The Hidden Reason Your Back, Hip, Knee, and IT Band Won’t Stop Hurting — And the 10-Second Test You Can Do Right Now

Sports Injuries

April 9, 2026

By Dr. Lijana Shestopal, DTCM, L.Ac Licensed Acupuncturist | Sports Acupuncturist, Northbrook, IL Last updated: April 2026

Quick Answer: A small muscle on the side of your hip called the gluteus medius may be the single source behind your back pain, hip pain, knee pain, and IT band tightness. When it stops firing, your lower back, hip joint, knee, and IT band all compensate — creating pain in four different locations from one root cause. The Trendelenburg sign is a 10-second test that tells you if this muscle is the problem. Stand on one leg. If your opposite hip drops or your standing knee caves inward — your gluteus medius is inhibited.

What Is the Gluteus Medius — and Why Does It Matter So Much?

The gluteus medius, or glute med, sits on the outer surface of your hip just below the iliac crest. Most people have never heard of it. But it performs one of the most critical jobs in the entire body.

Every single time your foot leaves the ground — walking, running, climbing stairs, standing up from a chair — your glute med fires to keep your pelvis level. It is your body’s built-in stabilizer for every single step you take.

When it works, everything moves the way it should.

When it stops working, your body doesn’t stop moving. It finds other muscles to cover for it. And that is where the pain begins.

Can One Muscle Really Cause Back Pain, Hip Pain, Knee Pain and IT Band Pain?

Yes. Research published in the European Spine Journal (2016) found a significantly higher prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. A review in Physiopedia confirms that gluteus medius inhibition is associated with Trendelenburg gait, IT band syndrome, patellofemoral pain syndrome, and anterior cruciate ligament injury.

When the gluteus medius stops firing, it triggers a compensation chain that affects every structure above and below it. Here is exactly how that chain works.

1. Low Back Pain

When your glute med switches off, a deep muscle in your lower back called the quadratus lumborum — or QL — steps in as the substitute. The QL connects your pelvis directly to your spine. It was never designed to be a full-time stabilizer.

According to Wikipedia’s anatomy reference on the quadratus lumborum, when the gluteus medius is weak or inhibited, the QL becomes the prime mover for hip stabilization — and the resulting hip hiking during gait places excessive side-bending compressive stress on the lumbar segments.

That constant overwork creates the chronic tightness, burning, and aching in your lower back that never fully goes away. This is why people foam roll their QL, feel better for a day, and tighten right back up. The QL isn’t the problem. It’s been covering for the glute med. Until the glute med is restored, the QL will keep tightening.

2. Hip Pain

Your glute med provides lateral support to your hip joint with every step. When it stops firing, that support disappears. The hip joint is no longer held in proper alignment from the side. Over time, that unprotected joint starts to grind, ache, and develop pain that feels deep and difficult to locate.

Hip bursitis, hip impingement, and SI joint pain are all commonly connected to a gluteus medius that stopped doing its job.

3. Knee Pain

When the glute med stops firing, the pelvis drops on the opposite side with every step — and the standing knee compensates by rolling inward. This is called valgus collapse, and it changes the entire way the knee tracks and loads.

The patella starts tracking incorrectly. The medial structures of the knee get stressed. Research from Physiopedia confirms that gluteus medius weakness has a high correlation with common knee injury patterns including patellofemoral pain syndrome and ACL vulnerability.

What feels like a knee problem is often a hip problem showing up twenty inches below where it started.

4. IT Band Tightness

That same inward roll of the knee pulls your IT band — the thick band of fascia running along the outside of your thigh — under tension with every single step. The IT band is not a muscle. It cannot relax on its own. It responds to what the structures around it are doing.

Research published in PMC (2010) theorizes that weakness of the hip abductors, including the gluteus medius, causes compensatory dynamic valgus knee alignment resulting in increased stress on the IT band. When the knee rolls inward repeatedly, the IT band gets pulled tighter and tighter until you feel that nagging tightness on the outside of your knee and thigh that no amount of foam rolling will fix.

