For low lumbar L4-L5, which hip muscles are strong and weak?

• A. Glute med and TFL have variable strength
• B. Glute max absent
• C. Lateral hamstring absent
• D. Variable weakness around foot/ankle

Answer: (A)

In a low lumbar (L4–L5) lesion, hip strength patterns follow the nerve roots that supply the hip muscles, so understanding which muscles get affected helps explain the observed weakness. The hip abductors, especially gluteus medius and tensor fasciae latae, rely on the superior gluteal nerve (root levels around L4–S1). At L4–L5, involvement of these fibers can be incomplete or variable, so gluteus medius and TFL often show inconsistent strength—sometimes normal, sometimes weak. That’s why the best statement is that glute medius and TFL have variable strength.

Gluteus maximus, on the other hand, is innervated by the inferior gluteal nerve (L5–S2) and is typically more preserved at this level, so it’s less expected to be weak. The lateral hamstrings and distal foot/ankle muscles involve different nerve paths (sciatic and distal nerves) and don’t define the primary hip-weakness pattern for an L4–L5 level, which is why they’re not the best descriptors of the common hip strength picture at this level.