00:00:0500:00:06
This is Brent of the Brookbush Institute,
00:00:0600:00:08
today we're talking about gluteus
00:00:0800:00:10
maximus manual muscle testing for an
00:00:1000:00:12
active population. So we're going to go
00:00:1200:00:14
ahead and set that Kendall scale aside,
00:00:1400:00:16
with the one through five the pluses and
00:00:1600:00:18
minuses, and can the person move against
00:00:1800:00:20
gravity and through a full range of
00:00:2000:00:24
motion and resist manual pressure from
00:00:2400:00:25
the practitioner. We're going to set all
00:00:2500:00:27
of that aside. We're going to replace it
00:00:2700:00:31
with a simpler scale -strong, weak with
00:00:3100:00:36
compensation, or with pain. But we're
00:00:3600:00:38
going to make the test more provocative.
00:00:3800:00:40
I'm going to talk about some stuff today
00:00:4000:00:42
guys about range of motion as well as
00:00:4200:00:44
overactive synergists, and how to inhibit
00:00:4400:00:48
them so that this test becomes much more
00:00:4800:00:50
provocative for those individuals who
00:00:5000:00:52
are leading an active lifestyle. They go
00:00:5200:00:55
to the gym, or they play sports, or maybe
00:00:5500:00:57
even a professional athlete. Alright so
00:00:5700:00:59
I think we need to find a little bit
00:00:5900:01:02
more congruence between what we see in
00:01:0200:01:05
movement assessment, versus what we see
00:01:0500:01:08
in these manual muscle tests; and like I
00:01:0800:01:10
said that probably has to do with how
00:01:1000:01:12
provocative is the manual muscle test
00:01:1200:01:13
itself. I'm going to have my friend
00:01:1300:01:15
Melissa come out, she's going to help me
00:01:1500:01:18
demonstrate. So she's going to lie prone,
00:01:1800:01:21
first thing we need to talk about is
00:01:2100:01:24
what are all of the synergists for an
00:01:2400:01:26
inhibited glute, and what we end up with
00:01:2600:01:30
is this deep longitudinal subsystem
00:01:3000:01:33
dominance. When the glute max becomes
00:01:3300:01:35
inhibited, so she'll start using her
00:01:3500:01:39
erector spinae, her biceps femoris and her
00:01:3900:01:42
adductor Magnus the posterior head, to do
00:01:4200:01:45
an extension type pattern; which
00:01:4500:01:46
unfortunately becomes lumbar extension
00:01:4600:01:50
as well as hip extension, to try to make
00:01:5000:01:52
up for the fact that the glute is not
00:01:5200:01:55
doing what it's supposed to do. What we
00:01:5500:01:57
need to figure out during this test is
00:01:5700:02:00
how to ensure that when I get a strong
00:02:0000:02:04
extension from my patient or client, that
00:02:0400:02:06
it's not this compensation pattern and
00:02:0600:02:11
that it is in fact a strong glute max. So
00:02:1100:02:12
I'm going to use some techniques to
00:02:1200:02:15
reciprocally inhibit those overactive
00:02:1500:02:17
synergists, and make sure that all I
00:02:1700:02:19
leave behind is the glute. So starting
00:02:1900:02:20
with her erector spinae, we're going to
00:02:2000:02:23
draw in and maybe even have her make a
00:02:2300:02:25
six-pack. Let's go ahead and have her
00:02:2500:02:27
contract her rectus abdominis a little bit.
00:02:2700:02:29
So now she can't extend at the spine, I'm
00:02:2900:02:32
left with only hip extension. Her erector
00:02:3200:02:33
spinae are not going to be able to help
00:02:3300:02:36
her out. Now let's take care of the other
00:02:3600:02:38
hip extensors right, so we have adductor
00:02:3800:02:42
Magnus and biceps femoris. Now Kendall has
00:02:4200:02:44
you try to create active insufficiency
00:02:4400:02:46
by shortening this muscle as far as you
00:02:4600:02:48
possibly can. Now I know this is anecdotal
00:02:4800:02:50
but i don't really like this
00:02:5000:02:53
flexed knee thing, you know I think too
00:02:5300:02:54
many times I've heard man I really feel
00:02:5400:02:57
that in my my hamstrings; and if somebody
00:02:5700:03:00
feels it in their hamstrings my guess is
00:03:0000:03:01
is that their hamstrings are working
00:03:0100:03:04
pretty hard, and I want just the glutes.