Because foam rolling doesn’t fix the knee roll. And the knee roll won’t stop until the glute med starts working again.

Why Does the Gluteus Medius Stop Working?

The gluteus medius doesn’t just get weak. It gets inhibited — meaning your nervous system loses the signal to it.

This happens after an old injury, a fall, prolonged sitting, or a compensation pattern your body has been running for years. The muscle is still there. It looks fine on an MRI. It tests normal on paper. But functionally, your brain has disconnected from it.

Think of it like a phone that lost its signal. The phone is perfectly fine. But without the signal, it won’t work.

This is why people do glute bridges and clamshells for months and their back still hurts. You cannot strengthen a muscle your nervous system has switched off. The connection has to come back first.

The 10-Second Test: How to Do the Trendelenburg Sign at Home

The Trendelenburg sign is one of the most reliable clinical tests for gluteus medius function. It was first described by German surgeon Friedrich Trendelenburg in 1897 and remains a standard assessment in sports medicine and orthopedic practice today (StatPearls, NIH).

The good news is you can do a version of it at home right now.

📱 Watch it on Instagram: See the Trendelenburg Test demonstrated

▶️ Watch it on YouTube: The Hidden Reason Your Back Won’t Stop Hurting

How to Do the Trendelenburg Test

Stand in front of a mirror if possible, or have someone watch from behind.
Stand on one leg. Arms slightly out for balance. Do not hold onto anything.
Hold for 10 to 20 seconds.
Watch what happens to your hips and your standing knee.

What a Positive Trendelenburg Sign Looks Like

Your opposite hip drops toward the floor. This is a positive Trendelenburg sign. The gluteus medius on your standing leg is not holding your pelvis level.

Your standing knee caves inward. This is the same result. When the glute med fails, the knee compensates by rolling in to find stability elsewhere.

Here is the part that surprises most people. The problem is not on the side where the hip drops. It is on the side you are standing on — the stance leg. The glute med that stopped holding. People instinctively focus on the dropping side, but the inhibited muscle is on the opposite side.

What a Positive Test Means for Your Pain

If your hip dropped on that test — your back pain, hip pain, knee pain, and IT band tightness may all trace back to one muscle that stopped firing.

That doesn’t mean it’s the only issue. But it is a significant piece of the puzzle that has almost certainly not been addressed.

Why Standard Treatments Often Don’t Fix This

Most treatment approaches address where it hurts — not why it hurts.

Your back gets massaged. Your IT band gets foam rolled. Your knee gets braced. Your hip gets stretched. You feel better temporarily because you have reduced the symptom without touching the source.

The glute med stays inhibited. The compensation chain keeps running. The pain comes back.

The MAP→ACT Approach at Sports Acupuncturist

At Sports Acupuncturist in Northbrook, IL, every session begins with MAP — Measure, Assess, Pinpoint. Before a single needle is placed, we observe your structure, perform manual muscle testing to identify what is on and what is off, and pinpoint the one or two real drivers behind your pain. Not ten things. The actual source.

Then we ACT — Activate the muscle that switched off, Circulate blood back into the tissues that need it, and Train the body to move the way it is supposed to again.

For an inhibited gluteus medius, this means using motor point acupuncture to restore the nervous system connection to the muscle — turning it back on at the source. Every needle has a reason. Every result gets tested. We retest after treatment to confirm the muscle has responded. If it is strong, the signal is back. No guessing.

Who Is Most at Risk for Gluteus Medius Inhibition?

People who sit for long periods — at a desk, in a car, or on a couch
Runners and cyclists who train primarily in one plane of motion
Anyone who has had a hip, lower back, or knee injury
Athletes returning from injury without proper neuromuscular rehab
People who have been told their MRI is clean but are still in pain

The Bottom Line

Your back pain, hip pain, knee pain, and IT band tightness might not be four separate problems.

They might be one muscle — the size of your hand — that stopped receiving its signal and sent the work to every structure around it.

The 10-second test you just did may have told you more about the source of your pain than anything else you have tried.

