Panel Discussion: Getting practical - How do you increase glute activity, recruitment, endurance and strength?
Many dysfunctions/pathologies/impairments result in decreased activity, recruitment and conditioning of the gluteus medius and gluteus maximus - we have the research to support these clinical finding. So, how do you as a practitioner address this issue? Any practical suggestion that our readers can take back to work on Monday is greatly appreciated.
Moderated by Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS
This Panel Discussion was originally posted on my facebook page - https://www.facebook.com/brent.brookbush - on October 4th, 2014
Brent Brookbush Some professionals in the post above did not get tagged, but I would still love your input Michelle Langsam, Aaron Swanson, Dr. Barbara Fralinger, Dr. Mike Clark, Mike Reinold, Mark Jamantoc, Kathy Dooley, Kathy Benson Zetterberg, Tim Henriques, Brittanie Gulzow Lockard, Cassandra Forsythe, Bill Ito, Jinny McGivern, Dr. Stefanie DiCarrado, DPT, CPT, CES
October 4 at 11:41am
Maurice D. Williams As a limited personal trainer who has some knowledge of "corrective exercise", I use the NASM-CES approach & OPT model to address glute activation, recruitment, endurance & strength. So, I first assess their posture through transitional and sometimes dynamic assessments. For transitional, i use the OH Squat, single leg squat & sometimes star excursion. I am going to add goniometric measurements in the future once i learn how to do them. Based upon what i see, i will then design a program that will address those particular under and overactive muscles. The program will include: inhibit, lengthen, activate & integrate. This could be something as simple as trigger point release & static stretch for the calf, TFL & piriformis. Activate glute med, max with bridges, clam shells, etc and then integrate with perhaps a single leg balance w/scaption exercise. Re- assess often for re/progression. For progression, i would then move them through the rest of the OPT model using appropriate acute variables. There is so much more i could say, but i hope this is a good start.
October 4 at 11:47am
Brent Brookbush Ya… I would say that is a pretty good start Maurice D. Williams, and probably more than most consider when they try to affect the activity level of the gluteus maximus. Any tips on the activation exercises themselves, for example in the research study below it was found that adding abduction increased glute max activation - Research Review: Optimal Positioning for Gluteus Maximus Activation
Gluteus Maximus Activation (More Glute & Less Hamstring) | Brent Brookbush
Gluteus Maximus Activation (More Glute & Less…
BRENTBROOKBUSH.COM
October 4 at 11:51am
Robert Gazso We would need to first determine why the muscle was not giving us proper force output to begin with and there are usually multiple factors. Years ago I would have just given the individual a strengthening exercise for the given area but I realize now it is usually much more complex than that. Here is an article that gives a list of causes of muscle weakness. http://www.humankinetics.com/…/causes-of-muscle-weakness
Causes of muscle weakness
A look at the causes of muscle weakness as well as Janda’s classification of muscle imbalance patterns.
HUMANKINETICS.COM
October 4 at 12:03pm · Edited · Like · 2 · Remove Preview
James Taylor Andrea Gibson Cross
October 4 at 12:00pm
Brent Brookbush Hey Robert Gazso,
I agree that there are multiple reasons for addressing the glute max and medius (more than listed in that short article)… and that addressing these muscles is not a diagnosis, and may not even be the root cause of the dysfunction. I assume that addressing the gluteus maximus and gluteus medius are one (or more) exercises in a routine or session that includes multiple interventions. For example, I may use glute max activation as a means of stabilizing the SIJ in someone who has come to see me for low back, buttuck and posterior thigh pain.
With that being said… this is a practical discussion. Can you give us one scenario and the intervention you would use, specific to the glute max or med?
October 4 at 12:05pm
Rob Fluegel No time atm to seriously post a reply to this so I'll just say the seated ABduction machine at the gym!
