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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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Fitness

Mere minutes of daily vigorous exercise can cut your risk of 8 diseases | CNN

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Mere minutes of daily vigorous exercise can cut your risk of 8 diseases | CNN

Move more. Sit less. For many years, that’s been accepted guidance for people wanting to get healthier.

Now that message is getting refined, with a growing body of research suggesting that certain types of movements may be more beneficial than others when it comes to health benefits.

The intensity of your exercise may matter as well. A new study published in the European Heart Journal found that a small amount of vigorous activity may be linked to lower risk of eight different chronic diseases.

The findings raise questions about why intensity matters and how people can incorporate more intense exercise routines into everyday life. To better understand the study’s implications, I spoke with CNN wellness expert Dr. Leana Wen, an emergency physician and clinical associate professor at George Washington University. She previously served as Baltimore’s health commissioner.

Before beginning any new exercise program, consult your doctor. Stop immediately if you experience pain.

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CNN: What did this study examine about exercise and its relationship to chronic disease?

Dr. Leana Wen: This investigation looked at how the intensity of physical activity is related to the risk of developing a range of chronic diseases. Researchers analyzed data from two very large groups in the UK Biobank, which is a long-term health study in the United Kingdom that tracks medical and lifestyle information from hundreds of thousands of participants. One group included about 96,000 people who wore wrist activity trackers that objectively measured their movement, and the other included more than 375,000 people who self-reported their activity.

The researchers followed participants over an average of about nine years and examined the development of eight conditions: major cardiovascular events, atrial fibrillation, type 2 diabetes, immune-related inflammatory diseases, fatty liver disease, chronic respiratory disease, chronic kidney disease and dementia, as well as overall mortality.

The key finding was that the proportion of activity done at vigorous intensity mattered. People who had more than about 4% of their total activity classified as vigorous had substantially lower risks of developing these conditions compared with people who had no vigorous activity at all. The numbers were stunning, with the participants having the following results:


  • 63% lower risk of dementia,

  • 60% lower risk of type 2 diabetes,

  • 48% lower risk of fatty liver disease,

  • 44% lower risk of chronic respiratory disease,

  • 41% lower risk of chronic kidney disease,

  • 39% lower risk of immune-mediated inflammatory diseases,

  • 31% lower risk of major cardiovascular events,

  • 29% lower risk of atrial fibrillation, and

  • 46% lower risk of death from any cause.

These results are amazing. Imagine if someone invented a medication that could reduce the risks of all these diseases at once — it would be very popular! Crucially, even people who exercised a lot still benefited if the proportion of time they spent doing vigorous physical activity was increased. Conversely, people who were relatively inactive also benefited from adding just a little bit of higher-intensity exercise to their daily routines.

CNN: What counts as “vigorous” physical activity?

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Wen: Vigorous activity is generally defined as exercise that substantially raises your heart rate and breathing. A simple way to gauge it is the “talk test.” If you can speak comfortably in full sentences while exercising, you are likely in the low to moderate range. If you are so out of breath that you can only say a few words at a time, that is vigorous.

Running, cycling, lap swimming or climbing stairs quickly could count. But this also depends on people’s baseline fitness. For some individuals, taking longer strides with walking can be vigorous exercise. Others who are already fairly fit would need to do more. It’s also important to remember that vigorous activity doesn’t have to be in the context of a structured exercise plan. Short bursts of effort in daily life, such as rushing to catch a bus or carrying heavy groceries upstairs, can also qualify if they raise your heart rate and make you breathless.

CNN: Why might higher intensity exercise provide additional health benefits?

Wen: Higher intensity activity places greater demands on the body in a shorter period. This type of movement can improve cardiovascular fitness, increase insulin sensitivity and support metabolic health more efficiently than lower-intensity activity alone. Some studies have also linked vigorous activity with cognitive benefits.

Greater intensity may have distinct benefits across different organ systems. The researchers found that some conditions, such as immune-mediated inflammatory diseases, appeared to be more strongly linked to the intensity of activity than to the total amount. On the other hand, type 2 diabetes and kidney disease were influenced by both how much activity people did and how intense it was. Why this is the case is not yet known, but intensity appears to have a significant impact across diseases affecting multiple organs.

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CNN: How much vigorous activity do people need?

Wen: The threshold for people seeing a benefit appears to be relatively low. The researchers found that once people reached more than about 4% of their total activity as vigorous, their risk of developing chronic diseases dropped substantially.

To put that into practical terms, we are not talking about professional athletes dedicating their lives to hours of high-intensity training. Everyday people may see benefits from just doing a few minutes of vigorous effort daily.

CNN: How can people realistically incorporate vigorous activity into their daily routines?

Wen: One helpful way to think practically is that vigorous activity does not have to happen all at once. It can be accumulated in short bursts throughout the day.

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People can take the stairs instead of the elevator and do so at a faster pace than usual. When they are heading to work, they can add some speed walking. They can park farther away when grocery shopping and walk briskly while carrying groceries.

