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Back or Knee Pain? Uh-Oh, You May Have ‘Dead Butt Syndrome’

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Back or Knee Pain? Uh-Oh, You May Have ‘Dead Butt Syndrome’

Nov. 13, 2025 – You won’t find any support groups for dead butt syndrome, aka gluteal amnesia, sleepy glutes, flabby butt, longback, or, for King of the Hill fans, diminished gluteal syndrome.

“They all mean sort of the same thing: weak gluteal muscles,” said Dean Somerset, a clinical exercise physiologist based in Edmonton, Alberta, Canada, and co-author of Rock Solid Resilience.

If you guessed that small, weak, and poorly functioning glutes are often the result of too much sitting and too little exercise, you wouldn’t be wrong, according to Somerset.

Meanwhile, Los Angeles-based physical therapist Chad Waterbury, DPT, has seen it in healthy, fit, active clients, including a few professional athletes. “When we do exercises like squats, deadlifts, lunges, it’s very easy for other muscles to do the work you want the glutes to do,” Waterbury said

In both populations, the glutes stop doing what they should, and that can lead to serious problems up and down the movement chain. 

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If misfiring glutes force the lower-back muscles to take on loads they’re not meant to handle, the result can be years of back pain. And if the glutes fail to perform their stabilizing role in exercise and sports, you could be looking at chronically sore knees, or perhaps even an ACL injury. 

That means the Venn diagram of dead butt sufferers includes people who sit a lot, active people, those with back pain, and those with knee pain. All those people, all that overlap, all those butts.

Is your butt among them?

Putting a Name to the Pain

Stuart McGill, PhD, coined the term “gluteal amnesia” to describe what happens when pain causes people to change how they move.

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“In people with longer-term pain, the pattern of nerve pulses distributed to the muscles can become corrupted,” he explained. “The pain kicks off an inhibition pathway, so the brain finds a different way to do the same basic thing.” 

That, in turn, changes the way muscles like the hamstrings contribute to the movement.

“But even when the pain has gone away, the brain often remembers the painful pattern,” McGill said. Which means it also forgets how to use the muscles appropriately and efficiently. 

McGill, a distinguished professor emeritus at the University of Waterloo and author of Back Mechanic, showed how the process works in a 2013 study. In that paper, he and his co-authors used “gluteal amnesia” and “gluteal inhibition” interchangeably. 

The latter term is probably more appropriate, given that some people hear the former and think it implies gluteal dementia, as if the misplaced movement patterns can never be restored.

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Fortunately for the gluteally deficient among us, they can. Just not in the way most of us would assume. 

Hips, Femur, Knees, and Woes

While McGill was teasing out the connection between gluteal amnesia and back pain, Christopher Powers, PT, PhD, was looking at how abnormal glute activation patterns could lead to knee problems. 

“The gluteal muscles control the femur,” he explained. “The femur’s half the knee joint. So by definition, the gluteal muscles control half the knee.”

Powers is associate chair of the Division of Biokinesiology and Physical Therapy at the University of Southern California, where he studies the root causes of the lower-body injuries. And he addresses a lot of them with the athletes and patients he sees at the Movement Performance Institute in Los Angeles, which he founded and owns. 

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His research has shown that a key function of the gluteal muscles is to prevent the femur from rolling inward during sports, exercise, or everyday physical activities. 

“Once you stop using the muscle, the brain kind of forgets about it,” Powers said. “You lose the neural connectivity.”

And if the brain forgets how to stabilize the femur, just about anything you do, from walking to landing after a jump, will put stress on your knee joints. 

How to Know if Your Butt is Dead or Dying

Remember, given that sedentary and active people have this issue, aside from chronic knee or back pain, you may not be able to tell if your glutes are firing properly or improperly. 

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Waterbury recommends this self-test: the single-leg glute bridge. 

Lie on your back with one leg lifted out straight and the other leg bent at a 45-degree angle with the foot flat on the floor. Your thighs should be parallel. Raise your butt so your thighs and torso form a straight line. 

