0:05 This is Brent of the Brookbush Institute, 0:06 today we're talking about gluteus 0:08 maximus manual muscle testing for an 0:10 active population. So we're going to go 0:12 ahead and set that Kendall scale aside, 0:14 with the one through five the pluses and 0:16 minuses, and can the person move against 0:18 gravity and through a full range of 0:20 motion and resist manual pressure from 0:24 the practitioner. We're going to set all 0:25 of that aside. We're going to replace it 0:27 with a simpler scale -strong, weak with 0:31 compensation, or with pain. But we're 0:36 going to make the test more provocative. 0:38 I'm going to talk about some stuff today 0:40 guys about range of motion as well as 0:42 overactive synergists, and how to inhibit 0:44 them so that this test becomes much more 0:48 provocative for those individuals who 0:50 are leading an active lifestyle. They go 0:52 to the gym, or they play sports, or maybe 0:55 even a professional athlete. Alright so 0:57 I think we need to find a little bit 0:59 more congruence between what we see in 1:02 movement assessment, versus what we see 1:05 in these manual muscle tests; and like I 1:08 said that probably has to do with how 1:10 provocative is the manual muscle test 1:12 itself. I'm going to have my friend 1:13 Melissa come out, she's going to help me 1:15 demonstrate. So she's going to lie prone, 1:18 first thing we need to talk about is 1:21 what are all of the synergists for an 1:24 inhibited glute, and what we end up with 1:26 is this deep longitudinal subsystem 1:30 dominance. When the glute max becomes 1:33 inhibited, so she'll start using her 1:35 erector spinae, her biceps femoris and her 1:39 adductor Magnus the posterior head, to do 1:42 an extension type pattern; which 1:45 unfortunately becomes lumbar extension 1:46 as well as hip extension, to try to make 1:50 up for the fact that the glute is not 1:52 doing what it's supposed to do. What we 1:55 need to figure out during this test is 1:57 how to ensure that when I get a strong 2:00 extension from my patient or client, that 2:04 it's not this compensation pattern and 2:06 that it is in fact a strong glute max. So 2:11 I'm going to use some techniques to 2:12 reciprocally inhibit those overactive 2:15 synergists, and make sure that all I 2:17 leave behind is the glute. So starting 2:19 with her erector spinae, we're going to 2:20 draw in and maybe even have her make a 2:23 six-pack. Let's go ahead and have her 2:25 contract her rectus abdominis a little bit. 2:27 So now she can't extend at the spine, I'm 2:29 left with only hip extension. Her erector 2:32 spinae are not going to be able to help 2:33 her out. Now let's take care of the other 2:36 hip extensors right, so we have adductor 2:38 Magnus and biceps femoris. Now Kendall has 2:42 you try to create active insufficiency 2:44 by shortening this muscle as far as you 2:46 possibly can. Now I know this is anecdotal 2:48 but i don't really like this 2:50 flexed knee thing, you know I think too 2:53 many times I've heard man I really feel 2:54 that in my my hamstrings; and if somebody 2:57 feels it in their hamstrings my guess is 3:00 is that their hamstrings are working 3:01 pretty hard, and I want just the glutes. 3:04 So I'm actually go opposite, i'm going to 3:07 have Melissa extend her leg, we're even 3:09 going to have her reinforce a triple 3:10 extension pattern, so she can point her 3:12 toe. We're going to make sure she 3:14 contracts her quad real hard, extends her 3:16 knee. and I'm hoping that this quad 3:18 contraction reciprocally inhibits our 3:20 biceps femoris. Now as far as my adductor 3:23 Magnus, I'm going to have Melissa move as 3:25 close to me as she possibly can, all the 3:27 way to the edge of the table; and I'm 3:29 going to have her abduct against my thigh here. So 3:33 now that she's abducted, I know her 3:35 adductor Magnus has to be shut down. So I 3:38 got her drawn-in, contracted, making her 3:41 leg as long as possible, she's pushing 3:44 against my leg; and now i'm gonna say go 