Introduction

Kinematics and Variations

Comparing the Hip Thrust to other Compound Movements

Correlation with Performance

Hip Thrusts and Training

Form and Progressions

Research Summary

Motor Behavior and Recommendations

Abduction and Adduction

External Rotation/Internal Rotation

Knee Flexion

Additional Cues

Stable vs Unstable Surfaces

Vibration & Outcomes

Bridge and Progressions

NASM

ACSM

AFAA

CanFitPro

PTAGlobal

ISSA

REPSI

PACE

WITS

AUSactive

CIMSPA

AUSPHYSIO

TPTA

NYPT

AOTA

This course discusses the variations, <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a>, and <a id="exercise-regression" data-tip="1178" target="_blank" href="/glossary-term/exercise-regression" class="glossary">regressions</a> of the glute bridge exercise (a.k.a bridges, hip bridges, glute bridges, hip thrusts, glute thrusts, etc.). This includes tips and cues for trunk <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a>, lower extremity <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a>, reducing hip flexor over-activity, hamstring over-activity, feelings of tightness in the &#x201C;quads&#x201D;, etc. Discussion of core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> anatomy, <a id="relevance" data-tip="1505" target="_blank" href="/glossary-term/relevance" class="glossary">relevant</a> research, and programming will highlight why the bridge exercise has become incredibly popular in gyms and clinics with personal trainers and physical therapists alike.
This course includes <a id="exercise-regression" data-tip="1178" target="_blank" href="/glossary-term/exercise-regression" class="glossary">regressions</a> suitable for beginners, like the floor bridge, to variations designed to maximize gluteus maximus recruitment and challenge the most advanced exerciser, like the &#x201C;ultimate glute bridge&#x201D; <a id="exercise-progression" data-tip="1184" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progression</a> (band resisted abduction, free weight resisted, on a <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> ball). Further, programming the bridge exercise during core workouts may aid in setting up more advanced exercises like dumbbell chest press on a <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> ball, crunch and catch on a <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> ball, resisted walking, and resisted sprints. Performing the glute bridge exercise with the addition of the <a id="drawing-in" data-tip="1580" target="_blank" href="/glossary-term/drawing-in" class="glossary">drawing-in</a> maneuver may aid in integrating core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> synergies including the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> Oblique Subsystem and Intrinsic Stabilization Subsystem. Further, the bridge exercise may be included in physical rehabilitation programs to address the glute <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> inhibition correlated with low back pain, sacroiliac dysfunction, hip pain, knee pain, and/or pronation (pes planus.)
Movement and sports medicine professionals (personal trainers, fitness instructors, physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) should consider adding the glute bridge exercise to their repertoire with the intent of improving patient/client outcomes from their <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> performance exercise programs and therapeutic (rehabilitation) interventions.
<h4>Bridges:</h4>
<ul>
 <li>Floor bridge</li>
 <li><a href="https://brookbushinstitute.com/videos/ball-bridge">Ball Bridge</a></li>
 <li><a href="https://brookbushinstitute.com/videos/static-ball-bridge-with-trunk-rotation">Ball Bridge with Trunk Rotation</a></li>
 <li><a href="https://brookbushinstitute.com/videos/ultimate-glute-bridge">Ultimate Glute Bridge</a></li>
</ul>
<h4>Subsystem Integration:</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/posterior-oblique-subsystem-pos" target="_blank" rel="noopener">Posterior Oblique Subsystem</a></li>
</ul>
<img title="Dr. Brent Brookbush demonstrating a hip bridge progression" src="https://www.datocms-assets.com/25800/1644608952-ultimate-glute-bridge.png" alt="A loaded hip bridge progression targeting the glutes">

Course Description: Bridge and Progressions

<h3>Target Musculature:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener"> Gluteus Maximus </a></li>
 <li>Gluteus Medius</li>
</ul>
<h3>Target Subsystem:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/posterior-oblique-subsystem-pos" target="_blank" rel="noopener"> </a><a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> Oblique Subsystem </li>
</ul>
<h3> Signs of Under-activity (<a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">Gluteus Maximus</a>): </h3>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/sign-clusters-compensation-patterns-overhead-squat-assessment" target="_blank" rel="noopener">Overhead Squat Assessment: </a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-6-knees-bow-in-breakdown" target="_blank" rel="noopener"> Knees Bow In </a> (Long/under-active)</li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-8-excessive-forward-lean" target="_blank" rel="noopener"> Excessive Forward Lean </a> (Long/Under-active)</li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-9-anterior-pelvic-tilt-excessive-lordosis" target="_blank" rel="noopener"> Excessive Lordosis/Anterior Pelvic Tilt </a> (Long/Under-active)</li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-15-sign-clusters-asymmetrical-weight-shift" target="_blank" rel="noopener"> Asymmetrical Weight Shift </a> (Long/Under-active)</li>
</ul>
<ul>
 <li> Manual <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing for an Active Population (MMT) : </li>
 <li><a href="https://brookbushinstitute.com/video/gluteus-maximus-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener"> Gluteus Maximus Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> (Weak or With Compensation)</li>
 <li><a href="https://brookbushinstitute.com/video/gluteus-medius-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener"> Gluteus Medius Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> (Weak or With Compensation)</li>
</ul>
<h3>Acute Variables:</h3>
<ul>
 <li>Sets: 1- 3</li>
 <li>Repetitions: 1-20 (depending on the phase of training)</li>
 <li>Frequency:<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;"></li>
 <li><span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">Strength: 2 - 3 days/week<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;"></li>
 <li>
 <span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;"><span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">Corrective/Therapeutic: Up to 1-2 submaximal sets performed daily
 </li>
</ul>
<h3> Sample Program (Anterior Pelvic Tilt):</h3>
<h3> Mobility:</h3>
<h4>Release</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/video/tensor-fascia-latae-tfl-self-administered-release" target="_blank" rel="noopener"> Tensor fascia latae (TFL) </a><a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> </li>
 <li><a href="https://brookbushinstitute.com/video/gluteus-minimus-sa-release" target="_blank" rel="noopener"> Gluteus minimus </a><a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> </li>
 <li><a href="https://brookbushinstitute.com/video/vastus-lateralis-sa-static-release" target="_blank" rel="noopener"> Vastus lateralis release</a></li>
</ul>
<h4>Mobilization</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/video/open-books-self-administered-spine-rotational-mobilizations" target="_blank" rel="noopener">Open Books</a></li>
</ul>
<h4>Lengthen</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/video/kneeling-hip-flexor-static-stretch" target="_blank" rel="noopener"> Kneeling hip flexor static stretch</a></li>
</ul>
<h3> Activity:</h3>
<h4>Isolated Activation</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/videos/quick-glute-activation-circuit">Glute Activation Circuit</a></li>
</ul>
<h4>Core:</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/video/quadruped-crawl-2" target="_blank" rel="noopener"> Dynamic Quadruped </a><a id="exercise-progression" data-tip="1184" target="_blank" href="/glossary-term/exercise-progression" class="glossary">Progression</a> </li>
 <li><a href="https://brookbushinstitute.com/video/ultimate-glute-bridge" target="_blank" rel="noopener"> Ultimate Glute Bridge </a></li>
</ul>
<h4>Integration:</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/video/static-lunge-to-row-posterior-oblique-subsystem-integration-progressions" target="_blank" rel="noopener"> Static Lunge to </a><a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">Unilateral</a> Row</li>
</ul>

<h2> Summary: </h2>
<h3>Activity and Brookbush Institute Recommendations</h3>
<ul>
 <li>The <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and gluteus medius are <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> to under-activity.</li>
 <li>The Brookbush Institute recommends that <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> issues are addressed before active techniques; further, <a href="https://brookbushinstitute.com/courses/gluteus-maximus-activation" target="_blank" rel="noopener"> isolated activation</a> techniques should precede core <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a> techniques like the bridge/hip thrust. However, the bridge alone (and <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a>) has demonstrated excellent efficacy for <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and gluteus medius recruitment and performance enhancement.</li>
</ul>
<h3>Resisted Abduction and Adduction (External Rotation and Internal Rotation)</h3>
<ul>
 <li> Abduction - The addition of resisted hip abduction to a bridge may result in a relatively large increase in <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity, with potentially a small increase in <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> activity, and no additional activity in the <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a>.</li>
 <li> Adduction - Adding resisted adduction to a bridge may increase <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> and quadriceps activity. Curiously, these studies did not record hip <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity. The Brookbush Institute does not recommend adding resisted adduction in practice due to the likelihood of increased <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductor</a> activity, decreased gluteus medius activity, and reinforcement of <a href="https://brookbushinstitute.com/video/overhead-squat-assessment-6-knees-bow-in-breakdown" target="_blank" rel="noopener">knee valgus</a>.</li>
 <li> External Rotation and Internal Rotation - The addition of hip external rotation to a straight-leg bridge may be similar to adding hip abduction to a flexed-knee bridge, and the addition of hip internal rotation may be similar to adding hip adduction to a flexed-knee bridge. However, the straight-leg bridge is not recommended for the reasons discussed below.</li>
</ul>
<h3>Knee Flexion Angle</h3>
<ul>
 <li> Extensors - As knee flexion angle increases <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> and <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity decrease relative to <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and potentially semitendinosus activity.</li>
 <li> Trunk muscles - Trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity during a bridge increases as the knee flexion angle increases, with the possible exception of 0&#xB0; of knee flexion resulting in the highest levels of activity. Research may suggest that the increases resulting from changes in knee flexion angle start with increases in transverse abdominis activity, followed by <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> activity, and the <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> affected the least.</li>
</ul>
<h3>Additional Cues:</h3>
<ul>
 <li>Cueing may have a significant effect on <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> recruitment and <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>, including the verbal cue &quot;squeezing the glutes&quot; and manually resisting hip abduction to increase <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> recruitment, cueing additional arm motion to increase <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> abdominal <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, and cueing the abdominal <a id="drawing-in" data-tip="1580" target="_blank" href="/glossary-term/drawing-in" class="glossary">drawing-in</a> maneuver (<a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a>) to increase transverse abdominis activity, decrease <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity and improve lumbar <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>.</li>
</ul>
<h3>Stable versus Unstable:</h3>
<ul>
 <li> <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">Bilateral</a> to Unilateral: Progressing from a <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">Bilateral</a> bridge to a single-leg bridge nearly doubles <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and gluteus medius activity, and increases trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity. Further, adding an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface may further increase gluteus medius and <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity (unless force output decreases), and will significantly increase trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity.</li>
 <li> Trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Activity: An increase in <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> activity (and perhaps transverse abdominis activity) may match initial demand when progressing from stable to <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> environments; however, as demand increases, the activity of the <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a> and <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> may aid in compensating for further increases. Similarly, multifidus activity increases initially, followed by <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity when demand increases.</li>
 <li> Adding Un-resisted Abduction: The addition of un-resisted abduction of the <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> leg during a <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> bridge is likely to increase core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity and may improve recruitment by increasing transverse abdominis, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener"> internal oblique</a>, and multifidus activity relative to <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a>, and <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity.</li>
 <li> Not Enough:&#xA0; Two studies reported no significant difference when comparing a floor bridge to a bridge on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface. Based on the effects demonstrated in previous studies, these studies may be demonstrating that the BOSU&#xAE; ball is an insufficient stimulus to result in significant changes in recruitment, or that allowing clients to keep their arms on the floor may provide an alternative method for maintaining <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>.</li>
</ul>
<h3>Vibration</h3>
<ul>
 <li>The addition of vibration to bridges may increase core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> recruitment; however, it may not increase performance when used as part of a <a id="post-activation-potentiation" data-tip="1392" target="_blank" href="/glossary-term/post-activation-potentiation" class="glossary">PAP</a> protocol incorporating bridges.</li>
</ul>
<h3>Outcomes</h3>
<ul>
 <li> Immediate Outcomes:&#xA0; Sufficiently challenging bridge variations may decrease peak <a id="torque" data-tip="1294" target="_blank" href="/glossary-term/torque" class="glossary">torque</a> for up to an hour post-exercise; however, they may also improve core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> endurance and recruitment during functional activities.</li>
 <li> 3 - 6 Week Programs: Incorporating bridges into a program of 3-6 weeks may have a positive effect on trunk <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a>, trunk position, and pelvic position, especially when progressed to <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> environments and the <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a> is included. Further, low back pain patients incorporating bridges into a rehabilitation program may exhibit improvements in <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>, pain, and disability scores.</li>
</ul>
<h3>Hip Thrusts</h3>
 Hip Thrust - The hip thrust is a variation of a bridge, most often done with the intent of increasing hip extension and lower extremity strength. Conventionally, this variation starts with the torso elevated on a bench and a significant amount of resistance is added using bands, dumbbells, or barbells.
<ul>
 <li> Kinematics - Kinematic studies demonstrate that hip thrusts are hip dominant with the largest moments occurring at the end-range of hip extension.</li>
 <li> Variations - <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener"> Gluteus maximus</a> recruitment is optimized when knee flexion angle is larger, barbells/dumbbells are used for resistance (when compared to bands), and the torso is supported at the upper thoracic spine/scapula (when compared to lower on the thoracic spine).</li>
 <li> Comparison - Comparing the hip thrust, squat, deadlift, and hex bar deadlift, studies imply that <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity is highest during hip thrusts and potentially deadlifts, <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener"> biceps femoris</a> activity is highest during deadlifts, vastus lateralis activity is highest during squats, and <a href="https://brookbushinstitute.com/article/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity is similar during these exercises.</li>
 <li> Correlations with Performance - Hip thrusts have a strong correlation with certain aspects of sports performance (e.g. acceleration); however, vertically loaded lower extremity strength exercises have stronger correlations with other aspects of performance (e.g. top speed).</li>
 <li> Post-activation <a id="post-activation-potentiation" data-tip="1393" target="_blank" href="/glossary-term/post-activation-potentiation" class="glossary">Potentiation</a> (<a id="post-activation-potentiation" data-tip="1392" target="_blank" href="/glossary-term/post-activation-potentiation" class="glossary">PAP</a>) - Hip thrusts and squats may be equally effective for <a id="post-activation-potentiation" data-tip="1392" target="_blank" href="/glossary-term/post-activation-potentiation" class="glossary">PAP</a>, 85% of 1-RM or power-optimized loads may be slightly more effective than 50% of 1-RM, a 4min inter-set rest interval may be preferred to an 8min inter-set rest interval and 15-sec inter-set rest intervals may decrease performance, and the addition of vibration is unlikely to have an effect on performance.</li>
 <li> Hip Thrusts Incorporated in Training - Hip thrusts may be an effective strength exercise, especially for improving hip thrust strength, but are likely not effective, or at least not as effective as squats, for improving power/sports performance.</li>
</ul>