If your hip dropped — now you know where it actually starts.

Ready to find out what is really going on? Book a consultation at Sports Acupuncturist in Northbrook, IL.

🔗 sportsacupuncturist.com 📍 Northbrook, IL

Frequently Asked Questions

What is the Trendelenburg sign? The Trendelenburg sign is a clinical test used to assess gluteus medius function. A positive result occurs when the opposite hip drops during single-leg stance, indicating that the stance leg’s gluteus medius is not holding the pelvis level. It was first described in 1897 and is widely used in sports medicine and orthopedic assessment today.

What does a positive Trendelenburg sign mean? A positive Trendelenburg sign means your gluteus medius — on the leg you are standing on — is not functioning adequately. This can be caused by muscle inhibition, injury, or neurological factors. It is associated with low back pain, hip pain, knee pain, IT band syndrome, and SI joint dysfunction.

Can a weak gluteus medius cause back pain? Yes. When the gluteus medius is inhibited, the quadratus lumborum in the lower back compensates as a stabilizer during walking and standing. This overload of the QL is one of the most common and overlooked causes of chronic low back pain.

Can a weak gluteus medius cause knee pain? Yes. Gluteus medius inhibition causes the pelvis to drop and the standing knee to roll inward — a pattern called valgus collapse. This altered tracking creates stress on the patella and medial knee structures, leading to patellofemoral pain syndrome and other chronic knee conditions.

Can the Trendelenburg test be done at home? Yes. A basic version can be performed at home by standing on one leg in front of a mirror for 10 to 20 seconds and observing whether the opposite hip drops or the standing knee caves inward. A positive result warrants a full clinical assessment.

Why does foam rolling the IT band not fix the tightness? The IT band is a band of fascia, not a muscle. It cannot be lengthened by foam rolling. IT band tightness is typically the result of the knee rolling inward due to gluteus medius inhibition. Until the glute med is reactivated and the knee tracking is corrected, the IT band will remain under tension.

What is motor point acupuncture? Motor point acupuncture is a specialized form of acupuncture that places needles at the neuromuscular junction of a muscle — the point where the nerve enters the muscle — to restore the nervous system’s connection to an inhibited muscle. It is used at Sports Acupuncturist to reactivate muscles that have lost their signal, including the gluteus medius.

What is the difference between sports acupuncture and regular acupuncture? Regular acupuncture works with energy pathways and meridians to promote overall balance and wellness. Sports acupuncture uses manual muscle testing, structural assessment, and motor point acupuncture to identify and reactivate inhibited muscles, restore circulation, and retrain movement patterns. Every treatment is tested and measured for an objective result.

How long does it take to fix gluteus medius inhibition? It depends on how long the inhibition has been present and how many compensation patterns have developed around it. Some patients notice significant improvement in the first session. Others require a series of treatments to fully restore function and retrain movement patterns.

Is sports acupuncture only for athletes? No. Sports acupuncture is for anyone dealing with musculoskeletal pain — whether you are a professional athlete, a weekend runner, or someone whose back hurts from sitting at a desk. If your pain is related to how your muscles are functioning, sports acupuncture addresses the root cause.

Sources

Cooper NA et al. Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. European Spine Journal, 2016.
Gogu S, Gandbhir VN. Trendelenburg Sign. StatPearls, NIH National Library of Medicine, updated 2022.
Gluteus Medius. Physiopedia. Retrieved 2026.
Quadratus Lumborum muscle. Wikipedia, citing Janda V, 1987.
Hip abductor muscle strength and iliotibial band tightness in individuals with low back pain. PMC, 2010.
Gluteus Medius. Brookbush Institute, updated 2024.

Dr. Lijana Shestopal, DTCM, L.Ac is a licensed acupuncturist and certified sports medicine acupuncturist practicing in Northbrook, IL. She specializes in motor point acupuncture, manual muscle testing, and functional movement assessment for active individuals and athletes.

Sports Acupuncturist | Northbrook, IL | sportsacupuncturist.com

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