October 4 at 12:15pm
Brent Brookbush Rob Fluegel, I think this is all the reply we need - a close up of your glute work - http://youtu.be/8Dm7i0u7OI8
Transverse Abdominis and Gluteus Maximus Activation Progressions
For the best education in Human Movement Science and…
YOUTUBE.COM
October 4 at 12:18pm
Leon Chaitow Gluteal dysfunction may relate to influence from deep layer of the
thoraco- lumbar fascia which has attachments to:
• Gluteus medius • Internal obliques • ITB • Latissimus dorsi • Long head of biceps • PSIS • Sacrum • Sacrotuberous ligament • Serratus posterior inferior … and between the deep fascial layer and the erector spinae muscles. (Willard et al 2013)…….FOR EXAMPLE SEE : Carvalhais V et al 2013 Myofascial force transmission between the latIssimus dorsi and gluteus maximus muscles: An in vivo experiment Journal of Biomechanics 46:1003–1007 ALSO :Stecco A et al (2013) NOTE THAT DISSECTION REVEALED THAT: “In all (12) subjects gluteus maximus presented a major insertion into the fascia lata, so large that the iliotibial tract could be considered a tendon of insertion of the gluteus maximus …..
…. transmission of the forces from the thoracolumbar fascia to the knee.”(The anatomical and functional relation between gluteus maximus and fascia lata JBMT - IN PRESS) …..IN OTHER WORDS…PROBLEMS IN THE GLUTEALS MAY HAVE LITTLE TO DO WITH THOSE STRUCTURES, AND THE THORACOLUMBAR FASCIA AND ITS FORCE TRANSMISSION FEATURES NEED TO BE CONSIDERED. SORRY FOR CAPITALISATION….BUT FACEBOOK'S INABILITY TO ALLOW FORMATTING MAKE IT A FRUSTRATING EXERCISE……
Leon Chaitow's photo.
October 4 at 12:33pm
Maurice D. Williams Leon Chaitow: yep, POS subsystem. I believe Brent Brookbush is asking this question b/c the assumption is that it is a glute issue though. Am I incorrect?
October 4 at 12:35pm
Robert Gazso Okay Brent. First I would say that I would take a whole body approach to this in order to get the proper result. If you take a look at Mike Clark’s article "An NBA Knee" you will see that he addresses the whole body in order to rehabilitate the knee. The knee itself is just a piece of the puzzle. He lists on the last page of his article a series of things that he does in order to achieve proper rehabilitation of the knee. As he addresses the foot and ankle knee hip core etc he sees that the knee functions better. The same applies to achieving proper muscle function in the glutes or any other muscle.
Likewise we need to take a whole body approach to optimize the functioning of the glutes. The system(s) are interdependent. As an example of a first step to increasing function I may look at the relationship between the hip flexors and extensors. If for example I find that there is overactivity in the iliacus I may address this first. I find that addressing the patterns of reciprocal inhibition is often helpful. NASM recommends stretching and self myofascial release to the overactive followed by using an activation exercise for the underactive muscle. I may do these simultaneously and use an ART like pin/stretch on the overactive area as they do a squat in order to increase neural drive to GMax and hip extension. This will get us started but is only one step in a “whole body approach.” Clark writes “A Whole-Body Approach: The kinetic chain is made up of the muscular, skeletal, and nervous systems, which work together to allow optimum function. If any component of the system is out of balance, it leads to a complex dysfunction.” A whole body approach is required to properly rehabilitate the knee and the same is true of achieving optimal performance from the glutes.
