Muscle Activity During Aquatic and Land Exercises in People With and Without Low Back Pain

Effects of an aquatic protocol on electromyography activation and strength of lower limb muscles in blind women: A randomized controlled trial

PURPOSE

Visual impairment poses considerable challenges to mobility and everyday tasks, frequently leading to a more sedentary lifestyle and reduced physical fitness levels. Therefore, this study investigated the effects of a tailored aquatic exercise protocol on muscle activation and strength in visually impaired individuals.

MATERIALS AND METHODS

Thirty women who were blind (mean age = 29.03 ± 2.20 years) were randomly assigned to an experimental (EX) group and a control (CO) group. The EX group participated in three weekly 60-minute aquatic sessions, while the CO group maintained regular activities. Electromyography (EMG) activation and onset time were measured in the tibialis anterior, gastrocnemius medialis, rectus femoris, and biceps femoris. Muscle strength was also assessed in the ankle dorsiflexors and plantarflexors, as well as the knee flexors and extensors.

RESULTS

The EX group showed increased EMG activation for the tibialis anterior, gastrocnemius medialis, rectus femoris, and biceps femoris in both anterior-posterior (2.23 MVIC%, 95% CI: 1.13 to 3.34, p < 0.001) and posterior-anterior directions (2.35 MVIC%, 95% CI: 1.80 to 2.91, p < 0.001) compared to CO group. Onset time decreased significantly in the EX group relative to CO group (anterior-posterior: -108.07 ms, 95% CI: -117.23 to -98.89, p < 0.001; posterior-anterior: -98.72 ms, 95% CI: -106.54 to -90.90, p < 0.001). Muscle strength significantly increased in the EX group compared to the CO group, with greater strength in ankle dorsiflexors (4.42 N/kg, 95% CI: 3.42 to 5.42, p < 0.001) and knee extensors (2.72 N/kg, 95% CI: 1.04 to 4.40, p < 0.001).

CONCLUSIONS

The aquatic exercise program improved neuromuscular function and strength in women with visual impairments, supporting its use in rehabilitation.

TRIAL REGISTRATION

IRCT2017022132705N1.

Aquatic exercise versus standard care on paraspinal muscle morphology and function in chronic low back pain patients: a randomized controlled trial

Low back pain (LBP) is a disabling disease and a public health concern. Aquatic exercise is an alternative form of exercise with less spinal loading and difficulty performing movements, benefiting those with pain-related fear. This study aimed to investigate the effect of an aquatic exercise program (SwimEx) versus standard care (SC) on lumbar paraspinal muscle volume and composition, strength and patient outcomes in individuals with chronic LBP. This randomized controlled trial included 34 participants with chronic LBP. Participants were randomly allocated to each group (SwimEx, n = 18; SC, n = 16) and underwent a 10-week supervised intervention program twice per week. Magnetic resonance imaging was performed at baseline and 10-weeks to examine the impact of each intervention on multifidus (MF) and erector spinae (ES) muscle volume (cm3) and fatty infiltration (% FI) at L1-L2, L2-L3, L3-L4, L4-L5, and L5-S1. Mixed model repeated measures ANCOVA revealed no significant time*group interactions for MF and ES volume and %FI. SwimEX had significant increases in MF volume at L2-L3 and L3-L4, and ES volume at L1-L2. Furthermore, SwimEX also had a significant increase in MF %FI at L2-L3. Both groups displayed significant increases in lumbar strength. Correlations between muscle morphology and patient outcomes showed improvements in MF volume were moderately correlated with an increase in physical quality of life and decrease in anxiety/depression. Interestingly, improvements in MF volume, MF %FI, and ES %FI, were each moderately correlated with a decrease in sleep disturbance. In conclusion, aquatic therapy may help increase lumbar paraspinal muscle volume and strength in participants with chronic LBP. Our findings support the notion that improvements in paraspinal muscle health are related to improvements in patient-reported outcomes. More imaging studies are required to examine the impact of exercise on overall paraspinal muscle health in chronic LBP and investigate these associations.

Hip biomechanics in patients with low back pain, what do we know? A systematic review

BACKGROUND

Biomechanical alterations in patients with low back pain (LBP), as reduced range of motion or strength, do not appear to be exclusively related to the trunk. Thus, studies have investigated biomechanical changes in the hip, due to the proximity of this joint to the low back region. However, the relationship between hip biomechanical changes in patients with LBP is still controversial and needs to be summarized. Therefore, the aim of this study was to systematically review observational studies that used biomechanical assessments in patients with non-specific LBP.