3:46 ahead and try to squeeze your butt, and 3:48 run your leg kind of against my thigh 3:52 here. Now that i got her in extension, you 3:54 guys need to put quite a bit of force 3:56 through to the point that you know 3:59 somebody has a really strong glute. What 4:01 should probably move, is you should be 4:04 able to push down on their leg and see 4:05 their whole whole body move as one 4:08 segment. Not their whole body move is 4:09 like a compensation pattern like they're 4:11 doing something weird, but as you push 4:13 down here, you can almost feel her want to 4:15 tip this way. The glutes a big strong 4:18 muscle, I should be able to push down 4:20 really really really hard and she should 4:25 be able to hold it. Now 4:27 what are the common things you guys are 4:29 going to see when somebody doesn't have 4:30 a strong glute max, well you could see 4:34 weakness. I could set her up into this 4:36 whole position get her pushed in, and 4:38 then like just push her back down to the 4:40 table with almost no no real force 4:44 applied. Remember this is a bigger muscle 4:46 guys, unlike your tibialis 4:48 posterior -posterior tibialis where I had 4:51 to be careful how much force I applied, 4:53 because your posterior tib isn't the 4:54 biggest muscle in the world. Her glute 4:56 max I should be able to lean, even though 4:58 I'm a bigger individual than she is, I 5:00 should have be able to lean and she should be able to 5:01 hold me up. If I can just kind of lean 5:03 over without much added force and push 5:07 her right back down to the table, I'm 5:08 going to give that a W for weak. Now I don't 5:12 get too many weak glutes, I do get some, I 5:14 do get some weak glutes where you take 5:16 out all of their synergists and and they 5:18 really don't know how to get this guy 5:19 firing. What you'll see a lot of is like 5:22 different compensations starting to 5:24 happen. Probably the most common one is 5:28 is you'll go ahead and have them do this 5:30 and then as soon as you push, they start 5:33 arching here. Right you'll see them, can 5:36 you kind of arch for me as I push down, 5:38 so they go into an anterior pelvic 5:40 tilt, like they start doing this thing. 5:41 You might even see some hip flexion on 5:43 this side as they try to figure out a 5:45 way to pull up. That's probably the most 5:47 common, and then of course they' get 5:49 a C for with compensation. And I'm going to 5:52 start going to, if I saw too much lumbar 5:55 extension, one of my lumbar extensors 5:58 that'd be my erector spinae. My erector 6:00 spinae are probably overactive, maybe I 6:03 want to try to get some release and 6:04 lengthening here, and then start working 6:06 on that glute maximus activation. Some 6:10 other signs you might see is not being 6:12 able to hold the abduction against your 6:13 thigh, or you might see them actually try 6:16 to bend their knee and recruit their 6:19 hamstrings. Now another really 6:22 interesting test to try somebody who's a 6:24 little bit more advanced, or maybe you 6:27 want to do something that's a little bit 6:28 more sensitive pretest post-test. I 6:30 learned in these 6:31 Maitland workshops I have been taking for 6:33 certified orthopedic manual therapists, 6:36 this little test that they showed us in 6:38 one of the workshops works really really 6:40 well. I think it's a a fascinating thing 6:43 to do in a lab, get a bunch of your your 6:45 colleagues together and just try doing 6:48 what i'm about to show you, glute max 6:50 activation, and then try it again. And 6:53 here's how it goes, you guys are going to 6:56 make your your hands like this right, 6:59 you're going to go biceps femoris, so 7:02 lateral hamstring. Your thumbs are going 7:04 to be over the glute max, and then this 7:06 other pinky is going to be over their 7:08 erector spinae. What you're going to do 7:11 is have them go ahead and extend at 7:14 their hip, and what you're going to try 7:18 to figure out is the timing of these 7:20 three things. So what I felt with Melissa 7:23 which