The Ultimate Glute Bridge (Hip Thrust) and Additional Evidence-based Bridge Progressions

The Ultimate Glute Bridge (Hip Thrusts) and Evidence-based Bridge Progressions

by Dr. Brent Brookbush DPT, PT, MS, CPT, HMS, IMT

Ultimate Glute Bridge Introduction

Research does more than provide objective data and statistics. It often inspires new ideas or new modifications to conventional exercises and techniques. Our systematic research review for the course "Bridge and Progressions " highlighted several modifications that could be added to a bridge (hip thrust), that may increase recruitment, hypertrophy, and/or strength, of the gluteus maximus , gluteus medius, and core musculature. However, the most exciting realization was that many of these modifications could be combined. It is the combination of these modifications that led to a variation that we like to refer to as the "ultimate glute bridge ".

Research Summary (Annotated Bibliography Below):

• Abduction: Adding band-resisted abduction to a glute bridge improves gluteus medius and gluteus maximus recruitment, and may improve lumbopelvic alignment.
• Stability Ball: A stability ball under the shoulders improves core and glute recruitment and hypertrophy, and improves lumbopelvic control.
• Cueing: Cuing the abdominal drawing-in maneuver (ADIM) and cueing "squeeze the glutes" also increases core and glute recruitment. Further, these cues may reduce erector spinae over-activity correlated with low back pain, and improve lumbopelvic stability.
  
  

Recommended Courses

• Bridge and Progressions
• Gluteus Maximus
• Posterior Oblique Subsystem
• Intrinsic Stabilization Subsystem

Recommended Articles:

• Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging Exercise in Active Females? A Randomized Controlled Trial
• Squat Foot Placement: Unique Hip Anatomy and Squat Form
• Squat Depth Recommendations
• Are Olympic Lifts the Best Choice for Power Development?
• Optimal Rest Between Sets is NOT Determined by Goal or Load

Ultimate Glute Bridge Progression

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Written Instructions

1. First, make sure the ball is close by and will not roll away as the client/patient prepares for the set.
2. Have your patient/client start by placing a resistance band loop of the desired difficulty, around both legs, just above the knees.
3. Then have the client/patient lift the load to their thighs (deadlift from the floor).
4. Have your patient/client sit on the stability ball as they place the load in their lap.
   • Writing out this sequence may seem overly simplistic, but if not performed in that order, setting up the exercise becomes very awkward. A different sequence may also force the patient into dangerous positions as they try to get the band on while already seated on the ball, or try to lift the load from the floor while in the bridge position.
5. Have them "walk" their feet out and roll down the ball as if they were going to sit on the floor, but have them stop when the gluteus maximus is a few inches from the floor.
6. Ensure their feet are parallel (second toe point forward), feet, knees, and hips are in alignment, the patient is maintaining a neutral spine, and the ball is centered between their shoulder blades.
7. Have the patient test the top position of the bridge; ensure their weight is supported by their upper back on the ball and not their neck, and the knee flexion angle is 90° or more.
   • Note, during this exercise, the patient will likely need to hold the weight with their hands in position over the top of their thigh (just distal the ASIS).
8. Instruct the patient/client to sit straight down, hinging at the hips; returning to the starting position.
9. To enhance core muscle recruitment and trunk stability, have them perform the abdominal drawing-in maneuver before initiating the concentric phase.
10. Cue the patient to "squeeze the glutes" and thrust the hips straight-up toward the ceiling. The goal is to reach terminal hip extension, without additional lumbar extension.
11. Have your client hold a maximal voluntary contraction of their gluteus maximus ("squeeze their glutes") at the end of terminal hip extension (top of the movement).
12. Slowly return to the starting position maintaining a neutral spine and optimal lower extremity alignment.
    • The unique feature of this exercise is that the force resists terminal hip extension in the transverse plane. To optimize the benefits of this feature of the exercise, the hip joint should follow a nearly vertical path throughout the movement. Try to ensure that your patient/client is driving the hips straight up and sitting straight-down. They should not be pushing back into the ball, or sliding forward into additional dorsiflexion/knee flexion.
13. Repeat for the desired number of reps.

The Research Findings That Inspired This Progression:

• An annotated bibliography has been included below.

Adding a Band Around the Knees (Abduction) (1-4)

Several studies have demonstrated that a glute bridge with a resistance band around the knees, to resist isometric hip abduction, integrates more than the gluteus medius (the prime mover of hip abduction). Adding abduction significantly increases gluteus maximus activity as well (the prime mover of hip extension). Further, research by Choi et al. (2015) demonstrated that adding band-resisted hip abduction may reduce an anterior pelvic tilt during a bridge, helping to optimize the lumbar spine and pelvic alignment (posture). These studies could imply that this easy addition may be the perfect addition for better glute hypertrophy (better-looking glutes), glute strength (better athletic performance), and an increase in lumbopelvic alignment and glute recruitment (physical rehabilitation).