Bridge Research Corner

As described in the Brookbush Institute&apos;s predictive <a id="model" data-tip="1471" target="_blank" href="/glossary-term/model" class="glossary">models</a> of <a href="https://brookbushinstitute.com/courses/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener">Lumbo Pelvic Hip Complex Dysfunction (LPHCD)</a>&#xA0;and lower<a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">&#xA0;Extremity Dysfunction (LED) </a> and demonstrated in a growing body of research, the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and gluteus medius are <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> to under-activity (1 - 17). This reduction in activity has been correlated with pain and dysfunction of the lumbar spine, sacroiliac joint (SIJ), <a href="https://brookbushinstitute.com/courses/hip-joint" target="_blank" rel="noopener">hip</a>, &#xA0;<a href="https://brookbushinstitute.com/courses/knee" target="_blank" rel="noopener">knee</a>, and <a href="https://brookbushinstitute.com/courses/ankle-joint-talocrural-subtalor-tibiofibular-joints" target="_blank" rel="noopener">ankle </a> (4- 9). Even in the absence of pain, <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and gluteus medius weakness has been correlated with <a href="https://brookbushinstitute.com/video/overhead-squat-assessment-6-knees-bow-in-breakdown" target="_blank" rel="noopener">functional knee valgus</a>, a loss of hip extension, an <a href="https://brookbushinstitute.com/glossary/anterior/" target="_blank" rel="noopener">anterior</a> pelvic tilt, and/or a lack of <a href="https://brookbushinstitute.com/video/overhead-squat-assessment-8-excessive-forward-lean" target="_blank" rel="noopener">forward lean</a> during running (10 - 14). Research also demonstrates that the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and gluteus medius respond well to <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> interventions, resulting in improvements in pain, reduced risk of injury, and/or improved kinematics during gait, running, and squatting (5, 6, 11, 12, 16, 17). The Brookbush Institute recommends that <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> issues are addressed prior to active techniques; further, <a href="https://brookbushinstitute.com/courses/gluteus-maximus-activation" target="_blank" rel="noopener">isolated activation</a> techniques should precede core <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a> techniques like the bridge/hip thrust. However, as reviewed below, the bridge alone (and <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a>) has demonstrated excellent efficacy for <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and gluteus medius recruitment and performance enhancement.
<h3>Modifications</h3>
Research has investigated a variety of modifications and <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> for the glute bridge. Most of these studies include electromyographic (EMG) analysis of <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity or <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> thickness using ultrasound. This allows for a comparison of these modifications based on <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> recruitment and activity. The volume of studies has allowed for a relatively detailed description of the benefits of the bridge and modifications.

Several studies have investigated <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity during a bridge modified with resisted <a href="https://brookbushinstitute.com/courses/hip-joint" target="_blank" rel="noopener">hip</a> adduction and hip abduction. Noffal et al. demonstrated that there were no statistically significant differences in <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> to <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">hamstring</a> ratio when comparing a floor bridge, a floor bridge with feet pressing against a stopper (knee extension), and a bridge with thera-band loop resisting hip abduction; however, the resisted abduction bridge did increase <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity (18). The increase in <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity without reaching a significant difference in <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> to <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">hamstring</a> ratio may imply a larger sample size would have reached statistical significance. Choi et al. demonstrated that <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity increased by 21.1% and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt angle decreased by 20.5%, with no change in <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">hamstrings</a> or <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity, when isometric hip abduction (using Thera-band&#xAE; resistance) was added to a bridging exercise (19). Note, this could be viewed as a relative decrease in <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">hamstrings</a> and <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity. Hollman et al. demonstrated that verbal (&quot;squeeze the glutes&quot;) and tactile cues (manually pressing the knees into abduction) may increase <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity of both the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>&#xA0;and <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> but are unlikely to preferentially recruit the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>&#xA0;or decreased activity of the <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> in healthy/asymptomatic individuals (20). Additional studies have investigated resisted hip adduction. Kang et al. demonstrated that resisted hip abduction increased <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity, and resisted adduction increased quadriceps activity when compared to a normal bridge (21). Hwang et al. demonstrated that the additions of isometric hip abduction against a resistance band increased activity of the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>, and the addition of isometric hip adduction against a <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> ball increased <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> activity (22). Na et al. demonstrated that hip adduction during a bridge increased <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> activity, and <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> to <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> activity ratio; but did not affect trunk extensor muscles (23). Kim et al. demonstrated that the use of a Pilates ring (adduction) resulted in an increase in <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a>, transverse abdominis, and <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> activity, and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> activity increased when adding a <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> ball (<a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> <a id="base-of-support" data-tip="1197" target="_blank" href="/glossary-term/base-of-support" class="glossary">support</a>) (24). Further, Lee et al. demonstrated that adding adduction increased transverse abdominis thickness (25). These studies imply that the addition of hip abduction to a bridge may result in a relatively large increase in <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity, with potentially a small increase in <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> activity, and no additional activity in the <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a>. Further, adding resisted adduction to a bridge may increase <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> and quadriceps activity. Curiously, these studies did not record hip <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, in particular, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductor</a> and abductor <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity was not evaluated. The Brookbush Institute does not recommend adding resisted adduction in practice due to the likelihood of increased <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductor</a> activity, decreased gluteus medius activity, and reinforcement of knee valgus. Knee valgus during functional activities has been correlated with an increased risk of injury (17, 26, 27).

Two additional studies investigated the effect of adding <a href="https://brookbushinstitute.com/courses/hip-joint" target="_blank" rel="noopener">hip</a> internal rotation and external rotation; however, it is important to note that the bridge included in these studies was a &quot;straight-leg bridge&quot; with the feet elevated. Kim et al. demonstrated that <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> activity increased when bridges were performed with 25&#xB0; of <a href="https://brookbushinstitute.com/courses/hip-joint" target="_blank" rel="noopener">hip</a> internal rotation on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface, and <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity increased when bridges were performed with 25&#xB0; of hip external rotation on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface (28). Lee et al. also demonstrated that adding hip external rotation increased <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and gluteus medius activity (29, 30). These findings suggest that the addition of hip external rotation to a straight-leg bridge may be similar to adding hip abduction to a flexed-knee bridge, and the addition of hip internal rotation may be similar to adding hip adduction to a flexed-knee bridge. However, the straight-leg bridge is not recommended for reasons discussed in the next section.