Hold that position for 20 seconds (or as long as you can up to 20), while paying close attention to which muscles you feel are working the hardest. Lower your hips and repeat with the other leg. 

If you felt the strongest contraction in your hamstrings or lower back, instead of your glutes, you need to improve your gluteal activation. Also, muscle imbalances are common, so it’s also not unusual for you to feel weaker in one glute or the other.

Two of Powers’s studies offer encouraging news for those whose glutes have lost their way. 

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The first, published in 2016, found that a week of glute-activation exercises increased neural drive to the muscles. 

A follow-up, published in 2022, found that the same exercise protocol made the muscles more able to stabilize the femur.   

So let’s take a look at the program.

Wake Up, Dead Butt

Powers’s program includes just three exercises, all of which may look familiar: clamshell, side-lying hip abduction, and fire hydrant. 

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Even if you haven’t used the exercises in your own routines, you’ve probably seen other people doing variations of them. 

Here’s the catch: To do the program correctly, you have to forget what you’ve done or seen. 

Instead of doing sets and reps, you’ll hold each position for up to a minute at a time. And you’ll need to do the program almost every day. 

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“When you do reps – up and down, up and down – the focus tends to be on the movement,” Powers said. Isometric holds like these require something else: intense concentration on squeezing the muscle in one continuous position.

That extended muscle activation allows the brain to reopen its channels of communication. If you follow the isometric holds with exercises that use the glutes, like squats or step-ups, you reinforce those neural signals.

To get the most out of the exercises, you’ll want to use a miniband positioned around your thighs, just above your knees. When you can hold a position for a full minute, use a more challenging band the next time. 

Here’s a closer look at each exercise. 

Clamshell

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Lie on your side with your legs together and your hips and knees bent 45 degrees. 

Lift your top knee straight up while keeping your feet in contact with each other. 

Feel the squeeze in your glutes and hold for up to a minute. Switch sides and repeat. 

Side-Lying Hip Abduction

 Lie on your side with your top leg straight and bottom leg bent at the knee about 45 degrees.

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Lift your top leg up and slightly back.

Feel the squeeze in your glutes and hold for up to a minute. Switch sides and repeat.

Fire Hydrant

To Powers, the fire hydrant is the best of the activation exercises. “If I were to pick one, I’d take it over the other two,” he said.

But it’s also the trickiest one to get right, since you’re asking your glutes to perform three functions, as you’ll see: 

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Kneel on all fours with your hips parallel to the floor and your hands shoulder-width apart.

Without shifting your hips, lift one leg up (hip abduction) and back (hip extension). Position your thigh so it’s neither perpendicular to your torso (straight out to the side) nor aligned with it (straight back), but instead about halfway between those two points. (It’s called “fire hydrant” because you’re mimicking a dog doing what a dog does to a fire hydrant.)

Now turn your thigh outward (external rotation) until you feel tension in the band. 

The goal isn’t to achieve any particular range of motion. It’s to reach a position you can hold while keeping your hips level with the floor.

Hold for up to a minute, switch sides, and repeat. 

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Restoring Your Seat of Power

People in Powers’s studies did three isometric holds of each exercise, with each leg, twice a day for seven consecutive days. 

But Waterbury, who studied under Powers at USC, uses a streamlined version of the program with clients, athletes, and patients. 

Start with these exercises:

  • Clamshell, 30 seconds per side
  • Side-lying hip abduction, 30 seconds per side
  • Fire hydrant, 30 seconds per side 

Do the exercises six days a week for four weeks, either on their own or as part of a warmup before a workout. “That’s plenty to get the glutes activated,” Waterbury said.

After four weeks, do the exercises three times a week, preferably before a strength workout that includes squats, deadlifts, lunges, or other movements that use your glutes in coordinated action with other lower-body muscles. 

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You can also do more advanced versions of the exercises, as Waterbury demonstrated in this video.

What matters most, he emphasized, is that you make these isometric holds a permanent part of your fitness routine.

“Too many things we do throughout the day make your glutes want to shut down again,” he said. 

Ultimately – and this is pretty good life wisdom – it’s a lot easier to keep your butt alive and well than it is to bring it back from the dead.

