises producing 40-60% MVIC:

• Side-lying hip abduction with wall-sliding - Controlled progression from basic abduction 2
• Resisted hip extension - Targets posterior hip musculature 2
• Stool hip rotations - Introduces rotational control 2
• Sidestepping exercise - Produces high gluteal-to-TFL activation ratio (64:1), meaning excellent gluteus medius recruitment while minimizing tensor fascia lata overactivity 4

Training parameters for Phase II: Progress to 8-12 repetitions at 60-70% of 1-RM for 2-4 sets, maintaining 2-3 days per week frequency 3

Phase III: Advanced Strengthening (Weeks 9-12+)

Advance to exercises producing >60% MVIC:

• Side-lying hip abduction (standard) - The gold standard exercise at 81% MVIC 1
• Single-limb squat - Produces 64% MVIC for gluteus medius and 59% MVIC for gluteus maximus 1
• Single-limb deadlift - Similar activation to single-limb squat (59% MVIC for both gluteal muscles) 1
• Side-lying hip abduction with internal rotation - Advanced variation for maximum recruitment 2
• Single-leg bridges - Unilateral loading with high gluteal-to-TFL ratio (59:1) 2, 4

Training parameters for Phase III: Use ≥80% of 1-RM for experienced individuals, 6-8 repetitions for 2-4 sets 3

Exercise Selection Strategy Based on Clinical Context

For Hip Stability and Lower Limb Pathology Prevention

Prioritize exercises with high gluteal-to-TFL activation ratios to avoid compensatory patterns that may contribute to abnormal hip kinematics (excessive adduction and internal rotation) 4:

1. Clam exercise - Highest ratio at 115:1 4
2. Sidestepping - Ratio of 64:1 4
3. Unilateral bridge - Ratio of 59:1 4
4. Quadruped hip extension (knee flexed or extending) - Ratio of 50:1 4

For Post-Hip Arthroscopy or Iliopsoas Tendinitis

Avoid exercises involving hip rotation in early phases and select movements that minimize iliopsoas activation while strengthening gluteus medius 2:

• Avoid in Phase I: Hip clam exercises (may aggravate hip flexor tendinitis) 2
• Safe progressions: Terminal knee extension → double-leg bridges → resisted hip extension → side-lying abduction with wall-sliding 2

For Knee Osteoarthritis with Hand-on-Knee Gait

Progressive strengthening of hip girdle muscles, particularly gluteus medius, can improve stability and reduce compensatory gait patterns 5. Focus on:

• Single-limb exercises to address unilateral weakness
• Functional weight-bearing exercises (single-limb squat, single-limb deadlift) 1
• Combine with quadriceps strengthening for comprehensive lower extremity stability 5

Implementation Guidelines

Frequency and Volume

• Minimum effective dose: 2 days per week for all populations 3
• Optimal frequency: 2-3 non-consecutive days per week to allow 48-hour recovery between sessions 3
• Rest intervals: 2-3 minutes between sets for strength development 3

Technique Considerations

• Perform exercises in a rhythmical manner at moderate to slow controlled speed 3
• Execute through full range of motion 3
• Avoid breath-holding: Exhale during contraction phase, inhale during relaxation 3
• Alternate between upper and lower body work if performing comprehensive resistance training 3

Supervision and Progression

• Supervised sessions are more effective than unsupervised home programs 3
• Twelve or more directly supervised sessions produce superior outcomes for pain and function 6
• Gradual progression by adjusting duration, frequency, and/or intensity reduces injury risk and enhances adherence 3
• Single-set programs are highly effective for beginners and promote adherence due to time efficiency 3

Critical Pitfalls to Avoid

Do not rely solely on functional exercises like lunges or hops - these produce only 48% MVIC for gluteus medius, significantly less than targeted abduction exercises 1

Avoid excessive tensor fascia lata dominance - if exercises cause anterior hip discomfort or the patient demonstrates excessive hip internal rotation, prioritize exercises with high gluteal-to-TFL ratios (clam, sidestep, unilateral bridge) 4

Do not progress too rapidly - allow 4-8 weeks at each phase for musculoskeletal adaptation and to reduce excessive muscle soreness and injury risk 3

Machine-based exercises are safer than free weights for individuals with comorbidities, neurological conditions, or severe osteoporosis 3