Several studies have investigated <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity during a bridge with various degrees of knee flexion. (Note, knee flexion angle is relative to terminal knee extension - 0&#xB0; would imply &quot;straight-leg&quot; and 135&#xB0; would imply heel near <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener"> gluteus maximus</a>.) Lee et al. demonstrated that 135&#xB0; of knee flexion increased <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and gluteus medius activity and decreased <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">hamstring</a> activity when compared to 90&#xB0; of knee flexion (29, 30). Lehecka et al. compared bridges with 90&#xB0; knee flexion to four randomly assigned knee flexion angles, demonstrating that <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and gluteus medius activity was similar at all angles; however, <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener"> hamstring</a> activity decreased by nearly 70% when knee flexion was 135&#xB0; (31). Youdas et al. demonstrated that a straight-leg, <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> bridge resulted in a significant increase in both <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">hamstring</a> activity, and a flexed-knee bridge resulted in a similar increase in <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity but much less <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">hamstring</a> activity (32). Ho et al. demonstrated that as knee flexion angle increased <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> and <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity decreased relative to <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity (33). Additional studies have included the semitendinosus in their investigation. Kim et al. demonstrated that <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and semitendinosus activity increased as knee flexion angle decreased, with the exception of higher semitendinosus activity at 0&#xB0; of knee flexion (34). This study is further supported by Bourne et al. who used MRI to analyze transverse relaxation time of the <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">hamstring</a> muscles following bridging, demonstrating that the semitendinosus exhibited the greatest increase in latent activity, and further that the long head was preferentially recruited over the short-head <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris </a> (35). These studies demonstrate that as knee flexion angle increases <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> and <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity decrease relative to <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and potentially semitendinosus activity.
Additional studies have investigated the effect of knee flexion angle on core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity. The study by Kim et al. mentioned above demonstrated that <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> activity was highest when knee flexion angle was 0&#xB0; (straight-leg) (34). However, Gong et al. demonstrated that relative to <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> activity, transverse abdominis activity was greater at 90&#xB0; than 60&#xB0; of knee flexion (36). Lee et al. demonstrated that <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener"> external oblique</a>, and <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> activity was greater at 120&#xB0; of knee flexion when compared to 45&#xB0; and 90&#xB0; (37 ). And, Mun et al. demonstrated there may be a significant difference in <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> thickness, but not <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> thickness, during bridges with varied knee flexion angles (38). In summary, research suggests that trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity during a bridge increases as knee flexion angle increases, with the possible exception of 0&#xB0; of knee flexion resulting in the highest levels of activity. Research may suggest that the increases resulting from changes in knee flexion angle start with increases in transverse abdominis activity, followed by <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> activity, and the <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> affected the least.

Knee Flexion Angle

The addition of cues to a bridge has also been investigated. As mentioned above, Hollman et al. demonstrated that the verbal cue &quot;squeeze the glutes&quot;, and the tactile cue of manually resisting hip abduction at the knees, increased <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity of both the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>; however, these cues did not preferentially recruit the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>&#xA0;or decreased activity of the <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> in healthy/asymptomatic individuals (20). It may be interesting to repeat this study with low back pain patients exhibiting altered recruitment of the hip extensor muscles. Kim et al. demonstrated that adding arm motion to a bridge exercise increased <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> abdominal activity, and these increases were augmented when bridging was performed on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface (<a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> ball) (39). Several studies have investigated the addition of the abdominal <a id="drawing-in" data-tip="1580" target="_blank" href="/glossary-term/drawing-in" class="glossary">drawing-in</a> maneuver (<a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a>). Moon et al. demonstrated that low back pain patients exhibited a reduction in <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity when the <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a> was added to the bridge exercise, and further, adding hip abduction increased <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>&#xA0;activation (40). Cho et al. demonstrated that an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> <a id="base-of-support" data-tip="1196" target="_blank" href="/glossary-term/base-of-support" class="glossary">base</a> during a bridge increased <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> and transverse abdominis activity; however, cueing the <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a> increased transverse abdominis activity further and reduced motion of the lumbar spine (41, 42). And, Gong et al. demonstrated that 6 weeks of performing an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> bridge, only improved static and dynamic lumbar <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> if the <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a> was included in training (43). These studies suggest that cueing may have a significant effect on <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> recruitment and <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>, including the verbal cue &quot;squeezing the glutes&quot; and manually resisting hip abduction to increase <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>&#xA0;recruitment, cueing additional arm motion to increase <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> abdominal <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, and cueing the <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a> to increase transverse abdominis activity, decrease <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity and improve lumbar <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>.

<h4>Vibration: </h4>
Studies have also investigated <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> recruitment and the effect of adding vibration to a bridge. Park et al. demonstrated that the addition of vibration to an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> straight-leg bridge (slings) increased <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> activity (59). Gong et al. used ultrasound to demonstrate that an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> straight-leg bridge (sling) increased transverse abdominis and <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> thickness and that the addition of vibration further increased transverse abdominis thickness (60). Last, Warpecha A. demonstrated that 4 sets of bridges prior to a vertical jump, in a post-activation <a id="post-activation-potentiation" data-tip="1393" target="_blank" href="/glossary-term/post-activation-potentiation" class="glossary">potentiation</a> (<a id="post-activation-potentiation" data-tip="1392" target="_blank" href="/glossary-term/post-activation-potentiation" class="glossary">PAP</a>) protocol, significantly increased jump height; however, the addition of vibration to bridges did not result in additional benefits (61). These studies suggest that the addition of vibration to bridges may increase core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> recruitment; however, it may not increase performance when used as part of a <a id="post-activation-potentiation" data-tip="1392" target="_blank" href="/glossary-term/post-activation-potentiation" class="glossary">PAP</a> protocol incorporating bridges.
<h4>Outcomes:</h4>
Outcomes resulting from incorporating bridges are being reported in a growing number of published studies. Two studies investigated the immediate outcomes after performing a set of bridges. Dias et al. compared peak <a id="torque" data-tip="1294" target="_blank" href="/glossary-term/torque" class="glossary">torque</a> an hour after performing either <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> or <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> bridges, on a stable or <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface (4 groups). A decrease in peak <a id="torque" data-tip="1294" target="_blank" href="/glossary-term/torque" class="glossary">torque</a> was only exhibited by the group that performed <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> bridges on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface (62). Kang et al. demonstrated that following a set of bridges, <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> endurance increased (timed <a href="https://brookbushinstitute.com/video/plank" target="_blank" rel="noopener">plank</a>), and <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity decreased during treadmill walking in high heels (63). These studies demonstrate that sufficiently challenging bridge variations may decrease peak <a id="torque" data-tip="1294" target="_blank" href="/glossary-term/torque" class="glossary">torque</a> for up to an hour post-exercise; however, they may also improve core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> endurance and recruitment during functional activities.
Longer-term studies (3-6 weeks) demonstrate the efficacy of integrating bridges into a program. Gong et al. demonstrated that performing the floor bridge for 30 minutes, 3x/week, for 6 weeks improved trunk inclination and pelvic position; further, progressing to <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> variations also improved trunk imbalance, pelvic torsion, and scapular position (64). A previously mentioned study by Gong et al. demonstrated that 6 weeks of performing an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> bridge improved static and dynamic lumbar <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>, but only if the abdominal <a id="drawing-in" data-tip="1580" target="_blank" href="/glossary-term/drawing-in" class="glossary">drawing-in</a> maneuver (<a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a>) was performed during training (43). Yoo et al. demonstrated that bridges (straight-leg) on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface (slings), 3x&apos;s/week for 4 weeks, resulted in a significant increase in lumbar flexion and extension range of motion (ROM) in healthy, asymptomatic young adults (65). Additional studies have investigated the effect of bridges on low back pain. Kim et al. demonstrated that 4 weeks of training with <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> bridges improved static and dynamic stabilization, and better results were demonstrated when rhythmic stabilization was incorporated (66). Another study by Kim et al. compared floor bridges, upper body resisted bridges, and <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> bridges performed 3x/week, 30 minutes per session for 8 weeks, demonstrating all variations resulted in similar improvements in abdominal <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> thickness, low back pain, and disability (67). In summary, Incorporating bridges into a program of 3-6 weeks may have a positive effect on trunk <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a>, trunk position, and pelvic position, especially when progressed to <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> environments and the <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a> is included. Further, low back pain patients incorporating bridges into a rehabilitation program may exhibit improvements in <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>, pain, and disability scores.

<ul>
 <li> Hip Thrust - The hip thrust is a variation of a bridge, most often done with the intent of increasing hip extension and lower extremity strength. Conventionally, this variation starts with the torso elevated on a bench and a significant amount of resistance is added using bands, dumbbells, or barbells.</li>
</ul>

Hip Thrust Research Corner

<h4>Kinematics:</h4>
The kinematics of a hip thrust suggests it may be ideal for individuals with the intent of maximizing <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> strength at the end-range of hip extension. Bezodis et al. demonstrated that kinematic analysis reinforces the assertion that the hip thrust is hip extensor dominant, with the largest moment arms occurring at the beginning and the end of the concentric phase (68). Another study by Bezodis et al. demonstrated that the kinematics of the hip thrust differ from squats and deadlifts, with hip thrusts exhibiting the largest moment arms at the end of the concentric phase, and squats and deadlifts exhibiting the largest moment arms at the beginning of the concentric phase (69). These studies suggest that hip thrusts are a hip dominant movement that differs from squats and deadlifts due to the largest moments occurring at the end range of hip extension.
<img title="An image of the gluteus maximus muscle on the posterior side of the hip" src="https://www.datocms-assets.com/25800/1649273641-glute-max.png" width="206" height="294" alt="The gluteus maximus muscle">
<h4>Variations:</h4>
Two studies have investigated variations of hip thrusts. Similar to the studies on bridges and knee flexion angle, Garcia et al. demonstrated that performing a hip thrust with feet further from the bench (decreased knee flexion angle) increased EMG activity of the <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">hamstrings</a>, while pulling the feet toward the bench (increased knee flexion angle) increased activity of the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus </a> (70). Further, Contreras et al. demonstrated that barbell hip thrusts resulted in higher mean and peak <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus </a> EMG activity when compared to band resisted hip thrusts or American hip thrusts (performed with bench on mid-back) (71). These studies may suggest that <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> recruitment is optimized when the knee flexion angle is larger, barbells/dumbbells are used for resistance, and the torso is supported at the upper thoracic spine/scapula.

Several studies suggest that hip thrusts are equally or more effective for recruiting hip extensor musculature when compared to other lower extremity strength exercises. Contreras et al. demonstrated that in comparison to a 10-RM back squat, a 10-RM hip thrust resulted in higher peak and mean EMG activity for the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> and as much activity for the vastus lateralis (72). Andersen et al. compared the hip thrust, barbell deadlift, and hex bar deadlift, demonstrating that the hip thrust resulted in the highest EMG activity for the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>, deadlifts results in the highest EMG activity for the <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>, and all exercises resulted in similar EMG activity for the <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae </a> (73). Delgado et al. compared EMG activity of the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>, <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener"> biceps femoris</a>, and the vastus lateralis during a back squat, Romanian deadlift, and hip thrust. <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener"> Gluteus maximus</a> activity was greatest during 1RM hip thrusts and Romanian deadlifts, and vastus lateralis activity was greatest for squats (74). Similarly, Tibbot et al. demonstrated gluteus medius and <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> peak EMG activity was higher during a hip thrust than a deadlift (75). Comparing the hip thrust, squat, deadlift, and hex bar deadlift, these studies may imply that <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity is highest during hip thrusts and potentially deadlifts, <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener"> biceps femoris</a> activity is highest during deadlifts, vastus lateralis activity is highest during squats, and <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity is similar during these exercises.
<img src="https://www.datocms-assets.com/25800/1644265279-gluteus-maximus-fascia.png" width="192" height="364" title="The gluteus maximus, hamstrings, and connecting fascia" alt="The gluteus maximus and connecting tissues">