Adding a Ball Underneath the Shoulder (Unstable Surface) (5-9)

The additional challenge of performing a bridge on an unstable surface has a significant effect on muscle activity. When compared to a floor bridge, the addition of an unstable surface under the feet (like an Airex pad or a Bosu ball) results in significantly higher gluteus medius activity. However, if the unstable surface is a ball underneath the shoulders, a larger increase in activity is noted for both core muscles and the gluteus medius. Additionally, a ball underneath the shoulders has the practical advantage of allowing the feet to be planted on the floor, which allows for the addition of the significant loads (dumbbell or barbell) necessary for rep ranges associated with hypertrophy (6-12 reps/set) or strength (1-6 reps/set).

"Belly Button Toward Spine" and "Squeeze the Glutes" (10-13)

Two additional cues may help to maximize the effectiveness of your glute bridges and hip thrusts. Research demonstrated that adding the abdominal drawing-in maneuver (ADIM) to glute bridges while training for several weeks, significantly increased hypertrophy of the intrinsic core muscles and improved lumbopelvic control (stability). Further, Moon et. al (2018), demonstrated that cuing the ADIM during bridges significantly reduced erector spinae over-activity for chronic low back pain patients (13). This reduction in over-activity could be the modification needed for low back pain patients to be able to perform this exercise without pain. Additionally, a study by Hollman et al. (2018) demonstrated that adding the cue "squeeze your glutes” could significantly increase gluteus maximus activity during a bridge (12). We think this is a pretty amazing finding; a simple cue resulted in a statistically significant average increase in gluteus maximus activity in a research study with a control group and randomization. In summary, two simple cues (ADIM & glute squeeze) can result in a significant increase in strength and hypertrophy of the intrinsic core muscles and gluteus maximus, reduce erector spinae over-activity for low back pain patients, and improve lumbopelvic stability.

• Abdominal Drawing-in  Maneuver (ADIM ) – A light contraction of the transverse abdominis (and potentially the entire intrinsic stabilization subsystem ) is achieved by gently pulling the lower abdominal region away from one’s waistband. This should have minimal effect on breathing, and should not be confused with a maximal contraction of the transverse abdominis resulting in a “vacuum pose”.

Caption: Kim et al. compared 20 healthy men (age: 23.35 ± 2.01 years) during a floor bridge, floor bridge with arm movement, ball under torso bridge, and ball under torso bridge with arm movement. Each participant performed the 4 bridge variations in random order while EMG activity was recorded for the rectus abdominis, internal oblique, erector spinae, and multifidus. The findings demonstrated that adding arm activity to a floor bridge did not significantly alter muscle activity. The addition of the ball did not significantly alter rectus abdominis and erector spinae activity. The addition of the ball resulted in significant increases in multifidus and internal oblique activity. And, adding arm motion on a ball only resulted in a significant increase in internal oblique activity. When compared to the floor bridge, the ball bridge with arm motion resulted in the largest increase in the internal oblique to rectus abdominis activity ratio. Kim, M. J., Oh, D. W., & Park, H. J. (2013). Integrating arm movement into bridge exercise: Effect on EMG activity of selected trunk muscles. Journal of Electromyography and Kinesiology, 23(5), 1119-1123.

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Annotated Bibliography

Band Resisted Hip Abduction during a Bridge

1. Choi et al. compared 21 healthy university students (6 males, 15 females; age = 22.5 ± 1.0 years) during floor bridges and band-resisted abduction bridges. EMG activity was recorded for the gluteus maximus, biceps femoris, and erector spinae, and the anterior pelvic tilt angle was recorded using "image J software". The findings demonstrated that muscle activity ratios were similar for both variations; however, the band resisted abduction variation resulted in a 21.1% mean increase in gluteus maximus activity and a 20.5% mean decrease in anterior pelvic tilt angle.

• Choi SA, Cynn HS, Yi CH, et al. (2015). Isometric hip abduction using a Thera-Band alters gluteus maximus muscle activity and the anterior pelvic tilt angle during bridging exercise. Journal of Electromyography and Kinesiology. 25: 310-315.

2. Kang et al. compared 17 subjects healthy subjects (8 men, 9 women; age: 21.4±1.12 years) during a floor bridge, a band-resisted ADDuction bridge, and a band-resisted abduction bridge. EMG activity was recorded for the vastus lateralis, vastus medialis, erector spinae, and gluteus maximus activity during 10 seconds of each variation, performed in random order. The findings demonstrated that compared to the floor bridge, the resisted hip adduction variation significantly increased vastus lateralis and vastus medialis activity, and the resisted hip abduction variation significantly increased gluteus maximus activity.