00:03:0400:03:07
So I'm actually go opposite, i'm going to
00:03:0700:03:09
have Melissa extend her leg, we're even
00:03:0900:03:10
going to have her reinforce a triple
00:03:1000:03:12
extension pattern, so she can point her
00:03:1200:03:14
toe. We're going to make sure she
00:03:1400:03:16
contracts her quad real hard, extends her
00:03:1600:03:18
knee. and I'm hoping that this quad
00:03:1800:03:20
contraction reciprocally inhibits our
00:03:2000:03:23
biceps femoris. Now as far as my adductor
00:03:2300:03:25
Magnus, I'm going to have Melissa move as
00:03:2500:03:27
close to me as she possibly can, all the
00:03:2700:03:29
way to the edge of the table; and I'm
00:03:2900:03:33
going to have her abduct against my thigh here. So
00:03:3300:03:35
now that she's abducted, I know her
00:03:3500:03:38
adductor Magnus has to be shut down. So I
00:03:3800:03:41
got her drawn-in, contracted, making her
00:03:4100:03:44
leg as long as possible, she's pushing
00:03:4400:03:46
against my leg; and now i'm gonna say go
00:03:4600:03:48
ahead and try to squeeze your butt, and
00:03:4800:03:52
run your leg kind of against my thigh
00:03:5200:03:54
here. Now that i got her in extension, you
00:03:5400:03:56
guys need to put quite a bit of force
00:03:5600:03:59
through to the point that you know
00:03:5900:04:01
somebody has a really strong glute. What
00:04:0100:04:04
should probably move, is you should be
00:04:0400:04:05
able to push down on their leg and see
00:04:0500:04:08
their whole whole body move as one
00:04:0800:04:09
segment. Not their whole body move is
00:04:0900:04:11
like a compensation pattern like they're
00:04:1100:04:13
doing something weird, but as you push
00:04:1300:04:15
down here, you can almost feel her want to
00:04:1500:04:18
tip this way. The glutes a big strong
00:04:1800:04:20
muscle, I should be able to push down
00:04:2000:04:25
really really really hard and she should
00:04:2500:04:27
be able to hold it. Now
00:04:2700:04:29
what are the common things you guys are
00:04:2900:04:30
going to see when somebody doesn't have
00:04:3000:04:34
a strong glute max, well you could see
00:04:3400:04:36
weakness. I could set her up into this
00:04:3600:04:38
whole position get her pushed in, and
00:04:3800:04:40
then like just push her back down to the
00:04:4000:04:44
table with almost no no real force
00:04:4400:04:46
applied. Remember this is a bigger muscle
00:04:4600:04:48
guys, unlike your tibialis
00:04:4800:04:51
posterior -posterior tibialis where I had
00:04:5100:04:53
to be careful how much force I applied,
00:04:5300:04:54
because your posterior tib isn't the
00:04:5400:04:56
biggest muscle in the world. Her glute
00:04:5600:04:58
max I should be able to lean, even though
00:04:5800:05:00
I'm a bigger individual than she is, I
00:05:0000:05:01
should have be able to lean and she should be able to
00:05:0100:05:03
hold me up. If I can just kind of lean
00:05:0300:05:07
over without much added force and push
00:05:0700:05:08
her right back down to the table, I'm
00:05:0800:05:12
going to give that a W for weak. Now I don't
00:05:1200:05:14
get too many weak glutes, I do get some, I
00:05:1400:05:16
do get some weak glutes where you take
00:05:1600:05:18
out all of their synergists and and they
00:05:1800:05:19
really don't know how to get this guy
00:05:1900:05:22
firing. What you'll see a lot of is like
00:05:2200:05:24
different compensations starting to
00:05:2400:05:28
happen. Probably the most common one is
00:05:2800:05:30
is you'll go ahead and have them do this
00:05:3000:05:33
and then as soon as you push, they start
00:05:3300:05:36
arching here. Right you'll see them, can
00:05:3600:05:38
you kind of arch for me as I push down,
00:05:3800:05:40
so they go into an anterior pelvic
00:05:4000:05:41
tilt, like they start doing this thing.