METHODS

The search for observational studies that evaluated hip biomechanical variables (i.e., range of motion, kinematic, strength, and electromyography) in adults with non-specific acute, subacute, and chronic LBP was performed in the PubMed, Embase, Cinahl and Sportdiscus databases on February 22nd, 2024. Four blocks of descriptors were used: 1) type of study, 2) LBP, 3) hip and 4) biomechanical assessment. Two independent assessors selected eligible studies and extracted the following data: author, year of publication, country, study objective, participant characteristics, outcomes, and results. The methodological quality of the studies was assessed using the Epidemiological Appraisal Instrument and classified as low, moderate, and high. Due to the heterogeneity of the biomechanical assessment and, consequently, of the results among eligible studies, a descriptive analysis was performed.

RESULTS

The search strategy returned 338 articles of which 54 were included: nine articles evaluating range of motion, 16 evaluating kinematic, four strength, seven electromyography and 18 evaluating more than one outcome. The studies presented moderate and high methodological quality. Patients with LBP, regardless of symptoms, showed a significant reduction in hip range of motion, especially hip internal rotation, reduction in the time to perform functional activities such as sit-to-stance-to-sit, sit-to-stand or walking, greater activation of the hamstrings and gluteus maximus muscles and weakness of the hip abductor and extensor muscles during specific tests and functional activities compared to healthy individuals.

CONCLUSION

Patients with LBP present changes in range of motion, task execution, activation, and hip muscle strength when compared to healthy individuals. Therefore, clinicians must pay greater attention to the assessment and management of the hip during the treatment of these patients.

SYSTEMATIC REVIEW REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020213599).

Comparison of aquatic physiotherapy and therapeutic exercise in patients with chronic low back pain

OBJECTIVE

To investigate and compare the effectiveness of aquatic physiotherapy and therapeutic exercise in the physical and functional performance of patients with chronic low back pain.

METHODS

Twenty-six participants were randomized into 3 groups, namely an aquatic physiotherapy group (AG), a therapeutic exercise group (EG), and a control group (CG). The pain, disability, and quality of life were compared before and after the exercise protocols for 2 months, twice a week, on alternate days, for 60 min. For statistical analyses, the Kruskal-Wallis test was used to test the difference between the groups; the Wilcoxon test and the effect size were used for before-and-after comparisons.

RESULTS

Twenty participants completed the study. There was a significant difference improvement in pain between the AG and the EG (p = 0.004), between the EG and the CG (p = 0.05), and in social role functioning between the groups (p = 0.02). No differences were observed in the other analyzed variables between the groups. Compared to the pre-treatment state, there were significant improvements in the AG in terms of pain (p = 0.02), functionality (p = 0.03), and general health status (p = 0.04).

CONCLUSION

The AG group showed significant and clinical improvement in pain, disability, and quality of life. Improvements related to social aspects were found in the EG compared to the CG. The water provides a safe environment that facilitates the onset of exercise, so aquatic physiotherapy could be considered the first recommendation for patients with low back pain.

Effect of aquatic exercise versus standard care on paraspinal and gluteal muscles morphology in individuals with chronic low back pain: a randomized controlled trial protocol

BACKGROUND

Low back pain (LBP) is one of the most disabling diseases and a major health issue. Despite the evidence of a link between paraspinal and gluteal muscle dysfunction and LBP, it is unknown whether aquatic exercises can lead to improvements in paraspinal and gluteal muscle morphology and function, and whether improvements in overall muscle health are associated with improvements in patients' outcomes. The unique properties of water allow a water-based exercise program to be tailored to the needs of those suffering from LBP. This study uses magnetic resonance imaging (MRI) to investigate the effect of an aquatic exercise program versus standard exercise on 1) paraspinal and gluteal muscle size, quality and strength and 2) pain, disability, and psychological factors (pain related fear, depression, anxiety, sleep quality) in chronic LBP.

