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Tuesday, June 6, 2023

Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging Exercise in Active Females? A Randomized Controlled Trial

Brent Brookbush

Brent Brookbush

DPT, PT, MS, CPT, HMS, IMT

Research Review: Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging Exercise in Active Females? A Randomized Controlled Trial

By Jacky Au, PhD, CPT

Edited by Brent Brookbush DPT, PT, COMT, MS, PES, CES, CSCS, ACSM H/FS

Original Citation:

Hollman, J. H., Berling, T. A., Crum, E. O., Miller, K. M., Simmons, B. T., and 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), 138-143. ABSTRACT

Introduction:

Research has demonstrated that dysfunction of the lumbo pelvic hip complex or lower extremity may alter muscle recruitment, including a relative decrease in gluteus maximus activity and increase in biceps femoris activity (1-4). The bridge exercise is often recommended by human movement professionals to aid in activating and/or strengthening the gluteus maximus  with the intent of optimizing recruitment. This 2018 study by American researchers investigated the use of verbal and tactile cues to increase gluteus maximus  activity and decrease hamstring activity during the bridge exercise. The findings suggest that verbal and tactile cues may increase muscle activity, but are unlikely to preferentially recruit the gluteus maximus or decrease activity of the biceps femoris.

Dr. Brookbush instructs model, Melissa Ruiz, on how to perform the "ultimate glute bridge" using a stability ball, band resistance around the knees and load via a dumbell.
Caption: Dr. Brookbush instructs model, Melissa Ruiz, on how to perform the "ultimate glute bridge" using a stability ball, band resistance around the knees and load via a dumbell.

Ultimate Glute Bridge

Study Summary

Study Design Randomized Controlled Trial
Level of Evidence IB Evidence from at least one randomized controlled trial
Participant CharacteristicsDemographics
  • Age Range: 18-40
  • Age (Mean ± SD)
    • Experimental Group (23.3 ± 1.7 years old)
    • Control Group (24.7 ± 4.2 years old)

  • Gender: Female
  • Number of participants: 30

Inclusion Criterion:

Exclusion Criteria:

  • Patellofemoral pain syndrome
  • History of hip or knee ligament injury, trauma, or surgery
  • Suspected femeroacetabular impingement
  • History of lumbar disc pathology
  • History of mechanical low-back pain
  • Limitations in functional activity due to lower-extremity pain and/or neurological conditions
MethodologyPretest
  • Demographic and activity level information (IPAQ) were collected via questionnaires.

Posttest

  • All participants were randomly assigned to a control or experimental group.
  • The control group performed the bridge exercise without instruction exactly as they did at pretest.
  • The experimental group received the following verbal and tactile cues as described by McGill (3), and hypothesized to increase gluteus maximus activity and decrease hamstring activity.

Verbal Cues:

  • “Squeeze your glutes”
  • “Extend your knees” (to recruit quadriceps and inhibit hamstrings)

Tactile Cues

  • “Push into my hands” (examiner's hands were placed on the lateral side of each knee to promote hip external rotation and abduction)
Data Collection and AnalysisData Collection
  • EMG data were collected at 1000 Hz through a 16-bit NI-DAQ PCI-6220 analog-to-digital card (National Instruments Corporation, Austin TX) with Bagnoli DE 2.1 single-differential bipolar surface EMG electrodes and a Bagnoli-16 amplifier (Delsys Inc., Boston MA).
  • The GM electrode was placed halfway between the sacral vertebrae and the greater trochanter.
  • The hamstring electrode was placed on the biceps femoris, two-thirds of the distance between the greater trochanter and the back of the knee.
  • EMG data collected on the gluteus maximus and hamstrings during MVIC was used to establish baseline muscle activity to compare EMG results during the bridge exercise.

Data Analysis

Mixed model 2x2 ANOVAs were conducted to analyze differences in EMG muscle activation (separately for the GM and hamstrings) with the following factors:

  • Between-groups factor condition (Experimental vs. Control)
  • Within-groups factor time (Pre/post)

Planned contrasts:

  • Significant interactions from the ANOVAs (p < 0.05) were followed up with simple effects contrasts with Bonferroni corrections
  • Cohen’s d effect sizes were calculated to estimate pre-to-post changes in EMG activity.
Outcome Measures
  • EMG activity of the right GM and hamstrings, normalized to the MVIC of each muscle group
ResultsDemographic and Control Variables
  • There were no differences between groups with respect to demographics and activity levels (p’s > 0.239)

Electromyography

  • Gluteus maximus activity increased from pre to post-test in the experimental group, from 16.8% to 33% MVIC (t=3.762, p=0.001, d=1.5)
  • Hamstring activity increased from pre to post-test in the experimental group, from 16.5% to 29.8% MVIC (t=3.166, p=0.004, d=0.8)
  • No pre-to-post changes were detected in the control group; however, statistics were not reported.
Our ConclusionsThe verbal and tactile cues used in the present study did not result in a preferential increase of gluteus maximus activity and concurrent decrease in hamstring activity during the bridge exercise. However, overall muscle activity in both muscle groups did increase, suggesting that human movement professionals may use these cues to increase overall muscle activity. It should be noted that the individuals in the study were not exhibiting signs of dysfunction; therefore, this study did not investigate the ability of cues to normalize altered muscle activity.
Researchers' ConclusionsThe present study failed to show evidence that using verbal or tactile cues during the bridge exercise can selectively increase recruitment of the GM over the hamstrings. Thus, it cannot endorse the use of these cues for remediation purposes in individuals with hip pain due to imbalanced lower extremity muscle recruitment patterns. However, it does not preclude that extended sessions, different cues, or different exercises may be more effective.