00:05:4100:05:43
You might even see some hip flexion on
00:05:4300:05:45
this side as they try to figure out a
00:05:4500:05:47
way to pull up. That's probably the most
00:05:4700:05:49
common, and then of course they' get
00:05:4900:05:52
a C for with compensation. And I'm going to
00:05:5200:05:55
start going to, if I saw too much lumbar
00:05:5500:05:58
extension, one of my lumbar extensors
00:05:5800:06:00
that'd be my erector spinae. My erector
00:06:0000:06:03
spinae are probably overactive, maybe I
00:06:0300:06:04
want to try to get some release and
00:06:0400:06:06
lengthening here, and then start working
00:06:0600:06:10
on that glute maximus activation. Some
00:06:1000:06:12
other signs you might see is not being
00:06:1200:06:13
able to hold the abduction against your
00:06:1300:06:16
thigh, or you might see them actually try
00:06:1600:06:19
to bend their knee and recruit their
00:06:1900:06:22
hamstrings. Now another really
00:06:2200:06:24
interesting test to try somebody who's a
00:06:2400:06:27
little bit more advanced, or maybe you
00:06:2700:06:28
want to do something that's a little bit
00:06:2800:06:30
more sensitive pretest post-test. I
00:06:3000:06:31
learned in these
00:06:3100:06:33
Maitland workshops I have been taking for
00:06:3300:06:36
certified orthopedic manual therapists,
00:06:3600:06:38
this little test that they showed us in
00:06:3800:06:40
one of the workshops works really really
00:06:4000:06:43
well. I think it's a a fascinating thing
00:06:4300:06:45
to do in a lab, get a bunch of your your
00:06:4500:06:48
colleagues together and just try doing
00:06:4800:06:50
what i'm about to show you, glute max
00:06:5000:06:53
activation, and then try it again. And
00:06:5300:06:56
here's how it goes, you guys are going to
00:06:5600:06:59
make your your hands like this right,
00:06:5900:07:02
you're going to go biceps femoris, so
00:07:0200:07:04
lateral hamstring. Your thumbs are going
00:07:0400:07:06
to be over the glute max, and then this
00:07:0600:07:08
other pinky is going to be over their
00:07:0800:07:11
erector spinae. What you're going to do
00:07:1100:07:14
is have them go ahead and extend at
00:07:1400:07:18
their hip, and what you're going to try
00:07:1800:07:20
to figure out is the timing of these
00:07:2000:07:23
three things. So what I felt with Melissa
00:07:2300:07:26
which is not great, is biceps femorisM
00:07:2600:07:28
erector spinae and then glutes came in
00:07:2800:07:32
last. What I would like to feel when I
00:07:3200:07:34
asked her to squeeze her glute and extend
00:07:3400:07:38
her hip is glute first, followed by biceps
00:07:3800:07:41
femoris, and then if she gets in further
00:07:4100:07:43
into extension gets her leg up off the
00:07:4300:07:46
table, then her erector spinae has to
00:07:4600:07:49
fire to stabilize her pelvis. Alright so
00:07:4900:07:50
I would do this again, go ahead and
00:07:5000:07:53
squeeze, that was a little bit better
00:07:5300:07:55
just from her hearing me talk, and having
00:07:5500:07:57
good body control. She went biceps
00:07:5700:07:59
femoris, erector spinae and then glute, but
00:07:5900:08:03
it was a little bit more combined. If we
00:08:0300:08:04
had a little bit more time on this video
00:08:0400:08:06
I would have her do a bunch of glute max
00:08:0600:08:08
activation stuff, maybe some hip flexor,
00:08:0800:08:11
hip flexor release and lengthening stuff,
00:08:1100:08:15
and try it again. So now you guys got two
00:08:1500:08:18
tests here, you guys got the glute max
00:08:1800:08:20
manual muscle test. What you're going to
00:08:2000:08:24
do is activate your core, go ahead and
00:08:2400:08:27
activate your quad, push against your
00:08:2700:08:30
thigh for abduction. Have them go into
00:08:3000:08:31
extension, and really squeeze they're
00:08:3100:08:33
glute. They're going to see if you can
00:08:3300:08:35
push them back down to the table, make
00:08:3500:08:37
sure you're watching for both weakness
00:08:3700:08:40
and compensation.
