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Are Weak Glutes Really Causing Your Back Pain?

By Dr. Mitch Whittal

Sep 11, 2026

Lest week we talked about hip flexors and back pain. This week we’re staying around the hips but moving to the back of the pelvis. Videos with millions of views say your glutes are "asleep" and your lower back has been forced to do their job. It’s true that people with low back pain often have weaker hip musculature, especially the gluteus medius muscles at the sides of the pelvis [1]. But does that mean that weak glutes causes back pain? Let’s find out.

TLDR

  • People with back pain often have weaker hip muscles, especially gluteus medius. We don't know which came first.
  • Some people’s glutes work harder during walking when they have back pain, so they aren't necessarily "asleep."
  • A glute-focused program improved strength but didn't beat conventional care for back pain or disability.
  • Glute training still belongs beside core/trunk work and regular movements for back pain.

Glutes

Everyone knows them. Your glutes are the group of muscles that form your butt. There’s actually three of them:

  • Gluteus maximus - the large muscle at the back of your hip. It extends your hip when you stand up, climb stairs or stand up from the bottom of a squat.
  • Gluteus medius and minimus - the smaller muscles along the sides of your hip. They help move the leg out to the side (abduction) and keep your pelvis level when you walk and stand on one leg.

Picture walking. For a good part of every step, your weight is on one leg. The gluteus medius on that side helps control the pelvis while the other leg swings forward. Your gluteus maximus then helps extend the hip as you push the ground away to step forward.

Having strong hip extensors matters for low back pain, but to say that the low back has been doing the job of the glutes is incorrect. The glutes extend the hips, and the low back musculature extends the spine. The muscles in our lower back can’t extend our hips for us.

Glute weakness and back pain

A systematic review pulled together 24 studies comparing gluteus medius function in people with and without low back pain [1]. The back pain groups had weaker glute medius muscles. The findings for muscle size, fatigue and timing were unclear.

Another review looked at hip movement, strength and muscle activity [2]. People with back pain often had less hip range of motion and weaker glutes (measured abduction and extension). They also measured EMG (electromyography - a fancy term for the amount of electrical activity in a muscle). The weird part was that even though people with back pain had weaker glutes, some of the tasks performed by these people produced more muscle activity in the hamstrings and gluteus maximus than those without back pain.

I have to say this because every single semester as a teaching assistant for intro to biomechanics, I would see the same mistake: confusing EMG/muscle activity for force generation. EMG measures when a muscle is active and by how much as a proportion of how hard someone can voluntarily contract that muscle. It does not tell you how much force is being produced or how strong a muscle is. Anyways, these studies measured hip strength and activity after back pain was already present, so we can’t tell which came first.

Are your glutes asleep?

Your glutes don't become dormant and forget to activate because we sit too much. They can get weaker over time due to inactivity. Then when we need them, they aren’t strong enough for the task, and other muscles may be excessively strained because of a lack of hip extension and abduction strength.

A small 2026 study measured gluteus medius activity while people walked for 10 minutes [3]. Near the end of the walk, the back pain group had greater glute medius activity than the group without pain. In this walking task, the gluteus medius appeared to work harder to produce similar control of the hips and pelvis. So, the ‘asleep’ glutes narrative is actually quite wrong - people with back pain appear to have glutes that don’t sleep.

Now, this was a small study of one task. I wouldn't use it to claim that everyone with back pain has glutes that work overtime.

Does glute strengthening help?

It can. It stands to reason that stronger hips (glutes and hamstrings) give people a greater ability to withstand and adapt to postures that challenge the low back (and posterior chain in general). We often talk about these muscles and their functions isolation (hip extension, abduction etc), but in reality, when I bend down and then pick up my daughter, all of the muscles from the base of my skull down to my toes are coordinating together to allow for that movement:

  • Spinal erectors and back musculature fight against flexion to keep my in a neutral posture
  • Surface hip muscles allow for the extension of my hips using the spine as a rigid axis
  • Deep hip and spine musculature contract bilaterally to stabilize the spine and pelvis
  • Core and trunk muscle contract isometrically (without changing length) to increase trunk rigidity and force transfer

The research findings are a little hard to interpret given that level of complexity. However, a 2026 trial had 48 adults with back pain complete four weeks of glute-focused training or standard care [4]. Both groups received flexibility work and other conventional treatments. The glute group gained more glute strength, but they didn't do any better for pain, disability or hopping performance.

Now, four weeks is pretty short, and the comparison treatment wasn't a structured strength program designed for the purposes of improving back pain. I'd like to see what happens over a much longer period and a review of the program to ensure that it doesn’t include counterproductive movements for those with back pain. For example: a lot of “fix your glutes” videos also push deep glute stretches like the pigeon pose. If you have sciatica symptoms, deep glute and hamstring stretches can make your pain worse. I wrote a previous newsletter on this that you can read here.

And this single study doesn’t erase the overall effectiveness of resistance training. A 2025 meta-analysis of people with chronic low back pain found that resistance training of the trunk and hips gave the biggest and most consistent improvements in function [5].

What I'd actually do

Strong hips are useful whether or not weak glutes started your back pain. Strong hips support you through back pain and here’s a few things that you can do:

  1. Train hip extension. Start with glute bridges at home or hip thrusts in the gym. Do 2-3 sets, 2-3 times per week. Stop when your hips reach a straight line with your trunk. Squeezing higher can put the lumbar spine into extension that’s painful for some.
  2. Train the glute medius. Use side-lying hip abduction or clamshells at home or cable hip abduction machines in the gym. Start with 2 sets of 8-12 reps per side.
  3. Add a hinge and trunk exercise. Try seated good mornings or Romanian deadlifts, then add bird dogs and side planks from my core exercise guide. Two sets of each twice a week is enough to start.
  4. Break up long sitting. Stand or walk for a couple of minutes every 30-45 minutes. If you sit all day, one workout still leaves a lot of hours with very little movement.

If you want a program that takes care of all of this, and helps you avoid the traps of your specific pattern of back pain, take my free 2-minute quiz to get started.

As always, have a great weekend.

Best,

Mitch

References

[1] Sadler et al., 2019 - https://doi.org/10.1186/s12891-019-2833-4. Gluteus medius muscle function in people with and without low back pain: a systematic review. BMC Musculoskeletal Disorders.

[2] Pizol et al., 2024 - https://doi.org/10.1186/s12891-024-07463-5. Hip biomechanics in patients with low back pain, what do we know? A systematic review. BMC Musculoskeletal Disorders.

[3] Sornkaew et al., 2026 - https://doi.org/10.1016/j.gaitpost.2026.110218. Increased gluteus medius activation during sustained walking in chronic low back pain: A compensatory strategy for mediolateral postural control. Gait & Posture.

[4] Abdeldaiem et al., 2026 - https://doi.org/10.1186/s13102-025-01475-x. Impact of gluteus maximus-focused intervention using Powers' program on chronic mechanical low back pain: A randomized controlled trial. BMC Sports Science, Medicine and Rehabilitation.

[5] Guo et al., 2025 — 10.3389/fphys.2025.1672010. Effects of different types of core training on pain and functional status in patients with chronic nonspecific low back pain: a systematic review and meta-analysis. Frontiers in Physiology, 16, 1672010.

Disclaimer: this content is educational only and does not constitute medical advice. See a practitioner if you suspect serious spinal trauma from a fall or accident, or if you experience any of the following red flag symptoms: loss of bowel or bladder control, numbness in the groin or saddle area, rapidly worsening leg weakness, back pain with fever or feeling generally unwell, or unexplained weight loss with back pain.