Several studies have demonstrated a relationship between hip thrust strength and performance. Lockie et al. demonstrated a moderate correlation between hip thrust relative strength (percent of body weight) and change of direction speed in college-age, recreationally trained women (76). Loturco et al. demonstrated that hip thrust relative strength had a stronger correlation with the acceleration phase of sprinting and that loaded and unloaded vertical jump performance had a stronger correlation with the top-speed phase of sprinting (77). Williams et al. compared correlations between top running speed and split squats, back squats, or hip thrusts, demonstrating that the amount of <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activation was most correlated between hip thrusts and running speed (78). Based on the findings of these studies it may be reasonable to conclude that hip thrusts have a strong correlation with certain aspects of sports performance (e.g. acceleration); however, vertically loaded lower extremity strength exercises have stronger correlations with other aspects of performance (e.g. top speed). 
<h3>Post-activation Potentiation (PAP)</h3>
Studies published on post-activation <a id="post-activation-potentiation" data-tip="1393" target="_blank" href="/glossary-term/post-activation-potentiation" class="glossary">potentiation</a> (<a id="post-activation-potentiation" data-tip="1392" target="_blank" href="/glossary-term/post-activation-potentiation" class="glossary">PAP</a>) have increased over the last decade, and several of these studies include hip thrusts. Carbone et al. compared back squats and hip thrusts at 85% of 1-RM followed by 8-minutes of rest, as part of a <a id="post-activation-potentiation" data-tip="1392" target="_blank" href="/glossary-term/post-activation-potentiation" class="glossary">PAP</a> protocol. Both exercises resulted in similar small improvements in sprint performance (79). Conversely, Atala&#x11F; et al. demonstrated that squats and hip thrusts done 8 minutes prior to activity had no effect on vertical jump, 20m sprint and 40m sprint times (80). Iacono et al. compared 50% and 85% of 1RM hip thrusts followed by 15sec, 4min, or 8min inter-set rest intervals (6 groups), before performing 10m and 15m sprint tests. The results suggest that only 85% of 1RM with a 15sec inter-set rest interval was detrimental to performance and that either load with 4min or 8min inter-set rest intervals may be beneficial. There was a trend toward 85% of 1RM with a 4min inter-set rest interval having the largest impact on performance, but statistical significance was not reached (81). Another, similar study by Iacono et al. resulted in similar findings; however, loading hip thrusts for <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> production was preferred over %1-RM due to higher efficiency (82). Last, as mentioned above, Warpecha A. demonstrated that performing 4 sets of bridges prior to a vertical jump significantly increased jump height; however, the addition of vibration to bridges did result in further increases in performance (61). These studies suggest that hip thrusts and squats may be equally effective for <a id="post-activation-potentiation" data-tip="1392" target="_blank" href="/glossary-term/post-activation-potentiation" class="glossary">PAP</a>, 85% of 1-RM or power-optimized loads may be slightly more effective than 50% of 1-RM, a 4min inter-set rest interval may be preferred to an 8min inter-set rest interval and 15-sec inter-set rest intervals may decrease performance, and the addition of vibration is unlikely to have an effect on performance.
<img src="https://www.datocms-assets.com/25800/1649306258-sprinters-glutes-1.jpeg" title="Gluteus maximus acts as the prime mover of the hip during sprinting" alt="Sprinters taking off out of a starting block at the start of a race">

Several studies have investigated outcomes following training incorporating hip thrusts (4 - 12 weeks). Two of these studies compared hip thrusts to squats and their effect on strength. Hammond et al. compared barbell back squats and barbell hip thrusts, performed at 80% of 1-RM, 2 times/week for 4-weeks, demonstrating that both groups increased squat and hip thrust strength; however, the squat group improved more on squats and the thrust group improved more on hip thrusts (83). Gonz&#xE1;lez-Garc&#xED;a et al. compared hip thrusts (bridges) to back squats as part of a progressive resistance training program for female adolescent soccer players without lifting experience, performed 2 times/week for 7-weeks. Both groups exhibited improvements on all tests; however, the hip thrust group did improve more on 10m and 20m sprint times, t-test times, and barbell velocity during hip thrusts. The squat group exhibited greater improvements in bar velocity during back squats (84). Additional studies fail to demonstrate significant differences in performance following training incorporating hip thrusts. Millar et al. compared hip thrusts and back squats as part of an in-season strength training program, 2 times/week for 6-weeks, for female high school soccer players, demonstrating that both groups improved equally on strength, vertical jump, broad jump, pro-agility, and ball-kicking distance tests (85). An RCT by Jarvis et al. demonstrated that an 8-week strength training program including hip thrusts resulted in an increase in 1-RM hip thrust strength, but did not translate to increases in sprint performance at any distance up to 40m (86). Lin et al. compared an 8-week baseball training regimen with and without hip thrusts, demonstrating that hip thrusts contributed to hip thrust and squat strength, but did not improve vertical jump, broad jump, or 30m sprint time performance (87). Two additional studies demonstrate trends that failed to reach statistical significance. An RCT by Zweifel et al. compared jumping, sprinting, change of direction, and strength performance following 6-weeks (3x/week) of training with squats, deadlifts, or hip thrusts. Although this study did not include sufficient participants to demonstrate statistically significant differences, trends were noted toward back squats most improving change of direction speed, hip thrusts most improving broad jump and sprinting speed, and deadlifts most improving vertical jump (88). An RCT by Contreras et al. compared hip thrusts and squats as part of a 6-week training program for adolescent male athletes, demonstrating that hip thrusts may be beneficial for sprint performance, and front squats more beneficial for vertical jump performance; however, again findings did not reach statistical significance (89).&#xA0;In summary, these studies imply that hip thrusts may be an effective strength exercise, especially for improving hip thrust strength, but are likely not effective, or at least not as effective as squats, for improving power/sports performance.

<h2>Bridge Progression, Form, and Videos</h2>
<ol>
 <li>Floor bridge arms on the floor</li>
 <li>Floor bridge arms across chest</li>
 <li>Floor bridge on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface</li>
 <li>Single leg floor bridge</li>
 <li>Single leg floor bridge on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface</li>
 <li>Ball bridge (upper back on a ball)</li>
 <li>Ball bridge with feet on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface</li>
 <li>Static ball bridge with trunk rotation</li>
 <li>Dynamic ball bridge to trunk rotation</li>
 <li>Resisted ball bridge (dumbbell in lap)</li>
 <li>Ultimate Glute Bridge Progression: Resisted ball bridge (dumbbell in lap) with band resisted hip abduction</li>
</ol>

<img src="https://www.datocms-assets.com/25800/1646155695-static-ball-bridge-with-trunk-rotation.png" title="Dr. Brent Brookbush demonstrating a glute bridge on a ball" alt="A glute bridge with rotation on a ball">
<hr>
<h3>Notes on form:</h3>
Common Compensations:
<a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">Optimal</a> <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a> can be summarized as feet parallel (the second toe points forward), feet, knees, and hips in alignment, neutral pelvis, neutral spine, and the torso supported at the shoulder blades. However, you may want to pay close attention to where the exercise is felt and any compensation patterns that are observed.
<ul>
 <li>Hamstring Dominance: This can often be addressed by increasing the knee flexion angle; that is, moving the feet closer to the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>, bench, or ball (as discussed above). Additionally, it may be helpful to <a href="https://brookbushinstitute.com/courses/hip-external-rotator-flexibility" target="_blank" rel="noopener">release the biceps femoris</a>, and/or <a id="assessment" data-tip="1486" target="_blank" href="/glossary-term/assessment" class="glossary">assess</a> and address any <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> restrictions of the hip and knee.</li>
 <li>Excessive Lumbar Extension: This can often be addressed by having the patient/client perform the abdominal <a id="drawing-in" data-tip="1580" target="_blank" href="/glossary-term/drawing-in" class="glossary">drawing-in</a> maneuver (<a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a>), or additionally engaging the rectus abdominis (bracing). The patient can then sequentially perform this maneuver, followed by &quot;squeezing the glutes&quot; at the beginning of each rep, with the intent of reciprocally inhibiting the <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">lumbar erectors</a>, and increasing <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> engagement. Additionally, you may want to <a id="assessment" data-tip="1486" target="_blank" href="/glossary-term/assessment" class="glossary">assess</a> and address any <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> restriction of the hip, sacroiliac joint, or lumbar spine.</li>
 <li>Adductor Magnus Dominance - Unfortunately, there is no research investigating the activity of the adductor magnus in healthy or symptomatic individuals during a bridge. However, clinical experience suggests that cramping of the &quot;inner thigh&quot; or knee valgus during this exercise may often be attributed to over-activity of the adductor magnus. <a href="https://brookbushinstitute.com/courses/hip-external-rotator-flexibility" target="_blank" rel="noopener">Release of the adductor magnus</a> and/or band resisted abduction are likely to resolve this issue. Additionally, you may want to <a id="assessment" data-tip="1486" target="_blank" href="/glossary-term/assessment" class="glossary">assess</a> and address any <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> restriction of the sacroiliac joint, hip, or knee</li>
 <li>Psoas/TFL Over-activity or Restricted Hip Extension &#x2013; Generally, over-activity of the hip flexors reduces hip extension, results in an <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt, and/or is accompanied by external rotation and abduction of the femur. <a href="https://brookbushinstitute.com/courses/hip-flexor-flexibility" target="_blank" rel="noopener">Release and lengthening of the hip flexors</a>, <a href="https://brookbushinstitute.com/courses/joint-mobilization-lower-body-self-administered" target="_blank" rel="noopener">mobilization of the hip</a>, and cueing &quot;squeezing the glutes&quot;, are often effective for reducing or eliminating this issue. Additionally, you may want to <a id="assessment" data-tip="1486" target="_blank" href="/glossary-term/assessment" class="glossary">assess</a> and address any <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> restriction of the lower extremity, sacroiliac joint, or lumbar spine.</li>
</ul>
<ol>
 <li style="list-style-type: none;"></li>
</ol>
<ul></ul>

Videos

<h3><iframe src="https://player.vimeo.com/video/82847479" frameborder="0" allowfullscreen="allowfullscreen"></iframe></h3>
<h4>Ball Bridge:</h4>
<ol>
 <li>Start by having your patient/client sit on a <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> ball that is about knee height.</li>
 <li>Have them &quot;walk&quot; their feet out and <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> down the ball as if they were going to sit on the floor, but stop when the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> is a few inches from the floor.</li>
 <li>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.</li>
 <li>Have the patient assume the top position of the bridge; ensure their weight is supported on the ball on their upper back, between their shoulder blades (not their neck), and knee flexion angle is 90&#xB0; or more.</li>
 <li>Instruct the patient/client to sit straight down, hinging at the hips, returning to the starting position.</li>
 <li>Cue the patient to &quot;squeeze the glutes&quot; and thrust the hips straight-up toward the ceiling. The goal is to reach terminal hip extension, without additional lumbar extension.</li>
 <li>Have your client hold a maximal voluntary contraction of their <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> (&quot;squeeze their glutes&quot;) at the end of terminal hip extension (top of the movement).</li>
 <li>Slowly return to the starting position maintaining a neutral spine and <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> lower extremity alignment.
 <ul>
 <li>The unique feature of this exercise is a force that resists terminal hip extension in the transverse plane. To take advantage of this feature the hip joint should follow a nearly vertical path throughout the exercise. Try to ensure that your patient/client is driving the hips straight up and sitting straight-down, and they are not pushing back into the ball or sliding forward into additional dorsiflexion/knee flexion.</li>
 </ul>
 </li>
 <li>Repeat for the desired number of reps.</li>
</ol>