http://www.momentummedia.com/online-courses/online-courses/articles/tc/tc1308/nbaknee.htm
An NBA Knee
Micheal A. Clark, MS, PT, NASM-PES, CSCS, is President and Physical Therapist and Tyler Wallace, NASM-PES, is Performance Enhancement Specialist at the National Academy of Sports Medicine. Aaron Nelson, ATC, NASM-PES, CSCS, is Head Athletic Trainer and Casey Smith, MS, ATC, NASM-PES, is Assistant At…
MOMENTUMMEDIA.COM
October 4 at 12:39pm · Edited · Like · Remove Preview
Maurice D. Williams Nice article there Brent Brookbush with the glute max activation. To answer your question with activation exercises, I use the exercises listed in this article: http://blog.nasm.org/…/which-exercises-target-the…/
Which exercises target the gluteal muscles while minimizing activation of the tensor…
BLOG.NASM.ORG
October 4 at 12:37pm
Leon Chaitow Maurice D. Williams - the question might be to do with an assumption of a gluteal issue…my response is that there may not be a gluteal issue to make assumptions about - since there are so many influences affecting gluteal behaviour, that these should be considered unless there is evidence of a direct insult to them.
October 4 at 12:43pm
Brent Brookbush Thank you Leon Chaitow - you always come through big with research - amazing stuff.
October 4 at 12:45pm
Robert Gazso As long as there is overactivity in the hip flexors we will have decreased neural drive to the hip extensors. Likewise if there is underactivity in the hip extensors there will be overactivity of the hip flexors. These should be addressed simultaneously. I am always asking how i can increase neural drive.
October 4 at 12:46pm
Brent Brookbush Yes Maurice D. Williams, Although, I do not want this to be such a restrictive conversation that individuals cannot post there thoughts. Lets say this conversation is "practical preferred"
October 4 at 12:47pm
Leon Chaitow There is a practical aspect to the observations …for example the Carvalhais study referred to above involved observation (and recording of) direct influences on gluteal activity when latissimus was contracted actively…..if TFL restrictions exist force transmission may be limited or absent ….resulting perhaps in dysfunction affecting hip rotation (example). Unless we have ways to evaluate TFL functionality (and ultrasound imaging might offer glimpses of that?) - we would not perhaps consider TFL or latissimus (or other connections)…? see for example: Langevin H et al 2011 Reduced thoracolumbar fascia shear strain in human chronic low back pain. BMC Musculoskelet Disord. 12:203
October 4 at 12:56pm · Edited · Unlike · 5
Brent Brookbush Hey Robert Gazso,
So you are saying you look to increase neural drive, but then in your example you do not actually use an activation exercise to increase neural drive - although it is pertinent to address restriction in the hip flexors, arthrokinematic dysfunction in the hip, and integrate the new pattern using an exercise like a squat - it is my humble opinion that you need to do something specific to the glutes. If you try to use an integrated pattern like a squat before "activating", the body will return to the same compensation pattern and synergistic dominance will thwart your efforts. (P.S. I work for NASM, know the article, know the athlete the article pertains to, and have had a chance to discuss this case in passing with Mike Clark years ago… activation exercise were most assuredly used).
October 4 at 1:09pm
Robert Gazso Right - thanks for pointing this out. I like the bridging exercise as Maurice has already pointed out. I think this is a good selection since it is it puts TFL,Iliacus and the other hip flexors on stretch as we are strengthening the hip extensors such as the GMax and Post Gmed. Stretch and strengthen at the same time.
October 4 at 1:24pm
Brent Brookbush Another study to Leon Chaitow's point on the connection between the TFL and Gluteus Medius - Research Review: Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata?
Which exercises target the gluteal muscles while minimizing activation of the TFL? |…
BRENTBROOKBUSH.COM
October 4 at 2:00pm
Robert Gazso The research article is only discussing one possible compensation pattern. “The following exercises had significantly greater EMG activity in Glute Med as compared to TFL” This is assuming that there is synergistic dominance (compensation) of the TFL for the Glut Med. This may or may not be the case. We may instead find when there is underactivity in the Glut Med there is oveactivity in other muscles in the lateral subsystem such as the same side adductors and/or the opposite quadratus lumborum.