METHODS

This study will include 34 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 65, who will be randomly assigned (1:1) to the aquatic exercise group or land-based standard care exercise group. Both groups will receive 20 supervised sessions, twice per week over 10 weeks. MRIs will be obtained along the lumbosacral spine (L1-L5) and pelvis at the start and end of the intervention to assess the effect of each exercise intervention on paraspinal and gluteal muscle size and quality. Pre- to post-intervention changes in all outcomes between each group will be assessed, and the association between the changes in back muscle quality and clinical outcomes will be examined. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment.

DISCUSSION

This study will determine if water-based exercises targeting the lower back and gluteal muscles can lead to important changes in muscle quality and function, and their possible relation with patients' pain and functional improvements. Our findings will have strong clinical implications and provide preliminary data to design a community program to better support individuals with chronic LBP.

TRIAL REGISTRATION

NCT05823857, registered prospectively on April 27th, 2023.

Aquatic Exercise Impact on Pain Intensity, Disability and Quality of Life in Adults with Low Back Pain: A Systematic Review and Meta-analysis

BACKGROUND

Low back pain is a common, multifaceted disorder that directly affects diverse aspects of people's lives in terms of health, personal and social lives. A variety of pathological disorders, including low back pain, may benefit from hydrotherapy.

OBJECTIVE

This study aimed to systematically analyze the efficacy of aquatic exercise on pain intensity, disability, and quality of life among adults with low back pain.

DATA SOURCES

A systematic search was conducted in PubMed, Web of Science, Medline, and Scopus up to February 2023 for randomized controlled trials (RCTs) that which examined the impact of aquatic exercise. The most relevant articles were selected based on research criteria. The PEDro scale was applied to assess the quality of the included studies. Review Manager 5.3 was used for conducting all analyses.

STUDY SELECTION

Out of 856 articles, 14 RCTs (n = 484 participants; 257 in the experimental groups and 227 in the control groups) met our inclusion criteria.

RESULTS

Pooled results illustrated that aquatic exercises significantly reduced pain (mean differences (MD): -3.82; p < 0.00,001), improved disability (standardized mean differences (SMD): 1.65; p < 0.00,001), and improved quality of life in both the physical component score (mean difference (MD), 10.13; p < 0.00,001) and the mental component score (MD, 6.45; p < 0.0001) when compared with a control group.

CONCLUSION

The current review showed that aquatic exercise regimens were effective among adults with low back pain. High-quality clinical investigations are still needed to support the use of therapeutic aquatic exercise in a clinical setting.

Feasibility Testing of Wearable Device for Musculoskeletal Monitoring during Aquatic Therapy and Rehabilitation

The objectives of this study were to test the feasibility of the developed waterproof wearable device with a Surface Electromyography (sEMG) sensor and Inertial Measurement Unit (IMU) sensor by (1) comparing the onset duration of sEMG recordings from maximal voluntary contractions (MVC), (2) comparing the acceleration of arm movement from IMU, and (3) observing the reproducibility of onset duration and acceleration from the developed device for bicep brachii (BB) muscle between on dry-land, and in aquatic environments. Five healthy males participated in two experimental protocols with the activity of BB muscle of the left and right arms. Using the sEMG of BB muscle, the intra-class correlation coefficient (ICC) and typical error (CV%) were calculated to determine the reproducibility and precision of onset duration and acceleration, respectively. In case of onset duration, no significant differences were observed between land and aquatic condition (p = 0.9-0.98), and high reliability (ICC = 0.93-0.98) and precision (CV% = 2.7-6.4%) were observed. In addition, acceleration data shows no significant differences between land and aquatic condition (p = 0.89-0.93), and high reliability (ICC = 0.9-0.97) and precision (CV% = 7.9-9.2%). These comparable sEMG and acceleration values in both dry-land and aquatic environment supports the suitability of the proposed wearable device for musculoskeletal monitoring during aquatic therapy and rehabilitation as the integrity of the sEMG and acceleration recordings maintained during aquatic activities.Clinical Relevance-This study and relevant experiment demonstrate the feasibility of the developed wearable device to support clinicians and therapists for musculoskeletal monitoring during aquatic therapy and rehabilitation.

The WATER study: Which AquaTic ExeRcises increase muscle activity and limit pain for people with low back pain?

OBJECTIVE

Aquatic exercise therapy is used for the treatment and management of chronic low back pain (CLBP). However, to the authors' knowledge, no studies to date have compared muscle activity between different aquatic exercises performed by people with CLBP. As such, this study assessed and compared muscle activity, pain, perceived exertion and exercise intensity between different rehabilitative aquatic exercises.