Ball Bridge

Static Ball Bridge with Trunk Rotation

Dynamic Ball Bridge with Trunk Rotation

Ultimate Glute Bridge Progression

Bibliography

Copyright

A-Band - Refers to the part of the muscle cell that looks darker under a microscope.  This area of the cell is darker due to parallel arrangement of thicker filaments (myosin) and overlap with the thinner filaments (actin).
<ul>
 	<li>As a muscle contracts, the A-band is where actin and myosin interact.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Accuracy - the proportion of individuals correctly identified by the test results.
<ul>
 	<li>For example, a special test with perfect accuracy would imply a test has 100% specificity, 100% sensitivity, 100% positive predictive value and 100% negative predictive values.</li>
</ul>

Action Potential - A rapid change in voltage, resulting in a wave of excitation, that may result in stimulation of a nerve or muscle cell.
<ul>
 	<li>In order for an action potential to be initiated, the resting membrane voltage must exceed the excitation threshold, which then results in a cascade of depolarization and the "wave of excitation." Any stimulus below that threshold will not result in an action potential, and a stimulus greater than the threshold will not increase a single action potential, but may result in additional action potentials.  In this way, the action potential functions more like an on/off switch (all or none), and less like a dimmer switch.</li>
</ul>

A single-joint movement pattern (most often) designed to load a specific under-active muscle(s), while minimizing the contribution of over-active synergists via specific cues/joint motions.
<ul>
 	<li style="text-align: left;">Activation techniques/exercises are performed with the intent of addressing a muscle exhibiting a reduction in activity (tone) as a result of, or contributing to postural dysfunction.</li>
 	<li style="text-align: left;">Activation techniques/exercises cannot be multi-joint movement patterns due to relative flexibility, altered reciprocal inhibition, and synergistic dominance resulting in compensation patterns.</li>
</ul>
Example, <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/activation/gluteus-medius-activation-progression/" target="_blank">gluteus medius activation</a> involves resisted hip abduction while minimizing the contribution of the TFL via hip extension.

Active stretching is a term used to describe a stretch that involves an active contraction of opposing musculature to lengthen a muscle to its end range. Generally these stretches are held for 2-5 seconds and repeated for 8-15 repetitions.

Adenosine triphosphatase (ATPase): is the enzyme responsible for catalyzing (initiating and accelerating) the decomposition of ATP to ADP.
<ul>
 	<li>This dephosphorylation (breakdown) reaction releases energy for processes like muscular contraction.</li>
</ul>

Adenosine triphosphate (ATP): The molecule that functions as a universal energy-transfer molecule, providing most of the energy associated with muscular contraction and human movement. ATP is composed of an adenine group, a ribose group, and three molecules of inorganic phosphates.
<ul>
 	<li>Energy is provided when hydrolysis results in the cleaving of a phophate group; resulting in adenosine diphosphate, an inorganigic phosphate group, and energy.</li>
</ul>

Algometry - measuring the amount of pressure to result in sensitivity or pain, using an algometer.
<ul>
 	<li>Generally, research uses algometry to establish a minimum pain pressure threshold (PPT), in which a lower PPT implies more sensitivity and pain, and a higher PPT implies less sensitivity and pain. PPT is a common outcome measure in trigger point research.</li>
</ul>
<a href="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg"><img class="aligncenter wp-image-140177" src="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg" alt="Image of an Algometer" width="500" height="333" /></a>

All-or-none principle - a nerve or muscle cell's response to a stimulus is independent of the strength of the stimulus. If that stimulus exceeds the threshold potential (threshold of an action potential), the nerve or muscle fiber will respond completely; otherwise, there is no response.

Example, when a motor unit in the biceps brachii is stimulated it contracts the same way whether a 10 lb or 50 lb dumbbell is lifted.  It is actually the number of muscle cells and the size of the motor unit that determines force output.

&nbsp;

The transition period between eccentric load and concentric contraction during a repetition of an exercise.  This term is most often used in reference to power/plyometric exercises, in which a shorter amortization phase is believed to be beneficial.  The shorter amortization phase may better use the stored energy from the elastic deformation of connective tissue and enhance synchronization of myotatic (stretch) reflex with maximum voluntary contraction.

Example, the athlete was cued to spend as little time as possible in the bottom of their squat stance (the amortization phase) during a set of box jumps.

Muscles that oppose the prime mover and synergists for a given joint action.

That is, all the muscles that can perform the opposing joint action.

Example: The triceps and anconeus are antagonists during elbow flexion.

An anatomical direction; toward the front

Example, the face is on the anterior aspect of the head

Appendicular Skeleton - referring to the bones the bones of the arms and legs, as well as the bones that support them. This includes the pelvis, clavicle and scapula. There are approximately 126 bones in the appendicular skeleton.
<ul>
 	<li>Etymology - Appendicular, as in appendage, "that which is appended to something as a proper part," 1640s, from <a class="crossreference" href="https://www.etymonline.com/word/append?ref=etymonline_crossreference">append</a> + <a class="crossreference" href="https://www.etymonline.com/word/-age?ref=etymonline_crossreference">-age</a>. - <a href="https://www.etymonline.com/word/appendage" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Appendicular skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/axial-skeleton/" target="_blank" rel="noopener">axial skeleton</a>".

A reflexive decrease in muscle activity due to joint dyskinesis.
For example, a reduction in deep cervical flexor activity as a result of cervical spine dyskinesis.

Arthrokinematic Motion - Small amplitude motions between bone surfaces at a joint.  The arthrokinematic motions are roll, glide (slide or translation), spin, compression and distraction (traction). Arthrokinematic motions accompany osteokinematic motions to maintain joint congruence.
<ul>
 	<li>Example, arthrokinematic motion of the talus includes posterior glide on the tibia during ankle dorsiflexion.</li>
</ul>
Synonyms include: arthrokinematics, passive accessory motion, joint play and component motion

&nbsp;

Assessment - is the act of assessing, i.e. determining the importance, size, or value of -

In most cases, the results of an assessment are compared to normative data. If the individual exhibits values that are within normal parameters, it may be assumed that the aspect of health or motion assessed is not contributing to the patient's complaint, symptoms or movement impairment. If the results fall outside of normal parameters, it may indicate that the aspect of health or motion assessed is contributing to, or being affected by the patient/client's complaint, symptoms, or movement impairment. In some cases, the results of an assessment are compared to an "ideal model." In this case, deviations from the ideal are noted as potential issues. For example, deviations noted in the <a title="Introduction to the Overhead Squat Assessment" href="https://brentbrookbush.com/online-courses/articles/assessment/introduction-overhead-squat-assessment/" target="_blank">Overhead Squat Assessment</a> are compared to an "ideal model" of posture and motion.

Assessments used by human movement professionals can be divided into three broad categories:
<ul>
 	<li>"Clear" the Patient/Client for Intervention - These are tests, assessments and evaluations used to determine if a patient/client's issue may improve given the assessing professional's scope, skills, abilities and willingness to treat that individual.
<ul>
 	<li>For example, many of the special tests used in orthopedic medicine assist in determining the level of pathology or likelihood of a particular diagnosis. Certain issues and diagnoses are beyond the scope of the human movement professional, and are better treated by diagnostic professionals in the medical community (physicians, podiatrists, surgeons, etc.). A Calf Squeeze (Thompson) Test is one example, in which a positive sign may indicate a rupture of the Achilles tendon that may be better treated via surgical intervention.</li>
</ul>
</li>
 	<li>Highlight Contraindications - Tests, assessments and evaluations used to stratify risk or preclude a professional from addressing certain tissues, motions or using a particular technique.
<ul>
 	<li>For example, the Vertebral Artery Test (VBI) is often used to determine if high velocity thrust mobilizations (manipulations) are safe for a patient with cervical dysfunction.</li>
</ul>
</li>
 	<li>Refine Exercise/Intervention Selection: Tests, assessments and evaluations used to assist the professional in determining which techniques, modalities and exercises will best address a patient/client's complaints or desired goals.
<ul>
 	<li>Most movement assessments fall into this category. For example, a positive <a href="https://brentbrookbush.com/vimeo_videos/elys-test-rectus-femoris-flexibility-assessment/" target="_blank">Ely's Test</a> may indicate a need to release and/or lengthen the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/rectus-femoris/" target="_blank">rectus femoris</a>.</li>
</ul>
</li>
</ul>
Note: An assessment, or assessment result, may fall into more than one category. For example, although goniometry is an assessment most often used to Refine Exercise/Intervention Selection, if a range of motion is significantly altered, with an abnormal end-feel, and/or causes the patient or client/pain, the individual may need to be referred to a physician for further testing and Clearance to resume rehab activities.  Further, that same patient may return to the human movement professional with a list of Contraindicated Activities from the physician. - "When in doubt, refer out!"

Axial Skeleton - referring to the bones of the head, neck, trunk and spinal column (does not include pelvis). There are approximately 80 bones in the axial skeleton.
<ul>
 	<li>Etymology - Axial, as in "axis", referring to "imaginary motionless straight line around which a body (such as the Earth) rotates," from Latin axis "axle, pivot, axis of the earth or sky" - <a href="https://www.etymonline.com/word/axis" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Axial skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/appendicular-skeleton/" target="_blank" rel="noopener">appendicular skeleton</a>".

Balance - The ability to maintain a body’s center of mass over its base of support. Balance can be static or dynamic.
<ul>
 	<li>For example, maintaining balance is harder on one leg because the center of mass must stay over a much smaller base of support.</li>
</ul>

A ball and socket joint (also called a spheroid joint or spheroidal joint) is a synovial joint in which the rounded or spherical end of one bone fits into a cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of axes, which have one common center. Examples include the hip and shoulder (glenohumeral joint)

Base of support (BoS) - refers to the area beneath an object or person, and the area within the perimeter created by every point of contact that the object or person makes with the supporting surface. This may include the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/gluteus-maximus/" target="_blank" rel="noopener">glutes</a> of someone sitting on a chair, or the back of someone leaning against a wall.
<ul>
 	<li>For example, during a single leg balance the BoS is the area of the foot in contact with the surface; however, when a person is standing on two feet, the BoS is the area of both feet and the surface between them.</li>
</ul>

Pertaining to both sides

Example, bilateral rows are performed with both arms at the same time.

Case-control Study - a particular form of retrospective study that samples a matched group of people who have, and do not have the outcome being studied. A case-control study is a quasi-experimental design, often used in medicine to aid in determining potential contributing factors (cannot determine causality). In this study type exposure is the dependent variable and outcome is independent.
<ul>
 	<li>Example, in this retrospective case-control, medical records were investigated for trends correlated with cervical pain (1).
<ol>
 	<li>Mäkela, M., Heliövaara, M., Sievers, K., Impivaara, O., Knekt, P., &amp; Aromaa, A. (1991). Prevalence, determinants, and consequences of chronic neck pain in Finland. American journal of epidemiology, 134(11), 1356-1367.</li>
</ol>
</li>
</ul>

An anatomical direction; toward the tail, relative to humans this term is often used to refer to "in the direction of the tale (toward the feet)".