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Forget the gym — you just need 20 minutes and 2 dumbbells to strengthen your whole body with this workout

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Forget the gym — you just need 20 minutes and 2 dumbbells to strengthen your whole body with this workout

One of the harder parts of committing to a training routine is knowing where to start, and that’s true of those who have never trained regularly before as well as more experienced people coming back after a break.

This 20-minute workout from fitness trainer Lindsey Bomgren, founder of Nourish Move Love on YouTube, is perfect for easing your way into a training routine, especially if you’re coming back from a break because of illness or any other reason.

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Ditch sit-ups and crunches — this 5-move standing abs workout will help you build a stronger and more sculpted core

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Ditch sit-ups and crunches — this 5-move standing abs workout will help you build a stronger and more sculpted core

The beauty of a standing abs workout is that you do not need a mat, much space, or to get down on the ground for any of the exercises. That makes it easy to fit into a busy day, whether you are working out at home, short on space, or prefer to stay off the floor altogether.

None of that means it is easier or delivers fewer results. Pilates instructor and Balance Body Educator Portia Page built this five-move, all-standing core workout to show that you can still challenge your abs effectively without a mat or traditional floor exercises.

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The future of fitness: How AI coaches are changing the way we exercise

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The future of fitness: How AI coaches are changing the way we exercise

Fitness and health apps have been promising “smart coaches” and “personalised training plans” for years. But, to date, most programmes have been like online shopping recommendations, with exercises broadly matching your demographic profile and performance level.

However, the rapid advances in real-time image recognition, generative AI and natural language processing are bringing an AI coach worthy of the name within our grasp. And not just for high-tech gyms like Lumin, but also for people working out at home or in the park. Peloton, for example, films how you exercise and provides feedback in real time. Google has also announced AI-powered personalised fitness and health advice for its Fitbit range.

HYROX pro athlete Jake Dearden putting in the work on an indoor bike

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© Baptiste Fauchille/Red Bull Content Pool

Market analysts think the AI fitness market could be worth close to $35b USD by 2030. But how close are we to that future? Which company is training up the supertrainer? And how will that change the way we exercise, sweat and track our progress? And what do we need to know about this new world?

Harnessing AI’s potential to make personalised training available to all

Lucy Charles-Barclay prepares for training in London, England, on July 14, 2021.

Most fitness apps give generic exercise suggestions

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Confidence Udegbue has the perfect CV for designing an AI coach. The Vice President of Product at fitness app Freeletics studied electrical and computer engineering and teaches fitness classes in his free time. His broad shoulders, muscular biceps and infectious spirit are a dead giveaway: this guy knows what he’s talking about.

“In the gym, I can see immediately when someone I’m teaching is making a mistake,” says Udegbue. “But that expertise is hard to scale.” Freeletics is trying to solve that problem with AI. The app has been using a predictive algorithm since 2019 to suggest workouts based on demographic data and self-assessed fitness levels. This means that a 39-year-old man who has been training for two years and is at level 63 in the app won’t receive the same instructions as a 25-year-old beginner.

Freeletics uses AI-based motion analysis powered by models like those from Google’s MediaPipe framework, which includes BlazePose – the successor to the earlier PoseNet model. The models provide a skeletal muscle database that can replicate all types of exercises, for which Freeletics sports scientists then define the movements. That way, the system can assess whether that squat you just did went low enough.

Can an AI coach give useful real-time workout feedback?

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One of the most revered sabre fencers in the world, Olga Kharlan, checks her phone during training

World-class sabre fencer Olga Kharlan checks her phone

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In 2024, Freeletics introduced the Coach+ feature – an AI-powered chatbot with Freeletics expertise and access to anonymised data from over 59m user journeys. Users can ask the virtual coach questions like, “How can I build muscle mass?” or “I feel weak – how can I motivate myself?”

Freeletics is currently testing a version that will allow the app to see you work out. As of April, users have been able to record themselves exercising on their smartphones. “AI counts the reps and gives direct feedback,” Udegbue says. That is particularly helpful because even experienced athletes do not always perform pistol squats or burpees correctly.