00:08:4000:08:43
You then have the timing test which
00:08:4300:08:46
should be glute, biceps femoris, erector
00:08:4600:08:49
spinae. Not biceps femoris, erector
00:08:4900:08:51
spinae, glutes which is a very common
00:08:5100:08:54
compensation pattern. One more little
00:08:5400:08:56
geek out molar for you guys, remember
00:08:5600:08:59
that strength is range of motion
00:08:5900:09:04
specific. So Melissa had a lack of hip
00:09:0400:09:08
extension, she had tight hip flexors, is
00:09:0800:09:09
she going to be able to get into
00:09:0900:09:11
extension real well. Is she going to be
00:09:1100:09:12
able to get into extension without
00:09:1200:09:16
compensation, probably not. That's going
00:09:1600:09:18
to have an effect on her test. Realize
00:09:1800:09:20
also that if you lengthen and release
00:09:2000:09:23
her hip flexors, alright she had a tight
00:09:2300:09:25
tfl gluteus minimus I went after that, psoas
00:09:2500:09:27
an iliacus got that out of the way, adductors,
00:09:2700:09:30
anterior adductors got those out
00:09:3000:09:31
of the way; got her all the way back to
00:09:3100:09:33
good hip extension; well she's been
00:09:3300:09:35
missing that ten degrees of hip
00:09:3500:09:36
extension, is she going to be very strong.
00:09:3600:09:38
So another thing you could do with this
00:09:3800:09:42
test is maybe you want to test it see if
00:09:4200:09:44
her glute max is strong, but then go
00:09:4400:09:47
ahead and do her mobility work, test it
00:09:4700:09:49
again. If it was strong before the
00:09:4900:09:52
mobility work but weak after, it might be
00:09:5200:09:54
that she's weak in her new range of
00:09:5400:09:58
motion. Sorry for the last minute and a
00:09:5800:09:59
half of this video guys, i know that's a
00:09:5900:10:00
little bit of an anatomy geek out but
00:10:0000:10:02
i've given you a lot to think about here.
00:10:0200:10:05
We have a manual muscle test with
00:10:0500:10:07
reducing the contribution of overactive
00:10:0700:10:09
synergists. You guys had the sequence tests,
00:10:0900:10:12
hopefully glute max, biceps femoris then
00:10:1200:10:14
erector spinae. And now you have a little
00:10:1400:10:17
range of motion to think about. Make sure
00:10:1700:10:19
that when you're doing this test as they
00:10:1900:10:22
gain range of motion you re-test, so
00:10:2200:10:23
they're not only strong through the
00:10:2300:10:26
range of motion they had, but the new
00:10:2600:10:28
range of motion you're giving them back
00:10:2800:10:30
to get them back to optimal. I hope you
00:10:3000:10:32
guys have enjoyed this video, I look
00:10:3200:10:34
forward to hearing about your results on
00:10:3400:10:37
these tests. Really try to do your pre
00:10:3700:10:39
and post-tests. If you're new to manual
00:10:3900:10:41
muscle testing do the manual muscle test,
00:10:4100:10:43
do some activation techniques, do the
00:10:4300:10:45
manual muscle test again. Start with your
00:10:4500:10:48
colleagues is always a good idea,
00:10:4800:10:49
grab some of your fellow personal
00:10:4900:10:51
trainers, physical therapist, athletic
00:10:5100:10:53
trainers, chiropractors. Get a study group
00:10:5300:10:56
together and practise these, and then by
00:10:5600:10:58
the time you get them to your client and
00:10:5800:11:00
patient, you're already be nice and
00:11:0000:11:01
comfortable. I look forward to hearing
00:11:0100:11:04
from you guys again soon.