Example, to release the trapezius muscle the therapist used a force directed caudally.

Center of mass (CoM) - an object's mean position of mass; that is, a point that is perfectly surrounded by an equal amount mass in all directions.

Center of gravity (CoG) - point where gravity appears to act. Since the human body is so small compared to the earth, we can assume gravity acts uniformly on the body, and that CoG and CoM are the same.
<ul>
 	<li>Example, the CoM of the human body while lying down or standing straight up is close to our navel. However, it is possible that during a resistance exercise, the combination of the body's weight and the weight of the resistance will place the combined CoM outside the body. For example, during the mid-portion of a <a href="https://brentbrookbush.com/vimeo_videos/back-squat/" target="_blank" rel="noopener">back squat</a> the CoM would be several anterior to the naval.</li>
</ul>

An anatomical direction; toward the head (synonym: cranial)

Example, hip pain was felt with any force directed cephalad.

Cohort Study - a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic), performing a cross-section at intervals through-out a period of time. A cohort study is a quasi-experimental design often used in medicine to aid in determining etiology or a cause-and-effect relationship. In this study type exposure is the independent variable and outcome is dependent.
<ul>
 	<li>Example, the study by Cholewicki et al. (1) investigated Yale Varsity Athletes (the cohort) with 2 and 3 year follow up (longitudinal design) and found that trunk muscle response time to off-loading was predictive of future low back injury.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/core/increased-trunk-muscle-latency-may-cause-rather-than-result-from-low-back-pain/" target="_blank" rel="noopener noreferrer">Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620</a></li>
</ol>

Comparable Sign: A combination of pain, stiffness and/or spasm during examination that is comparable to the patients symptoms.
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

An alternative movement pattern that has been adopted to compensate for dysfunction/impairment in the human movement system.
Example: A lack of calf extensibility may limit dorsiflexion, leading to the knees bowing inward (functional valgus) and excessive forward lean of the torso during a squat.

An arthrokinematic motion - the approximation of joint surfaces; that is, a force that directs one bone surface into another resulting in a reduction in intra-articular volume. Although widely thought of as a "destructive force", it is likely best to consider compression as a naturally occurring, stabilizing force. Any arthrokinematic force in excess (spin, glide, roll, traction) may be viewed as potentially deleterious.

For example, during a squat the femoral head is compressed into the acetabulum by muscular forces, bodyweight and any additional external load.

Concave (Concavity) - Having an outline or surface curved like the interior surface of a bowl or sphere - to cave-in or curve inward.
<ul>
 	<li>Example, the internal surfaces of the pelvis is concave, holding some of the bodies viscera.</li>
</ul>

Concordant Sign - The patient's specific pain, symptom or complaint. 
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

Conductivity: Stimulation results in more than a local effect (1).
<ul>
 	<li>For example, in a muscle cell the stimulation of a motor endplate results in a change in cell membrane polarity that rapidly propagates (is conducted) along the entire length of the muscle cell, stimulating all sacromere.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

A condyloid joint (also called condylar, bicondylar, ellipsoid, or ellipsoidal) is an ovoid articular surface, or condyle, that is received into an elliptical cavity.  These joints permit movement in two planes.  Examples include the knee, metacarpophalangeal joints and metatarsophalangeal joints.

Connective Tissue Cell - One of the four basic types of animal tissue, consisting mostly fibers and ground substance.  These cells are specialized to binds organs together, holds them in place, protect them from external forces, and may fill space in the body's cavities.

Example, the body's muscles are enclosed in durable connective tissue sheets known as the "epimysium", "perimysium", and "endomysium," which and in support and transmitting force.
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Contractility: The ability to shorten (1).
<ul>
 	<li>Contractility: Muscle cells are unique in the amount they can shorten when stimulated; this is this largerly due to the highly organized and unique arrangement of myofilaments (actin and myosin).</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Pertaining to the opposite side

Example, the external oblique muscle performs contralateral rotation; rotation to the opposite side.

Convex (Convexity) - Having an outline or surface curved like the exterior of a circle or sphere - to bulge or curve outward.
<ul>
 	<li>Example, the top of your head is shaped by the convex exterior surface of your skull.</li>
</ul>

Correlational Research - Non-experimental <a href="https://www.questionpro.com/blog/what-is-research/">research</a> method in which the statistical relationship between two variables is investigated.
<ul>
 	<li>In this research by Kwon et al., a correlation was noted between a decrease in extensibility during a hamstring length test (goniometry) and current knee pain (1).</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/correlation-patellofemoral-pain-syndrome-pfps-hamstring-activity/" target="_blank" rel="noopener">Kwon O, Yun M, and Lee W. (2014). Correlation between intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. J. Phys. Ther. Sci. 26: 961-964</a></li>
</ol>

Counter-nutation - posterior rotation of sacrum relative to ilium, and/or anterior rotation of ilium relative to sacrum.
<ul>
 	<li>The pelvic floor muscles are examples of muscle that may counter-nutate the sacrum.</li>
</ul>
[caption id="attachment_126335" align="aligncenter" width="400"]<a href="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png"><img class=" wp-image-126335" src="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png" alt="Nutation and Counter-nutation of the Sacroiliac Joint" width="400" height="967" /></a> Nutation and Counter-nutation of the Sacroiliac Joint[/caption]

&nbsp;

Crossover (Study) Design - A type of longitudinal, repeated measures quasi-experimental design in which each group receives both treatments, but at different times. It is named "crossover" due to the patients "crossing-over" to the other treatment or sham group after a specified period of time.
<ul>
 	<li>This type of study has the advantage of every individual serving as their own control, which may reduce the influence of confounding variables.</li>
 	<li>Unfortunately, the design itself introduces the chances that anyone receiving the experimental variable in the first period will continue to be effected in the second period.</li>
</ul>
In a study by Senna et al., a cross-over design was used to investigate the difference load made on inter-set rest intervals (1).
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/strength-training-research-corner/heavy-vs-light-load-single-joint-exercise-performance-with-different-rest-periods/" target="_blank" rel="noopener">Senna, G.W., Rodrigues, B.M., Sandy, Scudese, Bianco, A, &amp; Dantas, E.H.M. (2017). Heavy vs light load single-joint exercise performance with different intervals. Journal of Human Kinetics, 58, 197-206. </a></li>
</ol>

Cross-sectional Study - a research design that involves gathering data from a population or representative subset at a specific point in time.
<ul>
 	<li>Example, the study by Karimi-Mobarake et al.(1) investigated the prevalence of genu varum and genu valgum among school children 7-11 years old in Iran.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/low-prevalence-of-genu-varum-and-valgum-among-elementary-school-children/" target="_blank" rel="noopener noreferrer">Karimi-Mobarake, M., Kashefipour, A., Yousfnejad, Z. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. (2005) Journal of Medical Science 5(1). 52-54</a></li>
</ol>

Cytokine - A broad and loose category of small proteins that act through receptors, and are especially important to immune function (inflammation).
<ul>
 	<li>Cytokines include substances such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells. Their definite distinction from hormones is a topic of continued research.</li>
</ul>
&nbsp;

Dependent variable - in research, this is the variable that is changed by the independent variable, most often this is the "outcome" of the study.
<ul>
 	<li>Example, in the study by Cleland et al. (1), the independent variable is "thoracic manipulation," and the dependent variable is "lower trapezius muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/short-term-effects-lower-thoracic-manipulation-lower-trapezius-muscle-strength/" target="_blank" rel="noopener noreferrer">Cleland J, Selleck B, Stowell T, Brown L, Alberini S, St. Cyr H, Caron T. Short-term Effects of Thoracic Manipulation on Lower Trapezius Muscle Strength.  Journal of Manual &amp; Manipulative Therapy. 2004; 12(2): 82-90</a></li>
</ol>

An anatomical direction; further from the trunk or center of the body

Example, the foot is at the distal end of the leg.

An arthrokinematic motion - a force applied to a body part that may result in the separation of joint surfaces, a reduction in intra-articular pressure, and/or an increase in intra-articlar space.

For example, to hang from one's hands (i.g. in preparation for a pull-up) results in a traction force on the glenohumeral joint (shoulder).

An anatomical term of location; back or upper surface

Example, shoe laces may compress tissues on the dorsal surface of the foot

The "drawing-in" maneuver is a common cue used during exercise and rehabilitation programs. A light contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abominis</a> (and potentially the entire <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/core-subsystems/intrinsic-stabilization-subsystem/" target="_blank" rel="noopener">intrinsic stabilization subsystem</a>) achieved by gently pulling the lower abdominal region away from one's waist band. This should have minimal effect on breathing, and should not be confused with a maximal contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abdominis</a> resulting in a "vacuum pose".
<ul>
 	<li>Research often refers to this maneuver as the "abdominal drawing-in maneuver"; abbreviated ADIM.</li>
</ul>
Development and introduction of this cue into practice is based on the pivotal research and resulting text:
<ol>
 	<li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
</ol>

Faulty or abnormal movement; an alteration of normal kinematics.

For example, joint stiffness or a reduction in arthrokinematics motion that results in limited osteokinematic range of motion - inadequate inferior glide of the femoral head resulting in limited abduction of the hip.

The seeping into, or abnormal collection of fluid in a body cavity.

For example, knee effusion describes swelling within the knee joint.

Note: the word "effusion" is used differently in medicine than it is used in reference to the movement (seeping out) of liquids and gases, for example in chemistry.

&nbsp;

A trait of body tissues that allows a tissue to return to its resting length or state after deformation or stretch.
Example:  Muscle is elastic tissue; many muscles will return to their resting length after being stretched to 150% of that length without any appreciable change in tissue quality.

Elasticity: Elasticity refers to the ability of a cell to return to its resting length after being stretched/lengthened.
<ul>
 	<li>Note: this term is often confused with extensibility. Elasticity is not the ability to stretch; it is the ability to return to normal length after being stretched. Muscle tissue, connective tissue and even nerve tissue have varying levels of elasticity.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Epithelial cell - One of the four basic cell types, found lining the body's cavities, blood vessels, organs and constitutes most gland tissue.  These cells are specialized to aid with absorption, secretion, or act as a barrier from foreign objects.
<ol>
 	<li>Saladin, K. S., &amp; Miller, L. (1998). Anatomy &amp; physiology. New York (NY): WCB/McGraw-Hill.</li>
</ol>

Equilibrium - a state in which opposing forces or influences are balanced.
<ul>
 	<li>For example, to maintain a neutral trunk while pushing or pulling a weight in one hand, your core musculature must balance the force by creating an equal amount of force in the opposite direction.</li>
</ul>

The study of causation, or origination. The word is commonly used in the medical professions, where it may refer to the study of why things occur, or the reason behind why things act a certain way.

For example, the etiology of low back pain is a complex subject, with multiple contributing factors and various structures implicated.