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Democratising the personal coach experience

Max Verstappen of Oracle Red Bull Racing stretches before a F1 Grand Prix

Max Verstappen warming up before a F1 race

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A personal coach was long the preserve of Hollywood actors, top models and CEOs – a highly competent service provider, always available whenever a slot opened up in their client’s busy schedule. They know their clients’ allergies, preferences and weak spots. They always know how to set the pace. Sometimes they’re pushy, sometimes they go easy. They are a mix of therapist, personal assistant and best friend – open 24/7, all major credit cards accepted.

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In the soccer world, the manager is often called “boss” – a figure of respect who takes care of the players both on and off the field. A good coach can tell when something is off in a movement – when the person’s mind is elsewhere, or they’re lacking energy. Anyone who has had that person in their life knows that a good coach is worth their weight in gold, which is why there are coaches for everything – careers, relationships, nutrition – and why the idea of a personalised fitness coach is so appealing.

AI has no body or talent. It doesn’t know what it feels like for sweat to run down the skin or for muscles to cramp or for adrenaline to rush through the veins. But it does recognise patterns and make predictions that we humans can use increasingly often and, in the best-case scenario, find out more about ourselves in the process.

How AI will allow us to ‘chat with our body’

Mutaz Barshim powers through a workout in the gym

High-jump star Mutaz Barshim lifting heavy

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Mirrors show you how you see yourself. But the Magic AI Mirror promises that you will like what you see if you follow the exercises and tips on the reflective screen. Behind the glass surface is an AI coach who steers your workouts in real time.

Growl goes even deeper into movement detection. The start-up has developed an exercise boxing bag that captures every movement with 3D cameras and Lidar (light detection and ranging) technology. AI corrects your posture or encourages you when your energy decreases.

Whoop’s fitness trackers combine biometric data with generative AI. If you’re wondering when you got your best sleep, you’ll get a precise answer: “On July 14, because the allergy season was over and you didn’t drink alcohol.” You can chat with your body.

Freeletics is also banking on predictive AI. “Soon the system will recognise that user X has had an increased resting heart rate for days, so I won’t suggest high-intensity exercises,” says Udegbue.

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The vision all companies are working on is a multimodal coach: AI that unlocks information – biometrics, genetics, video, training history – and conveys it intuitively to the user. But a perfect coach is more than just an algorithm. Researchers are working on reinforcement learning systems that set individual step goals that are challenging but achievable, and adapt whenever progress has been made.

The power of human and AI combined

Adriano de Souza in seen during the video recording of Se Prepara series in Florianopolis, Brazil, on April 30, 2019.

Training is possible anywhere

© Marcelo Maragni/Red Bull Content Pool

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“We will not be able to deliver on the promise of absolute personalisation for the mass market,” Eskofier says. But before you lose hope, you should know what he means by personalisation.

His laboratory supports, among other people, Sebastian Steudtner, the big wave surfer and world record holder. To do this, they measured his body in an MRI scanner, carried out psychological assessments, calculated strength curves and even fitted his surfboard and wetsuit with sensors.

Eskofier’s team created Steudtner’s digital twin. By the time the project concluded in May 2025, their AI system could already discuss with a real coach what angle Steudtner should surf a 100-foot wave at, and whether he’d be strong enough to do it.

The one thing AI will never change in fitness training

Constantin Popovici of Romania stretches at the athletes' area during the training day of the final stop of the Red Bull Cliff Diving World Series in Boston, USA, on September 18, 2025.

No equipment, no excuses – embrace the simplicity of pure movement

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“We can’t offer that service to millions of people,” Eskofier says. “But these systems can still create real added value.” He believes AI coaches are a good base: “AI can take over data processing and routine personalisation, while real coaches can focus on mentoring.”

AI coaches are getting smarter all the time, too, which is why it’s important to know what they can and can’t do. Limited data sets can lead to bias if too few women or people of below-average height are represented in the data.

“No matter how good the technology gets, one thing will never change,” says Udegbue. “A coach can only make you better if you want to be better yourself, too.” It’s all in your hands.

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