Lateral Subsystem (LS) | Brent Brookbush
Lateral Subsystem (LS) Posted on August 22, 2013 by admin Lateral Subsystem Integration: By Brent…
BRENTBROOKBUSH.COM
October 4 at 3:03pm · Unlike · 2 · Remove Preview
Ryan Chow I don't even know where to begin. I think from my experience, the better I get at patient education - what they're trying to achieve and why in layman's terms - and how much of it to do, that usually works better than trying different activation exercises. Any hip ext w/ ER should work. The client just needs to understand that it's about the muscle firing and not about completing a movement (e.g. "Qualify the reps by how much burn you feel in the butt, not how far our your heel comes back")
October 4 at 3:18pm
Melinda Reiner Feel free to use me as a model. Dealing with this on a personal level right now. Looking forward to reading everyone's comments, suggestions, and practical experiences.
October 4 at 3:19pm
Robert Gazso Brent - I took the time to go through the articles that you posted here which were very good. I really liked the ideas you had with your glute progression and how you positioned Rob to insure a better activation.
October 4 at 6:00pm
Jason Erickson All of this talk about muscles, and so little discussion of the nervous system that determines whether or not the muscle(s) will do anything, and to what extent.
When I see a client exhibit indications of impaired/abnormal gluteal function, I usually start with the assumption that the altered function is an adaptive/protective response to an underlying set of somatosensory stimuli. However, I must question/discard that assumption when there are known/suspected motor neuron pathologies, developmental abnormalities, etcetera.
With a plethora of potential explanations for what is triggering the altered gluteal function, it is important for trainers/therapists to think carefully about how to assess a client, and then how/when to reassess throughout your work with that client. Simply following the OPT/CES models/progressions is not thinking - that's just following a recipe which may/may not result in the desired outcome(s). When it doesn't work, and it won't always work, you need to be able to think outside/beyond those models and adapt your approach based on the client's actual response(s) and not the expected response(s).
Sometimes, too, there is a much simpler method that will save you and your client some time and effort while achieving the desired result(s). What this simpler method may be will vary from case to case.
Here's one example:
Elderly female client with recent history of doing below-parallel weighted squats presents with inability to do bodywork parallel squats after three weeks away from training. All movement assessments indicate reduced gluteal force production, mild balance impairment, and elevated anxiety of client regarding perceived difficulty of returning to doing any exercises involving a lower squat. Client reports hips feel tight and fatigue quickly in walking laps around her yard.
Gentle palpation of the supine client revealed the glutes, lateral hips, and anterior hips to be tender to light pressure. This tenderness disappeared with repositioning the leg(s) and applying a gentle, sustained skin stretch for 1-2 minutes. Several different positions and skin stretching applications were applied on each side of the lower body. Upon returning the legs to anatomical position, the tenderness remained gone on each side.
The client was then encouraged to hold onto the squat rack and attempt lower squats. Client nearly achieved parallel squats and balance appeared to be nearly normal. While standing, the client was asked to perform several kegel exercises, then kegels with a posterior hip tilt. The client reported increased sensations in her glutes, and she returned to doing squats while holding onto the squat rack. She achieved nearly full depth below-parallel squats. While standing, the client was asked to perform several gentle, easy kickbacks for each leg. The client reported increased gluteal sensations. Finally the client graduated to doing nearly full depth bodyweight squats while NOT holding onto the squat rack. Client was surprised at her ability and quickly regained confidence in the movement… and she could perform full-depth bodyweight squats with light weights in her hands. Total time elapsed: about 15 minutes.
October 5 at 2:21am
Cassandra Forsythe Loving this thread
October 5 at 4:42am
Tim Henriques For me personally I like Xband walks and fire hydrants with a kick at the end to activate medius so you can do that prior. I like hip thrusts either with weight or just on an airex pad to activate maximus. I would also caution against doing too much of an official assessment on beginners, sometimes they just don't know how to lift. Spend at least a few months squatting (using Starting Strength form as the baseline and modify for the client as necessary) and see how their form improves over time. Proper neuromuscular coordination will fix a lot of apparent compensations especially with beginners
October 5 at 10:58am
Brent Brookbush You don't think the compensations are the result of restriction or postural dysfunction Tim Henriques? - in essence, you are arguing there is no such thing as "relative flexibility."