• Kang, S. A., Kwon, S. J., Lee, D. Y., Hong, J. H., Yu, J. H., & Kim, J. S. (2020). Differences of Muscle Activities of Various Bridge Postures Using Thera-band on the Stable Surface. Medico Legal Update, 20(1), 1178-1782.

3. Hwang et al. compared 20 healthy young adults (10 males, 10 females, age: 22.85±2.85 years) during a floor bridge, a band-resisted ADDuction bridge, and a band-resisted abduction bridge. EMG activity was recorded for the erector spinae, gluteus maximus, biceps femoris, and external oblique during 5-second holds of the variations. The findings demonstrated that compared to a floor bridge, isometric hip adduction against a stability ball significantly increased erector spinae  and external oblique activity, and isometric hip abduction against a resistance band significantly increased gluteus maximus  activity.

• Hwang, J. Y., Ahn, W. Y., Kim, H. J., Woo, J. H., Choi, W. J., Park, J. W., & Lee, M. Y. (2017). Effects of performing hip abduction and adduction during bridging exercise on trunk and lower extremity muscle activity in healthy individuals. Physical Therapy Rehabilitation Science, 6(1), 14-19.

4. Noffal et al. compared 20 recreationally trained males (age: 22.89 ± 1.91 years) during 3 reps of 3 variations of glute bride exercise, performed in random order. EMG activity was recorded for the gluteus maximus, biceps femoris, and rectus femoris during a "normal" glute bridge (floor bridge), a "shear" floor bridge (cueing knee extension by pressing the toes into rubber stoppers), and a band resisted abduction floor bridge. The findings demonstrate that the ratio of gluteus maximus to biceps femoris activity was not statistically different during the 3 conditions; however, band resisted abduction significantly increased gluteus maximus activity.

• Noffal, G. J., Capilouto, A. P., Frazier, B. S., & Lynn, S. K. (2013, May). Electromyographic (EMG) Analysis of the Hip Musculature During Variations Of The Glute Bridge Exercise. In MEDICINE AND SCIENCE IN SPORTS AND EXERCISE (Vol. 45, No. 5, pp. 586-586). 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA: LIPPINCOTT WILLIAMS & WILKINS.

Unstable Surface

5. Kong et al. compared 38 chronic low back pain patients (13 men, 25 women, mean age: ~40 years) randomly assigned to a floor bridge group, floor bridge with feet on a stability ball group, or plank group. All participants performed the exercise for 8 weeks, 3x/week, 3 sessions/day, 5 sets/session, 30-sec holds/set, 30-sec rest between sets, supervised by an experienced physical therapist. The findings demonstrated that external oblique, internal oblique, and transverse abdominis activity was higher during a stability ball bridge than a floor bridge (and highest during a plank ). Further, erector spinae activity was highest during a stability ball bridge, followed by a floor bridge (and lowest during a plank).

• Kong, Yong-soo, et al. "Change in trunk muscle activities with prone bridge exercise in patients with chronic low back pain." Journal of physical therapy science 28.1 (2016): 264-268.

6. Kim et al. compared 20 healthy men (age: 23.35 ± 2.01 years) during a floor bridge, floor bridge with arm movement, ball under torso bridge, and ball under torso bridge with arm movement. Each participant performed the 4 bridge variations in random order while EMG activity was recorded for the rectus abdominis, internal oblique, erector spinae, and multifidus. The findings demonstrated that adding arm activity to a floor bridge did not significantly alter muscle activity. The addition of the ball did not significantly alter rectus abdominis and erector spinae activity. The addition of the ball resulted in significant increases in multifidus and internal oblique activity. And, adding arm motion on a ball only resulted in a significant increase in internal oblique activity. When compared to the floor bridge, the ball bridge with arm motion resulted in the largest increase in the internal oblique to rectus abdominis activity ratio.

• Kim, M. J., Oh, D. W., & Park, H. J. (2013). Integrating arm movement into bridge exercise: Effect on EMG activity of selected trunk muscles. Journal of Electromyography and Kinesiology, 23(5), 1119-1123.

7. Son et al. compared 20 healthy adults (10 men, age: 21.9 ± 1.45 years; 10 women, age: 20.7 ± 0.48 years) performing a floor bridge, a bridge with shoulders elevated on a bench, a bridge with shoulders elevated with a sling, and a bridge with shoulders elevated on a ball. The findings demonstrated the internal oblique to rectus abdominis activity ratio was highest during a bridge with shoulders on a stable surface (floor and bench); however, the highest EMG activity for all muscles was exhibited during bridges with shoulders on unstable surfaces (sling and stability ball). The floor bridge resulted in the lowest activity for all muscles, and the stability ball bridge resulted in the highest activity for all muscles.

• Son, H. H. (2015). Trunk Muscle Activation during Bridge Exercise with Various Shoulder Supporting Surfaces. Journal of Korean Society of Physical Medicine, 10(3), 299-304.