is not great, is biceps femorisM 7:26 erector spinae and then glutes came in 7:28 last. What I would like to feel when I 7:32 asked her to squeeze her glute and extend 7:34 her hip is glute first, followed by biceps 7:38 femoris, and then if she gets in further 7:41 into extension gets her leg up off the 7:43 table, then her erector spinae has to 7:46 fire to stabilize her pelvis. Alright so 7:49 I would do this again, go ahead and 7:50 squeeze, that was a little bit better 7:53 just from her hearing me talk, and having 7:55 good body control. She went biceps 7:57 femoris, erector spinae and then glute, but 7:59 it was a little bit more combined. If we 8:03 had a little bit more time on this video 8:04 I would have her do a bunch of glute max 8:06 activation stuff, maybe some hip flexor, 8:08 hip flexor release and lengthening stuff, 8:11 and try it again. So now you guys got two 8:15 tests here, you guys got the glute max 8:18 manual muscle test. What you're going to 8:20 do is activate your core, go ahead and 8:24 activate your quad, push against your 8:27 thigh for abduction. Have them go into 8:30 extension, and really squeeze they're 8:31 glute. They're going to see if you can 8:33 push them back down to the table, make 8:35 sure you're watching for both weakness 8:37 and compensation. 8:40 You then have the timing test which 8:43 should be glute, biceps femoris, erector 8:46 spinae. Not biceps femoris, erector 8:49 spinae, glutes which is a very common 8:51 compensation pattern. One more little 8:54 geek out molar for you guys, remember 8:56 that strength is range of motion 8:59 specific. So Melissa had a lack of hip 9:04 extension, she had tight hip flexors, is 9:08 she going to be able to get into 9:09 extension real well. Is she going to be 9:11 able to get into extension without 9:12 compensation, probably not. That's going 9:16 to have an effect on her test. Realize 9:18 also that if you lengthen and release 9:20 her hip flexors, alright she had a tight 9:23 tfl gluteus minimus I went after that, psoas 9:25 an iliacus got that out of the way, adductors, 9:27 anterior adductors got those out 9:30 of the way; got her all the way back to 9:31 good hip extension; well she's been 9:33 missing that ten degrees of hip 9:35 extension, is she going to be very strong. 9:36 So another thing you could do with this 9:38 test is maybe you want to test it see if 9:42 her glute max is strong, but then go 9:44 ahead and do her mobility work, test it 9:47 again. If it was strong before the 9:49 mobility work but weak after, it might be 9:52 that she's weak in her new range of 9:54 motion. Sorry for the last minute and a 9:58 half of this video guys, i know that's a 9:59 little bit of an anatomy geek out but 10:00 i've given you a lot to think about here. 10:02 We have a manual muscle test with 10:05 reducing the contribution of overactive 10:07 synergists. You guys had the sequence tests, 10:09 hopefully glute max, biceps femoris then 10:12 erector spinae. And now you have a little 10:14 range of motion to think about. Make sure 10:17 that when you're doing this test as they 10:19 gain range of motion you re-test, so 10:22 they're not only strong through the 10:23 range of motion they had, but the new 10:26 range of motion you're giving them back 10:28 to get them back to optimal. I hope you 10:30 guys have enjoyed this video, I look 10:32 forward to hearing about your results on 10:34 these tests. Really try to do your pre 10:37 and post-tests. If you're new to manual 10:39 muscle testing do the manual muscle test, 10:41 do some activation techniques, do the 10:43 manual muscle test again. Start with your 10:45 colleagues is always a good idea, 10:48 grab some of your fellow personal 10:49 trainers, physical therapist, athletic 10:51 trainers, chiropractors. Get a study group 10:53 together and practise these, and then by 10:56 the time you get them to your client and 10:58 patient, you're already be nice and 11:00 comfortable. I look forward to hearing 11:01 from you guys again soon. 11:10