<div class="gs_citr" tabindex="0">Evidence-based medicine (practice) is the integration of best research evidence with clinical expertise and patient(client) values (2)."</div>
<ul>
 	<li class="gs_citr" tabindex="0">...the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (clients).  It involves the integration of at least (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve (1).</li>
</ul>
&nbsp;
<ol>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., &amp; Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. Bmj, 312(7023), 71-72.</li>
 	<li class="gs_citr" tabindex="0">Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1</li>
</ol>

Excitability: The ability of a cell to change in membrane conductance as a response to stimulation.

<ul>
 	<li>For example, muscle cells are specialized to react to a change in membrane potential with contraction, where as nerve cells are specialized to propagate a change in membrane potential along there axons and communicate that message to other tissues via neurotransmitters.
</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Excitation threshold: The level that a depolarization must reach for an action potential to occur.
<ul>
 	<li>The excitation threshold is a contributing factor to the "all-or-none" response of muscle and nerves cells to a stimulus.</li>
</ul>

Exercise Progression - Modification of an exercise with the intent of promoting adaptation by increasing demand. This can be accomplished by increasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise progression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise, or series of exercises that make it harder to maintain stability with good form.
<ul>
 	<li>Sample Exercise Progression: <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a></li>
</ul>
</li>
</ul>

Exercise regression - The opposite of progression; that is, modification of an exercise with the intent of reducing demand. This can be accomplished by decreasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability. Generally, regressions are used to modify an exercise to the client's current level of ability, with the intent of improving form, motor learning and retention.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise regression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise or series of exercises that make it easier to maintain stability with good form.
<ul>
 	<li>Sample Exercise Regression: <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a></li>
</ul>
</li>
</ul>

Experimental Research - Studies in which the researchers introduce the variable to be studied, with the intent of observing the outcome. This is different than observational research which observes the effect of a variable already present. Many texts also assert that experimental research should include randomization and ideally a control group, as is seen in Randomized Control Trials. Studies in which the variable is introduced by the researchers, but participants are not randomized may be considered Quasi-experimental research.
<ul>
 	<li>In this study by Esformes, the experimental variable was squat depth and the outcome measures observed were various performance measures related to power (1).</li>
</ul>
<ol>
 	<li><a href="https://brookbushinstitute.com/article/back-squat-depth-lower-body-post-activation-potentiation/" target="_blank" rel="noopener">Esformes, J., &amp; Bampouras, T. (2013). Effect of back squat depth on lower-body postactivation potentiation. Journal of Strength and Conditioning Research, 27(11), 2997-3000.</a></li>
</ol>
&nbsp;

Extensibility: The ability of a cell to be stretched or lengthened without damage (1).
<ul>
 	<li>For example, most cells would rupture with even a modest stretch, but muscles can stretch up to 3 times their contracted length.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

False Negative - the proportion of negatives in a group that were assessed incorrectly (assessed as negative when the patient was actually positive)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

False Positive - the proportion of positives in a group that were assessed incorrectly (assessed as positive when the patient was actually negative)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

The function of fascia is to transmit force, provide support, and protect tissues. Fascia can effect motion by:
Transmitting force from one or more muscles (example: the thoracolumbar fascia)
Restricting motion in cases of adaptive shortening and/or adhesion to proximal structures (example: iliotibial band in cases of lower-leg dysfunction)
Elastic recoil after stretching can contribute to force production (example: plyometric exercise)

Note: There is evidence that fascia may house more receptors related to human movement than other tissues. In this way fascia may act as a motherboard for the nervous system

The fascial system does not contract or develop trigger points, and its capacity to adapt to stretching and or strengthening exercise is limited, especially when compared to the adaptive capacity of muscle tissue.

Fibromyalgia - A loosely defined diagnosis that is associated with a combination of widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. Consideration may also be given to the presence of psychosocial stressors and inflammatory disease in the patients history. Newer research suggests that fibromyalgia may be at least in part due to central sensitization of myofascial pain, often associated with trigger points (1 - 4).
<ol>
 	<li>Wolfe, F. (2018). Fibromyalgia Syndrome and Fibromyalgia Syndrome Criteria: Problems in Definition and Validity. Fibromyalgia Syndrome and Widespread Pain: From Construction to Relevant Recognition.</li>
 	<li>Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., ... &amp; Fam, A. G. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis &amp; Rheumatism: Official Journal of the American College of Rheumatology, 33(2), 160-172.</li>
 	<li>Alonso-Blanco, C., Fernandez-de-las-Penas, C., Morales-Cabezas, M., Zarco-Moreno, P., Ge, H. Y., &amp; Florez-García, M. (2011). Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. The Clinical journal of pain, 27(5), 405-413.</li>
 	<li>Staud, R., Nagel, S., Robinson, M. E., &amp; Price, D. D. (2009). Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. PAIN®, 145(1-2), 96-104.</li>
</ol>
&nbsp;

Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.
Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.

An increase in joint stability via compressive forces resulting from muscular contraction and increased tension in fascial structures (1,2).
<ul>
 	<li>This term is most often used in reference to core intrinsic stabilizers, the thoracolumbar fascia and the sacroiliac joint; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Form closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

The relative contribution of joint shape and structure to the stability of a joint (1,2).
<ul>
 	<li>This term is most often used in reference to the "rough" articulating surfaces of the sacroiliac joint and the wedge shape of the sacrum; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Force closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

An arthrokinematic motion - linear motion across a joint surface parallel to the plane of the adjacent joint surface, just as your posterior moves relative to a "slide" in a park.

For example, the glide of facet joint in the spine during spinal flexion and extension, or the posterior glide of the humeral head that must accompany anterior roll to maintain congruence with glenoid fossa during shoulder horizontal adduction.

A plane joint (also called an arthrodial joint, gliding joint or plane articulation) is a synovial joint which allows only gliding movement in the plane of the articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement generally limited by tight capsules and ligaments. Plane joints are numerous, are most often small, and allow very little motion.  Examples include the carpal joints of the wrist, the tarsal joints of the ankle, and the facet joints of the spine.

"...refers to the measurement of angles, in particular the measurement of angles created at human joints by the bones of the body (1).

&nbsp;
<ol>
 	<li>Cynthia C. Norkin, D. Joyce White. Measurement of Joint Motion: A Guide to Goniometry 3rd Edition. Copyright (C) 2003 by F.A. Davis Company</li>
</ol>

Ground reaction force (GRF) - The force exerted by the ground on the body in contact with it.

For example, when a runner's foot strikes the ground with a force equal to the mass of the individual times their acceleration due to gravity, momentum and muscular exertion, the ground exerts an equal and opposite force on the runner's foot.
<ul>
 	<li>GRF is often measured in research studies using force plates as a means of quantitatively measuring the force generated by an individual.</li>
</ul>

H-Band - Refers to the central zone of a sarcomere that looks lighter under a microscope.  This area of the sarcomere is a lighter portion of the A-band where there is no overlap between the thinner filaments (actin), and the thicker filaments (myosin).
<ul>
 	<li>Example, when a muscle contracts, actin and myosin cross-bridging occurs in the region of the A-band until the H-band is reached where no overlap occurs.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

A hinge joint (also called a ginglymus) is a synovial joint in which the articular surfaces fit one another in a way that only permits motion in one plane. Examples include the elbow, the knee (unless considered a condyloid joint) and the interphalangeal joints.

Holism (holistic) (biological holism) - (from Greek holos "all, whole, entire") is the idea that systems and their properties should be viewed as wholes, not just as a collection of parts.
<ul>
 	<li>Summarized by Aristotle in his "Metaphysics": "The whole is more than the sum of its parts". However, the term "holism" was introduced into language by the South African statesman Jan Smuts as recently as 1926. (Smuts J. C. 1987 [1926]. Holism and evolution. Cape Town: N &amp; S Press.)</li>
</ul>
Example: The Brookbush Institute promotes a holistic approach to human movement science, in which the muscular, fascial, articular and neural systems are not viewed as separable and all proximal segments are considered.

Hormone: Chemical messengers produced by the endocrine system, transported via tissue fluids such as blood, to stimulate cells to "act."
<ul>
 	<li>Example: Growth hormone is secreted by the pituitary gland in the brain; stimulating growth, cell reproduction and cell regeneration in certain types of cells</li>
</ul>
The English physician E. H. Starling discovered in collaboration with the physiologist W. M. Bayliss secretin, the first hormone, in 1902. (1).
<ol>
 	<li>Henriksen, J. H., &amp; de Muckadell, O. S. (2000). Secretin, its discovery, and the introduction of the hormone concept. Scandinavian journal of clinical and laboratory investigation, 60(6), 463-472.</li>
</ol>

A range of motion achieved by the patient/client that is more than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If an individual can place their forehead on their knees they are likely hypermobile at one, if not several joints

Example 2: 110° of shoulder external rotation would be considered hyper-mobile.

Hyperplasia is an increase in organic tissue size due to an adaptive increase in the number of cells per organ.
<ul>
 	<li>Although muscle hyperplasia has been noted in some animals, human muscle tissue does not seem to have this adaptive ability.</li>
</ul>

A condition of excessive tone of the skeletal muscles; increased resistance of muscle to passive stretching.  May be related to increased neural drive, synergistic dominance, trigger points, reflexive over-activity, and/or muscle length.
Example:  Individuals who exhibit ankle eversion and abduction during an overhead squat assessment likely have hypertonic fibularis (peroneal) muscles.

Muscular hypertrophy is an increase in muscle mass/size due to increase in the volume and cross-sectional area (CSA) of individual muscle cells. The increase in cross-sectional area can be attributed to an an increase in contractile proteins and structural elements (myofibrillar hypertophy), as well as an increase in glycogen storage and elements related to metabolism (sarcoplasmic hypertophy). Hypertrophy is an adaptation of both cardiac and skeletal muscle fibers in response to progressive increases in workload.
<ul>
 	<li>Note: Hypertrophy is not hyperplasia. Hyperplasia is an increase in muscle size due to an adaptive increase in the number of muscle fibers/cells per muscle. This type of adaptation does not occur in human muscle tissue.</li>
</ul>

A range of motion achieved by a patient/client that is less than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If the end range of shoulder external rotation is reached and measured as 75° during goniometric assessment, the client/patient is exhibiting hypomobility of the glenohumeral joint (shoulder).

Hypothesis - a proposed explanation for a phenomenon; "scientific hypotheses" are generally constructed in a way that is testable or falsifiable.
<ul>
 	<li>Example: The hypothesis, "excessive knee valgus may be correlated with future knee pain and injury," has been the subject of several studies published over the last decade.</li>
</ul>

Diminished tone of skeletal muscles; diminished resistance of muscles to passive stretching.   May be related to inhibition, reciprocal inhibition, arthrokinematics inhibition and/or  increased resting length of muscle.
Example:  If your knees cave (hip adduction) during a squat or leg-press it is likely that your gluteus medius is hypotonic.

