0:04 This is Brent of the Brookbush Institute, 0:06 today we're talking about gluteus medius 0:08 manual muscle testing for an active 0:10 population. So since we're testing for an 0:13 active population I'm actually going to 0:14 go ahead and set that Kendall scale 0:16 aside, that one through five with pluses 0:18 and minuses, where we test can the person 0:20 move against gravity through a full 0:22 range of motion. Can they resist a little 0:25 bit of external resistance from the 0:27 manual practitioner. We're going to go 0:29 ahead and replace that scale with strong, 0:31 weak with compensation or with pain, and 0:35 although that sounds simpler we're also 0:38 going to make the test itself more 0:40 provocative, so that we can see if it is 0:43 in fact the gluteus medius that is weak, 0:47 strong, or whether this particular 0:50 movement pattern is being overrun by 0:54 those overactive synergists. I'm going to 0:56 have my friend Melissa come out, she's 0:57 going to help me demonstrate. 1:00 Now first things first we want to set up, 1:03 actually just like we set up for the 1:04 Kendall manual muscle testing for 1:06 gluteus medius. We want to make sure she 1:07 has a nice neutral spine, the one thing I 1:11 see on this test a little bit, and even 1:13 gluteus medius activation which isn't 1:14 great, is sometimes I see people prop 1:16 their head up right; as soon as you prop 1:18 your head up your spine is kind of 1:20 curved this way, we have a shorter 1:22 quadratus lumborum on this side, we have 1:24 shorter erector spinae on the side that 1:26 we're testing that could lead to 1:28 compensation and reinforcing patterns I 1:30 don't really want to reinforce. So let's 1:32 go ahead and have her lay her head down, 1:35 make sure she's neutral all the way 1:37 across. The next thing I'm going to do is 1:39 I'm going to stabilize her pelvis with 1:41 my webspace from index finger to thumb, 1:45 by going just over the top of her iliac 1:48 crest. So I don't want to try to control 1:51 her from here, I'm going to try to 1:52 control her from the top of her iliac 1:54 crest. I think you get a lot more sensory 1:56 feedback into your fingers as well, you 1:59 know as we're watching for anterior pelvic 2:00 tilt or posterior pelvic tilt, or her 2:03 like rotation of the pelvis. I'm going to 2:07 go ahead and have her straighten her leg back. 2:09 Good, and in the in the traditional 2:11 manual muscle test you'd have the person 2:14 abduct and then you push down into 2:17 adduction right, problem with that is is 2:19 that doesn't just test our gluteus 2:21 medius, there's other abductors, if she's 2:23 up here and I just keep putting her up 2:25 here to make her very tired, she's also 2:27 going to start trying to use her TFL and 2:29 gluteus minimus, but I want to test gluteus 2:32 medius. I know that's a very important 2:35 muscle. I know it's a muscle that has a 2:36 propensity to get under active. I want to 2:39 make sure that's what I'm testing. So how 2:41 am I going to do that, I'm going to make sure 2:44 her pelvis is stacked, that she's not 2:47 rolling back. 2:49 I'm going to have her go ahead and 2:50 abduct, and then she's going to have to 2:52 extend a little bit for me, and you guys 2:55 as soon as you try to put somebody in 2:57 this position, you're going to see your 2:59 first two most common compensations; 3:01 either they try to go into an anterior 3:04 pelvic tilt, alright so their pelvis 3:06 rotates this way, or as I pull them up 3:10 and back, rather than coming back into 3:13 abduction and extension of the femur 3:15 relative to their pelvis, they're just 3:18 going to roll their pelvis back, so 3:19 they're leg went in the same direction but 3:21 they're actually in abduction and 3:23 flexion, we don't want that either. Those 3:25 are both big compensation patterns, and 3:28 big hints that something's not right 3:31 with their gluteus medius. Let's try this 3:34 one more time, I'm going to go ahead and 3:36 pull her up and back into extension, 3:39 really stabilize her pelvis so I can get 3:41 her her leg in the position I'm looking 3:43 for, and we might just start by having 3:45 her hold this position without 3:46 resistance. All right you guys can even 3:49 slide your thumb down since it's right 3:51 here and see kind of palpate their 3:53 gluteus medius, is that gluteus medius 3:55 firing, can you feel those fibers firm 3:57 underneath your thumb contracting hard. 4:00 Good, tough. Okay, a little bit all right. 