Structured exercise also can incorporate intervals where people alternate between moderate and more intense effort. If you’re swimming laps, you can warm up at a more leisurely pace, then do a few laps at a faster pace, then again at a leisurely pace and repeat. This suggestion applies to any other aerobic exercise: Aim for multiple intervals of at least 30 seconds to a minute each where your body is working hard enough that you feel noticeably out of breath.

CNN: What about someone who is older or has mobility issues?

Wen: Not everyone can or should engage in high-intensity activity in the same way. Vigorous activity is relative to that person’s baseline. For someone who is not used to exercise, even a short period of slightly faster walking or standing up repeatedly from a chair could be considered high intensity. And not everyone may be able to walk. In that case, some exercises from the chair can have aerobic benefits.

Individuals who have specific medical conditions should consult with their primary care clinicians before embarking on a new exercise routine. People with mobility issues also may benefit from working with a physical therapist who can help to tailor exercises appropriate to their specific situation.

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CNN: What is the key takeaway for people trying to improve their health?

Wen: To me, the main takeaway from this study is that it’s not only how much total exercise you get but also how hard you push yourself that matters. And you don’t have to have a lot of high-intensity exercise: Adding just a little has substantial health benefits across a wide range of chronic health conditions.

At the same time, exercise needs be practical. People should look for opportunities to safely increase intensity in ways that fit their daily lives. The most effective approach to physical activity is a balanced one: Exercise regularly, incorporate more challenging activities when you can and build habits that are sustainable over time.

Get inspired by a weekly roundup on living well, made simple. Sign up for CNN’s Life, But Better newsletter for information and tools designed to improve your well-being.

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‘Not what the fitness industry is trying to sell you’: this is the one simple move everyone really needs to be doing, according to an exercise scientist

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‘Not what the fitness industry is trying to sell you’: this is the one simple move everyone really needs to be doing, according to an exercise scientist

Ask any exercise scientist what they would prescribe to someone serious about staying strong into their 50s and beyond, and the answer is rarely what you’d hope for — and certainly not what the fitness industry is currently trying to sell you.

It isn’t long sessions on one of the best under-desk treadmills or a stationary bike like the Peloton, nor the kind of machine-based exercises that isolate muscles without ever teaching them to work together.

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Ellie Kildunne built her powerful body by keeping things simple – focusing on these fundamentals

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Ellie Kildunne built her powerful body by keeping things simple – focusing on these fundamentals

Despite being named World Rugby’s Women’s 15s Player of the Year, England rugby star Ellie Kildunne admitted on an episode of Just As Well that the ‘gym was never easy’. In order for her to feel her best, she sticks to a no-nonsense approach to training and nutrition that focuses on the fundamentals: consistent exercise and eating enough.

‘If I haven’t put the work in, if I’ve skipped reps, if I haven’t eaten the right amount for the game, I would feel anxious,’ she says in her cover interview for Women’s Health UK. ‘But I’ve never put myself in that position because I want to be the best.’

What does being the best mean to her? ‘I want to become world player of the year twice. That’s my focus. Anything else that happens is by the by.’

On her episode of Just As Well last year, she said strength training now makes her ‘feel powerful’, while she ‘hates running’ – but a lot of her training involves speed, agility and endurance practice for her time on the pitch. That mix of conditioning and strength means she has built a strong, fast and resilient body.

Speaking of her physical transformation, she admits her personal body image hasn’t always been positive: ‘Body image is such a mental challenge,’ she tells Women’s Health UK. ‘My body is what made me World Player of the Year… I’ve got to remind myself of that.’ Visibility helps too: ‘We’re in that transition phase… social media is starting to lean more towards athletic women… I see people that look like me now.’ Now, Ellie says when she sees a muscular person, she thinks, ‘Respect. Because I know exactly what goes into that.’

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Headshot of Bridie Wilkins

As Women’s Health UK’s fitness director and a qualified Pilates and yoga instructor, Bridie Wilkins has been passionately reporting on exercise, health and nutrition since the start of her decade-long career in journalism.

After earning a first-class degree in journalism and NCTJ accreditation, she secured her first role at Look Magazine, where she launched the magazine’s health and fitness column, Look Fit, before going on to become Health and Fitness writer at HELLO!

Since, she has written for Stylist, Glamour, Cosmopolitan, Marie Claire, Elle, The Metro, Runner’s World and Red. Today, she oversees all fitness content across Women’s Health online and in print, spearheading leading cross-platform franchises, such as ‘Fit At Any Age’, which showcases the women proving that age is no barrier to exercise.

She has also represented the brand on BBC Radio London, plus various podcasts and Substacks – all with the aim to encourage more women to exercise and show them how. Outside of work, find her trying the latest Pilates studio, testing her VO2 max for fun (TY, Oura), or posting workouts on Instagram.   

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