8. Yoo et al. compared 20 older participants (age: 55-60 years) during 3 variations of a floor bridge including a balance board(s) under the lower extremities, the trunk, or both lower extremity and trunk ("both"). EMG activity of the right side L5 paraspinal increased when progressing from the lower extremity to the trunk variations, but activity paraspinal activity was similar for the trunk and "both" variations. EMG activity of the external obliques and gluteus maximus increased for each variation from the lower extremities, to the trunk, to "both".

• Yoo, I. G., & Yoo, W. G. (2012). Effects of different bridge exercises for the elderly on trunk and gluteal muscles. Journal of Physical Therapy Science, 24(4), 319-320.

9. Youdas et al. compared 13 male and 13 female participants during 3 repetitions of bilateral and unilateral floor bridges on stable and unstable surfaces. EMG activity was recorded for the lumbar multifidus, gluteus medius, gluteus maximus, and hamstrings. The multifidus and hamstrings exhibited similar muscle activity during all variations. Gluteus maximus activity was highest during a single-leg bridge on a stable surface, and gluteus medius activity was highest during a single-leg bridge on an unstable surface.

• Youdas, J. W., Hartman, J. P., Murphy, B. A., Rundle, A. M., Ugorowski, J. M. and Hollman, J. H. (2015) Magnitudes of muscle activation of spine stabilizers, gluteals, and hamstrings during supine bridge to neutral position. Physiotherapy theory and practice, doi: 10.3109/09593985.2015.1010672

Additional Cues

10. Cho et al. compared 30 students (4 males, 26 females, age: ~22 ± 1 years) evenly distributed by gender and randomly assigned to a floor bridge with an abdominal drawing-in maneuver (ADIM) group, or an unstable bridge (feet on Airex balance pad) with ADIM group. Both groups performed the exercise for 6 weeks, 3x/week, 15-sec holds/rep,10 sec between reps, 10 reps/set, and 6 sets/session. The findings demonstrated that the stable bridge group exhibited a significant increase in transverse abdominis thickness; however, the unstable bridge group exhibited a significant increase in transverse abdominis and internal oblique thickness.

• Cho, M. (2015). The effects of bridge exercise with the abdominal drawing-in maneuver on an unstable surface on the abdominal muscle thickness of healthy adults. Journal of physical therapy science, 27(1), 255-257.

11. And, Gong et al. used an identical methodology as Cho et al. (likely the same experiment), but used a biofeedback device to demonstrate a larger improvement in lumbar spine and pelvic control (stability) following training with the unstable bridge with ADIM .

• Gong, W. (2015). The effect of bridge exercise accompanied by the abdominal drawing-in maneuver on an unstable support surface on the lumbar stability of normal adults. Journal of physical therapy science, 27(1), 47-50.

12. An RCT by Hollman et al compared 30 adult women (age 24 ± 3 years) randomly assigned to a control group (bridge without instruction) or an experimental group (bridge with cuing). EMG activity of the gluteus maximus  and biceps femoris was recorded during 5 reps/set, 2 separate sessions, with 1 week between sessions. The experimental group received the cues "squeeze your glutes”, "extend your knees” (to recruit quadriceps and inhibit hamstrings), and “push into my hands” with the examiner's hands placed on the lateral side of each (promoting hip external rotation and abduction). The findings demonstrated that cueing resulted in a significant increase in EMG activity of the gluteus maximus (16.8 to 33.0% MVIC) and biceps femoris (16.5 to 29.8% MVIC), but did not significantly change the gluteus maximus to hamstring activity ratio.

• Hollman, J. H., Berling, T. A., Crum, E. O., Miller, K. M., Simmons, B. T., & Youdas, J. W. (2018). Do verbal and tactile cueing selectively alter gluteus maximus and hamstring recruitment during a supine bridging exercise in active females? A randomized controlled trial. Journal of Sport Rehabilitation, 27(2), 138-14

13. Moon et al. compared 21 low back pain patients (9 men, 12 women) EMG activity for the erector spinae, gluteus maximus, and biceps femoris. during a floor bridge, bridge with feet wide (hip abduction bridge), tibial internal rotation bridge, ADIM bridge, and ADIM and tibial internal rotation bridge. The findings demonstrated low back pain patients exhibited a significant reduction in erector spinae  activity when the ADIM was added, and a significant increase in gluteus maximus  activity when hip abduction was added.

• Moon, S. J., & Chung, J. (2018). Effect of Modified Bridge Exercise on Muscle Activity of Erector Spinae, Gluteus Maximus and Biceps Femoris Muscle in Patients with Chronic Low Back Pain. The Asian Journal of Kinesiology, 20(1), 64-70.

© 2023 Brent Brookbush (B2C Fitness, LLC d.b.a. Brookbush Institute )

Comments, critiques, and questions are welcome!