4:05 So now we get into adding a little bit 4:06 of resistance. So we're going to go up 4:09 and back, and rather than just pushing 4:11 straight down, all right let's go ahead 4:14 and resist those posterior fibers 4:17 through all planes, by using a pincer or 4:20 lumbrical grip over her calcaneus. Rather 4:23 than just pushing her straight down, i'm going to 4:26 get fancy and go ahead and push her 4:28 into adduction with a little bit of 4:31 flexion. So now she has to extend 4:33 into my hand, and I'm also going to try 4:35 to internally rotate her leg a little 4:37 bit. So relax for a second for me. I'm 4:40 going to try to push her kind of this 4:42 way. Don't go too far into flexion, but 4:45 just like you're trying to take her toes 4:47 and rather than put them right on top of 4:50 her other toes, you're trying to put her 4:51 toes right in front of other toes. All 4:54 right so go ahead and hold up here for 4:56 me, hold hold hold hold hold, ready to 4:59 resist. 5:01 Alright Melissa is doing a very good job 5:05 acting right now. If she was able to 5:07 resist that much force guys, the test 5:09 would be strong, that would be awesome. It 5:12 would be great to see somebody with a 5:13 strong gluteus medius, unfortunately i 5:15 don't see that test result very often. 5:17 What i usually get is somebody who has a 5:22 hard time even holding this position 5:23 right, which then would we just put weak, 5:26 that's that's a weak gluteus medius. Of 5:29 all I have to do is like put a couple 5:30 fingers like this and I can push them 5:32 over, that's a weak gluteus medius. I 5:34 think the sign you guys are going to get 5:36 most commonly though is with 5:39 compensation, and here's the two big 5:42 compensations you're going to see; either 5:44 you're going to go to push down just 5:46 like we were talking about right, so that 5:48 down, a little bit forward, a little bit 5:50 of internal rotation, you're going to go to 5:52 push like that, and their pelvis is going 5:54 to try to flip back on you. If their 5:56 pelvis tries to flip back on you, now 5:58 what they've done is they have 6:00 relatively put their femur in flexion, so 6:03 now they're trying to use those 6:05 abductors that are also flexors, which is 6:09 her TFL and gluteus minimus, to try to 6:12 resist you. The other thing you might see 6:15 is when you go to push down, you can 6:17 actually feel her leg slide away from 6:21 you into flexion. Once again trying to 6:23 bias the test into flexion, trying to 6:26 use that TFL and gluteus minimus to try 6:30 to resist you. So you have weak where you 6:34 just push down, but then we have the most 6:36 common thing I see which is this with 6:39 compensation, and I think you guys got 6:41 the hint there from both of my examples 6:44 with the pelvis turning forward, the leg 6:46 sliding forward, that somehow flexion is 6:48 involved. Well if we kind of go back to 6:51 our general human movement science, we go 6:53 back to those predictive models of 6:54 dysfunction, we kind of know that 6:56 inhibition of the gluteus medius is 6:57 going to lead to synergistic dominance 6:59 by the TFL and gluteus minimus, and this 7:03 is not a great thing. TFL and the gluteus 7:05 minimus are also internal rotators, we 7:07 know internal rotation at the hip is is 7:10 related to both hip dysfunction as well 7:12 as knee dysfunction; 7:13 and so if we get a sign of with 7:16 compensation on our provocative gluteus 7:19 medius test here, we know we've got some 7:20 work to do. We probably need to calm down 7:22 the TFL and gluteus minimus with things 7:25 like release of lengthening techniques, 7:27 and we know we're going to have some 7:29 work to do on that gluteus medius to get 7:32 it active, and to get it taking over the 7:35 role it's supposed to be taking over, 7:36 which is the prime mover of abduction. I 7:39 hope you guys can see from doing this 7:42 test, alright so I'm going to stabilize 7:44 her pelvis, up you know abduction and 7:47 extension here, that this definitely 7:50 biases the test more towards gluteus 7:53 medius; and instead of just doing that 7:55 abduction test where people will often 7:56 trust very strong, because they can use 7:59 those overactive synergists, we're 8:01 basically taking those out. And all of a 8:04 sudden that's where I think everybody 8:07 will start saying their movement 8:09 assessments match their manual muscle 8:12 tests, because all things being equal 8:14 shouldn't they match up. All right if I 8:18 see knees bow in, my gluteus medius 8:20 should probably test weak in most 8:22 individuals. And I think doing it this 8:24 way that's what you'll start to find. I 8:26 hope you guys enjoy testing the gluteus 8:30 medius, I think you'll find with a lot of 8:32 individuals they're not as strong as 8:35 they think they are, and then start doing 8:37 some of those gluteus medius activation 8:39 exercises, and see if this test changes. 8:42 You could start doing an assessment for 8:45 gluteus medius, do your activation 8:47 circuit and then immediately reassess, 8:49 and I think you guys will start to see 8:51 how this test can change. I think you'll 8:54 see how gluteus medius activation 8:57 exercises can really have a big benefit, 8:59 and I think you'll see a huge 9:01 improvement in your outcomes. I look 9:02 forward to talking to you guys again 9:03 soon.