DESIGN

Cross-sectional.

SETTING

A 25-m indoor swimming pool within a university building.

PARTICIPANTS

Twenty participants with non-specific CLBP.

ASSESSMENT

Twenty-six aquatic exercises in shallow water (1.25-m depth). Muscle activity was quantified bilaterally for the erector spinae, multifidus, gluteus maximus and medius, rectus abdominis, and external and internal obliques.

MAIN OUTCOMES

Mean and peak muscle activity, pain (visual analogue scale), perceived exertion (Borg scale) and exercise intensity (heart rate).

RESULTS

Hip abduction/adduction and extension/flexion exercises produced higher activity for gluteal muscles. Variations of squat exercises increased the activity of back extensors. Higher abdominal muscle activity was produced with exercises that made use of buoyancy equipment and included leg and trunk movements while floating on the back, and with some proprioceptive and dynamic lower limb exercises. Pain occurrence and intensity were very low, with 17 exercises being pain free.

CONCLUSIONS

This study provides evidence on trunk and gluteal muscle activity, pain, intensity and perceived exertion for people with CLBP performing aquatic exercises. The findings may be useful when prescribing exercises for rehabilitation, as physiotherapists seek to implement progression in effort and muscle activity, variation in exercise type, and may wish to target or avoid particular muscles. CONTRIBUTION OF THE PAPER.

Vibrating Exercise Equipment in Middle-Age and Older Women with Chronic Low Back Pain and Effects on Bioelectrical Activity, Range of Motion and Pain Intensity: A Randomized, Single-Blinded Sham Intervention Study

Background: Chronic low back pain (CLBP) is one of the most common musculoskeletal disorders. Physical activity (PA) is often recommended as part of the management of CLBP, but to date, no one particular exercise has been shown to be superior. Vibrating exercise equipment (VEE) is widely available and used despite little scientific evidence to support its effectiveness in the prevention and treatment of musculoskeletal problems. The aim of this study was to evaluate the efficiency of using VEE compared with sham-VEE in women with CLBP. Methods: A randomized (1:1 randomization scheme) single-blinded sham-controlled intervention study was conducted. Through simple randomization, 92 women aged 49-80 years were assigned to one of two groups: VEE (the experimental group) and sham-VEE (the control group). The VEE and sham-VEE intervention consisted of aerobic exercises with specific handheld equipment. Both groups performed physical activity twice weekly for 10 weeks. The erector spinae muscles' bioelectrical activity (using an eight-channel electromyograph MyoSystem 1400L), lumbar range of motion (Schober's test) and pain intensity (visual analog scale) were measured in all participants at baseline and after 10 weeks. Results: There was a significant decrease in the bioelectrical activity of the erector spinae muscles during flexion movement (left: Me = 18.2 before; Me = 14.1 after; p = 0.045; right: Me = 15.4 before; Me = 12.6 after; p = 0.010), rest at maximum flexion (left: Me = 18.1 before; Me = 12.5 after; p = 0.038), extension movement (right: Me = 21.8 before; Me = 20.2 after; p = 0.031) and rest in a prone position (right: Me = 3.5 before; Me = 3.2 after; 0.049); an increase in lumbar range of motion (Me = 17.0 before; Me = 18.0 after; p = 0.0017) and a decrease in pain intensity (Me = 4.0 before; Me = 1.0 after; p = 0.001) following a program of PA in the VEE group. Conclusions: No significant changes were found in intergroup comparisons. The beneficial changes regarding decreased subjective pain sensation in the VEE and sham-VEE groups may be due to participation in systematic physical activity. However, PA with vibrating exercise equipment could be a prospective strategy for increasing lumbar range of motion and for decreasing pain and erector spinae muscle activity in people with CLBP.

Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain: A Randomized Clinical Trial

Importance

Therapeutic aquatic exercise is frequently offered to patients with chronic low back pain, but its long-term benefits are unclear.

Objective

To assess the long-term effects of therapeutic aquatic exercise on people with chronic low back pain.

Design, Setting, and Participants

This 3-month, single-blind randomized clinical trial with a 12-month follow-up period was performed from September 10, 2018, to March 12, 2019, and the trial follow-up was completed March 17, 2020. A total of 113 people with chronic low back pain were included in the experiment.