Should we not start every client or patient with an assessment?
I guess I am a bit confused.
October 5 at 12:11pm · Like · 1
Tim Henriques What I am saying is if you watch a person squat for the first time and their knees come in you might think "weak/underactive abductors" but if a simple cue like knees out or keep the weight on the outside of your feet fixes the problem of course start with that. In someone that is more advanced if they know what they are supposed to do but they can't IMO that is more an expression of a potential postural issue. But with a total beginner it can sometimes be misleading and if you spend all of your time trying to make the movement perfect that can be a lot wasted time. People don't throw a football perfectly or pitch a baseball perfectly the first time out, they have to be trained how to do it. Same with the barbell lifts.
October 5 at 12:24pm
Brent Brookbush Interesting. I think you bring up an interesting misconception - that corrective exercise is done until everything is perfect and then you lift, when in actuality you correct what you can when you can and you have to prioritize every minute of your training or therapy.
I also preach that corrective exercise replaces the warm-up. Although we will have to agree to disagree on compensation versus potential compensation, one has nothing to lose by replacing there archaic 10 minutes on a treadmill (general warm up) with calf and TFL release, calf and hip flexor stretch, gluteus max and med activation and a squat to row (with a little practice this can be completed in 10 to 15 minutes)… at least in the "knees bow in" individual you discussed above.
Although I think cuing is important, if there is a mobility restriction you are simply replacing one compensation with another…
Unfortunately I see this far too much in the "Push Your Knees Out" cue that has become so popular in power-lifting. In essence, I get hip and low back patients who saved their knees by pushing them out.
Would really love your thoughts, especially on my last comment (not very often I get someone as open-minded as yourself with a power-lifting background).
October 5 at 12:32pm
Tim Henriques We'd have to look at a specific squat to analyze it. Knees out actually keeps the hips closer to the bar so it should be easier on the back, not harder. If the knees are coming in you say "knees out" not to actually push the knees way out of position but to prevent the form change. If you want to post some squat vids (or any other lift) that you feel is either ideal form or lacking something I would be happy to share my .02 on them.
October 5 at 12:47pm
Brent Brookbush Not on this post Tim Henriques - this discussion is supposed to be about glute activation and we have already veered off topic. But that may be a great discussion we should have in the future… maybe even a joint article - once my second book hits the stands maybe we can do a little cross promotion together
I can tell you that the dysfunction in the low back and hips that I discussed above does not stem from the mechanical force of the load during the squat, but the compensation pattern adopted by over-active synergists (Adductor magnus, piriformis, biceps femoris, erector spinae - aka the Deep Longitudinal Subsystem and what reliance on this subsystem does to lumbosacral mechanics). I think if more people took your cue of "Bow out till aligned with your 2nd and 3rd toe"… this would not be nearly the issue it is. Amazing how a simple cue taken to the extreme and held onto like dogma can be very harmful.
October 5 at 12:53pm
Tim Henriques I think our end position is in agreement, I concur with the femur being lined up with the 2nd and 3rd toe general area so if it comes in then we say knees out to get to that position, not just knees out all costs
October 5 at 12:57pm
Tony Susnjara I do it like this and this can be regressed in many different ways. I was recently delivering a course and was asked "Should I focus on the glutes when performing these movements?" My answer was to focus on good execution of the movements such as the lateral pelvic alignment and so on. If the glute medius is doing its job, you should not have to think about it. www.youtube.com/watch?v=sDS_msdXdDE
The Booty Board Superset
Four exercises that target the glutes and lower body and also fire up the metabolic system to burn calories.
YOUTUBE.COM
October 6 at 1:17am
Brent Brookbush Interesting Tony Susnjara