I-Band - Refers to the part of the muscle cell that looks lighter under a microscope.  This area of the cell is lighter due to parallel arrangement of thinner filaments (actin), and no overlap with the thicker filaments (myosin).
<ul>
 	<li>As a muscle contracts, the I-bands will decrease in width and move closer to one another.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Independent variable - in research, this is the variable or phenomenon being manipulated in the study.
<ul>
 	<li>Example, in the study by Ghanbari et al. (1), the independent variable is "knee joint mobilization", the dependent variable is "quadriceps muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/effect-knee-joint-mobilization-quadriceps-muscle-strength/" target="_blank" rel="noopener noreferrer">Ghanbari A. and Kamalgharibi S. (2013). Effect of knee joint mobilization on quadriceps muscle strength. International Journal of Health and Rehabilitation Sciences. 2(4): 186-191</a></li>
</ol>

An anatomical direction; toward the bottom (below)

Example, the mouth is inferior to the eyes

A reduction in neural drive, muscular activity, and or force output due to altered neuromuscular reflex.  Alterations in neuromuscular reflex may occur due to increases in muscle length (hypothesis: increased excitation threshold), altered reciprocal inhibition in response to increased antagonist tone, and or alterations in joint motion (arthrokinematics inhibition).

Making a whole of parts.

Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.

Intermuscular Coordination - Optimal timing and motor unit recruitment of agonists, antagonists, synergists, neutralizers, stabilizers and fixators.

Example: Role of Muscles during Hip Extension
<ul>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Prime Mover" href="https://brentbrookbush.com/glossary/prime-mover/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Prime Mover&lt;/div&gt;The muscle most responsible for a joint action under load -&lt;br /&gt;&lt;br /&gt;That is, the muscle that can produce the most force for a given joint action. Often this term is used synonymously with the term agonist. The prime mover as defined above, may or may not be the most active muscle for a joint action during activities of daily living.&lt;br /&gt;&lt;br /&gt;Example: the gluteus maximus is the most powerful hip extensor and therefore the prime mover; however, the hamstrings are likely the most active hip extensors during low level activities like walking or standing.">Prime Mover</a>:  <a href="https://player.vimeo.com/external/82855344.hd.mp4?s=54c3e7d98fb9d4e0af8d282c85ba9b3e">Gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Synergists" href="https://brentbrookbush.com/glossary/synergists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Synergists&lt;/div&gt;Muscles that assist the prime mover in performing a joint action.&lt;br /&gt;&lt;br /&gt;That is, all muscles that can perform a joint action that are not the prime mover, are termed synergists.&lt;br /&gt;Example: The rectus abdominis is the prime mover of spinal flexion. All other muscles that can perform spinal flexion are synergists including – external obliques, internal obliques and psoas.">Synergists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/biceps-femoris/">Biceps femoris (long head)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/semitendinosus-and-semimembranosus/">semitendinosus, semimembranosus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">posterior head of adductor magnus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Antagonist" href="https://brentbrookbush.com/glossary/antagonists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Antagonist&lt;/div&gt;Muscles that oppose the prime mover and synergists for a given joint action.&lt;br /&gt;&lt;br /&gt;That is, all the muscles that can perform the opposing joint action.&lt;br /&gt;&lt;br /&gt;Example: The triceps and anconeus are antagonists during elbow flexion.">Antagonists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/psoas/">Psoas</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/iliacus/">iliacus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/tensor-fascia-latae-tfl/">tensor fascia latae</a> (TFL),<a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-femoris/"> rectus femoris</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">anterior adductors (especially pectineus)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/sartorius/">sartorius</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Neutralizer" href="https://brentbrookbush.com/glossary/neutralizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Neutralizer&lt;/div&gt;Muscles that oppose unwanted joint motions created by the prime mover and/or synergists, and/or muscles that prevent unwanted ancillary motion.&lt;br /&gt;Example: The teres minor and infraspinatus neutralize the internal rotation force created by the pectoralis major during horizontal adduction of the shoulder.">Neutralizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-minimus/">Gluteus minimus</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-medius/">anterior fibers of gluteus medius</a> neutralize external rotation force of <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-maximus/">gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Stabilizer" href="https://brentbrookbush.com/glossary/stabilizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Stabilizer&lt;/div&gt;Muscles whose primary role is to improve arthrokinematics by maintaining optimal alignment of joint surfaces.&lt;br /&gt;&lt;br /&gt;Most often these muscles are the most intrinsic muscles of a joint, have a larger percentage of Type I muscle fibers and are rich in proprioceptors.&lt;br /&gt;Example: The muscles of the rotator cuff act as stabilizers for most shoulder motions.">Stabilizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/deep-rotators-of-the-hip/">Deep rotators of hip</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Fixator" href="https://brentbrookbush.com/glossary/fixators/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Fixator&lt;/div&gt;Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.&lt;br /&gt;Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.">Fixators</a>: <a href="https://brentbrookbush.com/articles/core-subsystems/intrinsic-stabilization-subsystem/">Intrinsic stabilization subsystem</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-abdominis/">rectus abdominis</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/internal-obliques/">internal</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/external-obliques/">external obliques</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/quadratus-lumborum/">quadratus lumborum</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/erector-spinae/">erector spinae</a></li>
</ul>
&nbsp;

Example from: <a href="https://brentbrookbush.com/articles/anatomy-articles/introduction-to-functional-anatomy/kinesiology-of-the-hip/" target="_blank" rel="noopener">Introduction to Functional Anatomy: Kinesiology of the Hip</a>

Intramuscular coordination refers to the coordinated recruitment of motor units within a single muscle. This concept is used to explain increases in maximal strength and power; however, the coordinated and sequential recruitment of motor units is also essential to strength endurance and smooth coordinated motion.  Related terminology may include; motor unit recruitment, preferential recruitment, rate coding, sequence, etc..

Example: It is hypothesized that the "shaking" noted during a novice exercisers attempt at an activity like the <a href="https://brentbrookbush.com/vimeo_videos/ball-crunch-and-progressions/" target="_blank">stability ball crunch</a> may be due to relatively poor intramuscular coordination. Rather than smooth, sequential firing of rectus abdominis motor units, groups of motor units turn on and off in an uncoordinated manner.

Pertaining to the same side

Example, the quadratus lumborum performs ipsilateral flexion; lateral flexion toward the same side as the muscle.

An isoform, or variant, is a member of a set of similar proteins, that originate from the same gene, or gene family.
<ul>
 	<li>Example, the variations in myosin heavy chain proteins (MHC I, MHC IIA, MHC IIB/X) that contribute to the characteristic differences between muscle fiber types.</li>
</ul>

“The Prime Assumption”
Everything crossing a joint will influence joint motion during every joint action.

A concept that has expanded over the past several decades to describe the integration of 4 body systems (muscle, joints, fascia and nerves), as well as, the coordinated function of various body segments (e.g. hip, knee and ankle) to produce motion. Kinetic referring to motion, and chain being an analogy for the interdependent link between systems.

Example, the posterior kinetic chain, refers to the integrated function of nerves, muscles, fascia and joints on the posterior side of the body.

The concept of the kinetic chain was originally adapted from the work of a mechanical engineer named Franz Reuleaux (Kinematics of Machinery (1875)) by Dr. Arthur Steindler in 1955 (Steindler A: Kinesiology of the Human Body. Springfield, IL, Charles C. Thomas Co.. 1955).

Latent Trigger Point - A myofascial trigger point that is not painful at rest, only painful when palpated, and may or may not exhibit a characteristic referral pain pattern when palpated.  Latent trigger points do result in an acute point of sensitivity, in a taut band of muscle, and may restrict range of motion (1).

Note: Based on the clinical experience, the Brookbush Institute suggests that latent trigger points (sometimes refereed to as Tender Points) are more common than active trigger points. Further, they are likely addressed more often than trigger points; being the intended target of many soft-tissue mobility techniques.
<ol>
 	<li>David G. Simons, Janet Travell, Lois S. Simons, Travell &amp; Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens</li>
</ol>

An anatomical direction; further from the midline

Example, the anterior deltoid is lateral to the pectoralis major

Length/Tension Relationship - The amount of force generated by a muscle is dependent on sarcomere length.
<ul>
 	<li>The ability of sarcomere to maximally produce force occurs when sarcomere length results in optimal overlap between actin and myosin. Stretching a sarcomere decreases overlap between actin and myosin filaments and reduces force production (1-3). When length is less than optimal, actin from opposite ends overlap and interfere with cross-bridging, and myosin filament are compressed as they contact the the Z-disk also reducing force (4)</li>
</ul>
<ol>
 	<li>Gordon, A. M., Huxley, A. F., &amp; Julian, F. J. (1966). The variation in isometric tension with sarcomere length in vertebrate muscle fibres. The Journal of physiology, 184(1), 170-192.</li>
 	<li>Edman, K. A. P. (1966). The relation between sarcomere length and active tension in isolated semitendinosus fibres of the frog. The Journal of Physiology, 183(2), 407-417.</li>
 	<li>Lieber, R. L., Loren, G. J., &amp; Friden, J. (1994). In vivo measurement of human wrist extensor muscle sarcomere length changes. Journal of neurophysiology, 71(3), 874-881.</li>
 	<li>Lieber, R. L. (2002). Skeletal muscle structure, function, and plasticity. Lippincott Williams &amp; Wilkins.</li>
</ol>
&nbsp;

Levels of Evidence - Relative to evidence-based practice, levels of evidence are an attempt to describe the strength of the results measured in a clinical trial or research study.  Note: levels of evidence do not supersede the critical evaluation of an experienced professional, and should be viewed as guidelines - a meta-analysis may be poorly constructed (Level IA), and a comparative study (Level III) may employ new technologies and a strong methodology.


The Levels of Evidence used by the Brookbush Institute, as described by Shekelle et al.(1):
<ul>
 	<li class="p1">IA - Evidence from meta-analysis of randomized controlled trials</li>
 	<li class="p1">IB - Evidence from at least one randomized controlled trial</li>
 	<li class="p1">IIA - Evidence from at least one controlled study without randomization</li>
 	<li class="p1">IIB - Evidence from at least one other type of quasi-experimental study</li>
 	<li class="p1">III - Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies</li>
 	<li class="p1">IV - Evidence from expert committee reports or opinions or clinical experience of respected authorities, or both</li>
</ul>
<ol>
 	<li>Shekelle, P. G., Woolf, S. H., Eccles, M., &amp; Grimshaw, J. (1999). Developing clinical guidelines. Western Journal of Medicine, 170(6), 348.</li>
</ol>

Likelihood Ratios - Likilihood ratios are used for assessing the value of performing a diagnostic test. They use sensitivity and specificity to determine whether a test result usefully changes the practitioner's chance (probability) of reaching the correct assessment. Calculation of likelihood ratios is based on Baye's theorem.
<ul>
 	<li>Positive Likelihood Ratio (LR+) - The ratio of a positive test result in people with the pathology to a positive test result in people without the pathology.</li>
 	<li>Negative Likelihood Ratio (LR-) - The ratio of a negative test result in people with the pathology to a negative test result in people without the pathology.</li>
</ul>

Longitudinal Study - a research design that involves observing the same variables, several times over a period of time.
<ul>
 	<li>Example, the study by Hewett et al. (1) is a type of longitudinal study called a "cohort study." This study investigated whether excessive knee valgus during landing was a predictor of knee injury risk in adolescent females over the course of a season.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/research-review-increased-valgus-during-landing-predicts-acl-injury-in-adolescent-female-athletes/" target="_blank" rel="noopener noreferrer">Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., &amp; Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501</a></li>
</ol>

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