Interventions

Participants were randomized to either the therapeutic aquatic exercise or the physical therapy modalities group. The therapeutic aquatic exercise group received aquatic exercise, whereas the physical therapy modalities group received transcutaneous electrical nerve stimulation and infrared ray thermal therapy. Both interventions were performed for 60 minutes twice a week for 3 months.

Main Outcomes and Measures

The primary outcome was disability level, which was measured using the Roland-Morris Disability Questionnaire; scores range from 0 to 24, with higher scores indicating more severe disability. Secondary outcomes included pain intensity, quality of life, sleep quality, recommendation of intervention, and minimal clinically important difference. Intention-to-treat and per-protocol analyses were performed.

Results

Of the 113 participants, 59 were women (52.2%) (mean [SD] age, 31.0 [11.5] years). Participants were randomly allocated into the therapeutic aquatic exercise group (n = 56) or the physical therapy modalities group (n = 57), and 98 patients (86.7%) completed the 12-month follow-up. Compared with the physical therapy modalities group, the therapeutic aquatic exercise group showed greater alleviation of disability, with adjusted mean group differences of -1.77 (95% CI, -3.02 to -0.51; P = .006) after the 3-month intervention, -2.42 (95% CI, -4.13 to -0.70; P = .006) at the 6-month follow-up, and -3.61 (95% CI, -5.63 to -1.58; P = .001) at the 12-month follow-up (P < .001 for overall group × time interaction). At the 12-month follow-up point, improvements were significantly greater in the therapeutic aquatic exercise group vs the physical therapy modalities group in the number of participants who met the minimal clinically important difference in pain (at least a 2-point improvement on the numeric rating scale) (most severe pain, 30 [53.57%] vs 12 [21.05%]; average pain, 14 [25%] vs 11 [19.30%]; and current pain, 22 [39.29%] vs 10 [17.54%]) and disability (at least a 5-point improvement on the Roland-Morris Disability Questionnaire) (26 [46.43%] vs 4 [7.02%]). One of the 56 participants (1.8%) in the therapeutic aquatic exercise group vs 2 of the 57 participants (3.5%) in the physical therapy modalities group experienced low back pain and other pains related to the intervention.

Conclusions and Relevance

The therapeutic aquatic exercise program led to greater alleviation in patients with chronic low back pain than physical therapy modalities and had a long-term effect up to 12 months. This finding may prompt clinicians to recommend therapeutic aquatic exercise to patients with chronic low back pain as part of treatment to improve their health through active exercise rather than relying on passive relaxation.

Trial Registration

Chinese Clinical Trial Registry: ChiCTR1800016396.

A review on muscle activation behaviour during gait in shallow water and deep-water running and surface electromyography procedures

BACKGROUND

Surface electromyography (sEMG) can provide information on muscle activation patterns during gait.

OBJECTIVES

To characterize electromyographic activity during gait in shallow water and during deep-water running compare to on land and to review and analyse underwater surface-electromyographic (sEMG) procedures.

SEARCH METHODS

Eight databases (MEDLINE, EMBASE, WEB OF SCIENCE, SPORT Discus, CINAHL, SCOPUS, SCIELO, and LILACS) were searched from their inception to the December of 2019.

SELECTION CRITERIA

The selected studies had to be related to electromyographic analysis of gait in an aquatic environment.

DATA COLLECTION AND ANALYSIS

The studies that met the inclusion criteria were reviewed by two independent reviewers and divided into four groups.

RESULTS

Ten studies met the inclusion criteria. Lower muscle activation was found with treadmill water walking compared to treadmill land walking. With deep-water running, the leg muscles (tibialis anterior and gastrocnemius lateralis) have lower muscle activation when compared to on land running, but the trunk and thigh muscles have higher activation.

CONCLUSION

If gait is performed on an aquatic treadmill, the muscles assessed had lower muscle activation when compared to land. During deep-water running activities, lower activation of the distal leg muscles and a higher activation thigh muscles were found when compared to on land. Studies did not follow standard processes in sEMG procedures.

Inspiratory Muscle Training in Rehabilitation of Low Back Pain: A Randomized Controlled Trial

CONTEXT

People with chronic low back pain (CLBP) suffer from weaknesses in their core muscle activity and dysfunctional breathing. Inspiratory muscle training (IMT) was recently developed to treat this condition.