How this study contributes to the body of research:

Research has demonstrated that dysfunction of the lumbo pelvic hip complex and/or lower extremity may alter muscle recruitment, including a relative decrease in gluteus maximus activity and increase in biceps femoris activity (1-4). This is one of the few studies investigating verbal and tactile cues as a means of optimizing recruitment during an exercise. Similar to other studies investigating cueing, this study demonstrated significant changes in muscle activity (6); however, this study failed do achieve the desired outcomes of preferential recruitment of the gluteus maximus , and/or a decreased activity of the biceps femoris . It is worth noting that this study investigated healthy participants. Future research should investigate whether cuing during a bridge exercise, may aid in optimizing or normalizing muscle recruitment in those individuals exhibiting dysfunction.

How the Findings Apply to Practice:

This study demonstrated that cuing during a bridge exercise resulted in significant changes in muscle activity; however, cues alone were not sufficient to alter relative muscle activity. Unfortunately, this study did not investigate whether the effects of cuing would aid in normalizing muscle activity in those with assessed impairments (e.g. LPHCD or LED ). Based on these findings, the human movement professional should take advantage of potential improvements that may result from cuing and increased overall muscle activity, but not exclusively rely on cuing to optimize recruitment patterns.

Strengths

  1. This study was registered with ClinicalTrials.gov prior to the commencement of the study, including the researchers’ hypotheses and analysis plans. This action improves transparency and validity by ensuring that the hypotheses and/or plans cannot be changed to match findings.
  2. The use of theoretically sound and previously published exercise cues (3) aids in standardization of a variable that could easily be confounded by infinite variations in word-choice, phrase length, comprehension, etc.
  3. Cuing is an inherent aspect of practice in fitness, physical rehab and performance, but few studies are available investigating their effectiveness. This study provided evidence of the effect of common cues, resulting in highly practical information.

Weaknesses and limitations

  1. Statistics and effect sizes were not appropriately reported for the control group, which makes it difficult to compare relative improvements between the control and experimental groups.
  2. The use of a healthy population with no identifiable lumbo pelvic hip complex and/or lower extremity  dysfunction does not account for the possibility that cuing may aid in normalizing muscle recruitment in those exhibiting dysfunction.
  3. The study did not control for prior experience with the bridge exercise, which may also effect muscle recruitment patterns and response to cuing.

How the study relates to Brookbush Institute Content?

The Brookbush Institute (BI) continues to develop and refine our library of corrective and core exercise courses, including Gluteus Maximus Activation and Bridge Progressions . This study found the use of tactile (resisting isometric knee abduction) and verbal cues (“squeeze the glutes”) were effective for increasing overall muscle recruitment, but the cues were not effective for altering the relative activity of the gluteus maximus , gluteus medius and hamstrings in healthy individuals. Further research is needed to determine the effect on individual’s exhibiting evidence of dysfunction. The BI has integrated this study on cuing with other studies on gluteus maximus and core exercise to refine corrective exercise recommendations.

If you enjoyed this article, you may enjoy:

Videos

The following videos interventions used to activate the gluteus maximus :

Gluteus Maximus Isolated Activation

Ultimate Glute Bridge

Gluteus Maximus Reactive Activation

Bibliography:

  1. Lewis CL, Sahrmann SA, Moran DW (2007): Anterior hip joint force increases with hip extension, decreased gluteal force, or decreased iliopsoas force. J Biomech 40: 3725–3731.
  2. Brookbush B. (2018): Lower Extremity Dysfunction (LED) - https://brookbushinstitute.com/article/lower-leg-dysfunction/
  3. Brookbush B. (2018): Lumbo Pelvic Hip Complex Dysfunction (LPHCD) - https://brookbushinstitute.com/article/lumbo-pelvic-hip-complex-dysfunction-lphcd/
  4. Sahrmann S (2002): Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis, Missouri: Mosby, Inc.
  5. McGill S (2014): Ultimate Back Fitness and Performance, 5th ed. Waterloo, Ontario, CA: Backfitpro Inc.
  6. Queiroz, B. C., Cagliari, M. F., Amorim, C. F., & Sacco, I. C. (2010). Muscle activation during four Pilates core stability exercises in quadruped position. Archives of physical medicine and rehabilitation, 91(1), 86-92.

© 2020 Brent Brookbush

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