Glute Medius pain/weakness

[Matt James]

I have a question about what I think is glute medius pain when deadlifting and squatting. I searched and there were quite a few old threads that mostly suggested foam rolling etc (which I am doing) but I am wondering if there is an effective way to load this muscle in an accessory fashion beyond just squats and deadlifts, because it seems like it’s more a case of muscle weakness than a tear or injury.

Briefly: I was deadlifting last Saturday and on my 3rd rep at 385 felt a pretty sharp, intense pain, on both sides but worse on the right, in the upper glute area. It’s just below the iliac crest, across the upper buttock, but doesn’t involve the muscles above that in the lower back. The pain hit in the last 4 inches or so before lockout. I wasn’t able to complete the set after that but did do a backoff at 315 where the pain was present but wasn’t worse. The muscle pain lingered for about a day and a half but it feels, again, like really exquisite DOMS, not a tear or other structural injury.

Yesterday (Tuesday) I was doing volume squats at 300. On set 4, the pain came back in more or less the same place. It was worst towards the top of the squat. I did manage to get my 5th set in, but unracking the bar and walking it out was very painful. The pain disappeared completely when I’d begin the descent, and came back (but less intensely) on the ascent. (I’ve never had pain unracking the bar before now).

Unsure if it’s related, over the past few weeks I was having a similar pain on my left side (although about 2 inches lower and more around the side of the hip) at the *bottom* of the squat which seemed to be related to weakness in the abductors—holding the knees out at the proper alignment was hard, painful, and I’d occasionally fail reps at the bottom because of it. I started doing a few sets of isometric exercises by holding one leg off the ground, bent, and pushing the pelvis into the wall. This helped with the pain, and it seems to have made a difference in my squats too, because I haven’t had any problems at the bottom of the squat for several sessions. Doing this same exercise seems to help alleviate the soreness I am having today.

So, to repeat the question, is there a way to load these muscles beyond the squat and DL beyond what I’m already doing? It doesn’t seem to affect my ability to squat, as long as I can get the bar unracked and actually start squatting. It may affect my DLs; I will find out Friday. I chose not to do any volume pulls last night because it just hurt too much.

[Nick D'Agostino]

Keep the isometrics in as a warmup before squats and deadlifts if they are providing. What does your programming look like (loads and general structure)?

[Matt James]

Just switched to intermediate programming a week and a half ago. Doing a 4-day TM split. (I'd been doing the other Nick's intermediate upper body programming already for a few weeks).

Day 1: Intensity Press, Volume bench,
Day 2: Volume Squats, Volume Pulls (haven't really nailed down the volume pulls yet, prior to intermediate I was alternating 80% DLs, chins, and DLs each workout)
Day 3: Intensity Bench, Volume Press
Day 4 Intensity Squat, Intensity DL

Current ID weights: Squat 330, DL 385, BP 240, Press 172
42 y/o, 5'10", 189 lbs

[Nick D'Agostino]

What are the volume day weights?

[Matt James]

What are the volume day weights?

This week it's 300 for the squat. Haven't figured out programming for the pulls as I never learned to clean. Was planning to do DLs in the 75 to 80% range and see how that worked, but didn't do that this week. Only in the second week of intermediate programming for the lower body so I am kind of playing it by ear right now in terms of tweaking the loads and/or total volume.

BP and press volume loads are 205 and 140, respectively. This loading is working really well so maybe I should drop my squat volume weight a bit.

Definitely open to advice.

[Nick D'Agostino]

Thanks for the info Matt. The first change would be to make the lower body structure follow the same pattern as the upper body structure. Meaning group squat volume with pull intensity, and squat intensity with pulling volume. This helps spread the amount of fatigue you are accumulating out better over the course of the week. Doubling up on squat and deadlift volume on the same day coming right off LP is a significant spike in workload compared to what you were previously adapted to. I think this is more of a load management situation that something specific that you need to fix at the glute med. I have a couple of more questions before I give you load recommendations. What was the heaviest 5 you pulled on DL? Also where did you end your LP for squats?

[Matt James]

I'm open to making that change, however I want to point out that last week and this week I only did volume squats and chins-- no other volume pulls (since one of the options in Practical Programming is just to do no pulls on the volume lower body day).

At the end of LP I was doing heavy DLs every fourth workout. So it was chins - 80% DLs - chins - heavy DLs. My last set of 5 was 375. I did 380 and 385 for 4+1, 390 for 3+1, and a single at 395 3 weeks ago. (Was waiting for my squat LP to end before transitioning both to intermediate).

My last 3x5 squats was 330. I missed reps at 335 two weeks ago which is why I decided to finally go intermediate. I had done a small reset in order to address the failing at the bottom problem I mentioned earlier and I'm pretty confident that the most recent miss at 335 was a indicative of needing a programming change rather than a form/structural issue.

Other possibly useful info: for the past few months I have been in a slight caloric restriction in order to lose some belly fat and address blood sugar concerns. I'm now back at maintenance or slightly above for the past two to three weeks. I had been doing a light squat day (coinciding with my heavy DL day) as well as generally two rest days between workouts (per the advanced novice section in Practical Programming) as recovery was tougher due to the caloric restriction.

Finally...I'm not necessarily stuck on doing 4-day TM, although it fits my schedule really well, and has been really great for the BP and press. I was doing Nick Delgadillo's template of Monday volume bench, Wednesday volume press, and Friday intensity for both prior to reorganizing it to accommodate the intermediate programming for the lower body.

[Nick D'Agostino]

It looks like you've done a great job on your linear progression, and it's time to move on. It sounds like your pain is somewhat intensity-dependent, and an initial reduction should hopefully but you below the threshold or pissing things off. If the pain is getting worse throughout the next couple of weeks, you may need an overall, but I would implement these small tweaks first and see if it goes away on its own over the next few weeks. I would keep the 4-day split with the upper body programming as is. For volume squats, I would start somewhere between 275-290x5x5. For the intensity day, I would begin between 315-325x3x3. For deadlift, you have to decide the rate you want to progress it (weekly vs. biweekly). I would probably start deadlift intensity somewhere between 345-365 for a triple and two backoff triples at 90%. I think doing deadlift volume at 80% of the intensity day for something like three sets of 5 is the right place to start. I would probably start with the lower end of those recommendations.

[Matt James]

Thank you *very* much for the advice. I'll give it a shot. Only question I have is for ID squats. Will that eventually move to 5x1 (and then through the lower rep ranges)?

Thanks again. Seriously.

[Nick D'Agostino]

Your welcome Once you are out of pain, you can make that call if you want to. My preference is to keep the total number of sets per week of squats around the same and reorganize the difficulty to let you keep setting those weekly PRs while you can. On LP, you were doing nine sets per week, and on this setup you will have eight sets per week. Most of my initial intermediate programs have 8-12 sets of squats per week (depending on if the trainee is switching to a 4-day split or using more of an HLM style). There are many trainees on this board, though, that have used the top set of 5 with gradually decreasing the reps models very successfully (it is especially useful if time becomes a limiting factor). The above recommendations should get you started, but how you should tweak it as things stall is going to dependent on information that arises through the process of training, combined with your unique situation (time constraints, personal goals, equipment access, etc.).