OBJECTIVES

The present study was conducted to investigate the effect of IMT on core muscle activity, pulmonary parameters, and pain intensity in athletes with CLBP.

DESIGN

This study was designed as a single-blind, randomized, controlled trial.

SETTING

Clinical rehabilitation laboratory.

PARTICIPANTS

A total of 23 male and 24 female athletes with CLBP were randomly divided into the experimental and control groups.

MAIN OUTCOME MEASURES

The experimental group performed IMT for 8 weeks, 7 days per week and twice daily, using POWERbreathe KH1, beginning at 50% of maximum inspiratory pressure with a progressively increasing training load. The surface electromyography muscle activity of the erector spinae, multifidus, transverse abdominis and rectus abdominis, respiratory function and Visual Analogue Scale score were also measured before and after the intervention in both groups. The repeated-measures analysis of variance and 1-way analysis of covariance were further used to compare the intragroup and intergroup results following the intervention.

RESULTS

The findings of the study revealed that multifidus and transverse abdominis activity, as well as respiratory function, increased significantly in the IMT group (P < .05). Moreover, a descending trend was observed in the Visual Analogue Scale score in the experimental group (P < .05).

CONCLUSION

The results showed that IMT can improve respiratory function, increase core muscle activity, and, consequently, reduce pain intensity in athletes with CLBP.

Muscle Activation and Distribution during Four Test/Functional Tasks: A Comparison between Dry-Land and Aquatic Environments for Healthy Older and Young Adults

BACKGROUND

The use of rehabilitation protocols carried out in water has been progressively increasing due to the favorable physical properties of the water. Electromyography allows one to register muscle activity even under water.

AIM

To compare muscle activity between two groups (healthy young adults (HYA) and healthy older adults (HOA)) in two different environments (dry land and aquatic) using surface electromyography during the execution of four different test/functional movements.

METHODS

Analytical cross-sectional study. HYA and HOA carried out four functional tasks (Step Up and Down, Sit To Stand test, Gait Initiation and Turns During Gait) in two different environments (dry land and aquatic). Absolute and relative muscle activation was compared between each group and between each environment. In addition, the stability of the measured was calculated through a test-retest (ICC 2:1).

RESULTS

Within the same environment there were significant differences between young and older adults in three of the four functional tasks. In contrast, in the gait initiation, hardly any significant differences were found between the two groups analysed, except for the soleus and the anterior tibial. Measurement stability ranged from good to excellent.

CONCLUSIONS

Level of the musculature involvement presents an entirely different distribution when the test/functional task is performed on dry land or in water. There are differences both in the relative activation of the musculature and in the distribution of the partition of the muscles comparing older and young adults within the same environment.

Does low back pain or leg pain in gluteus medius syndrome contribute to lumbar degenerative disease and hip osteoarthritis and vice versa? A literature review

[Purpose] Gluteus medius syndrome is one of the major causes of back pain or leg pain and is similar to greater trochanteric pain syndrome, which also presents with back pain or leg pain. Greater trochanteric pain syndrome is associated with lumbar degenerative disease and hip osteoarthritis. The objective of this review was to demonstrate gluteus medius syndrome as a disease entity by reviewing relevant articles to elucidate the condition. [Methods] Gluteus medius syndrome was defined as myofascial pain syndrome arising from the gluteus medius. We performed a search of the literature using the following keywords: “back pain”, “leg pain”, “greater trochanteric pain syndrome”, “degenerative lumbar disease”, “hip osteoarthritis”, and “gluteus medius”. We reviewed articles related to gluteus medius syndrome and described the findings in terms of diagnosis and treatment based on the underlying pathology. [Results] A total of 135 articles were included in this review. Gluteus medius syndrome is similar as a disease entity to greater trochanteric pain syndrome, which presents with symptoms of low back pain and leg pain. Gluteus medius syndrome is also related to lumbar degenerative disease, hip osteoarthritis, knee osteoarthritis, and failed back surgery syndrome. [Conclusion] Accurate diagnosis of gluteus medius syndrome and appropriate treatment could possibly improve lumbar degenerative disease and osteoarthritis of the hip and knee, as well as hip-spine syndrome and failed back surgery syndrome.