00:00:0400:00:06
This is Brent of the Brookbush Institute,
00:00:0600:00:08
today we're talking about gluteus medius
00:00:0800:00:10
manual muscle testing for an active
00:00:1000:00:13
population. So since we're testing for an
00:00:1300:00:14
active population I'm actually going to
00:00:1400:00:16
go ahead and set that Kendall scale
00:00:1600:00:18
aside, that one through five with pluses
00:00:1800:00:20
and minuses, where we test can the person
00:00:2000:00:22
move against gravity through a full
00:00:2200:00:25
range of motion. Can they resist a little
00:00:2500:00:27
bit of external resistance from the
00:00:2700:00:29
manual practitioner. We're going to go
00:00:2900:00:31
ahead and replace that scale with strong,
00:00:3100:00:35
weak with compensation or with pain, and
00:00:3500:00:38
although that sounds simpler we're also
00:00:3800:00:40
going to make the test itself more
00:00:4000:00:43
provocative, so that we can see if it is
00:00:4300:00:47
in fact the gluteus medius that is weak,
00:00:4700:00:50
strong, or whether this particular
00:00:5000:00:54
movement pattern is being overrun by
00:00:5400:00:56
those overactive synergists. I'm going to
00:00:5600:00:57
have my friend Melissa come out, she's
00:00:5700:00:59
going to help me demonstrate.
00:01:0000:01:03
Now first things first we want to set up,
00:01:0300:01:04
actually just like we set up for the
00:01:0400:01:06
Kendall manual muscle testing for
00:01:0600:01:07
gluteus medius. We want to make sure she
00:01:0700:01:11
has a nice neutral spine, the one thing I
00:01:1100:01:13
see on this test a little bit, and even
00:01:1300:01:14
gluteus medius activation which isn't
00:01:1400:01:16
great, is sometimes I see people prop
00:01:1600:01:18
their head up right; as soon as you prop
00:01:1800:01:20
your head up your spine is kind of
00:01:2000:01:22
curved this way, we have a shorter
00:01:2200:01:24
quadratus lumborum on this side, we have
00:01:2400:01:26
shorter erector spinae on the side that
00:01:2600:01:28
we're testing that could lead to
00:01:2800:01:30
compensation and reinforcing patterns I
00:01:3000:01:32
don't really want to reinforce. So let's
00:01:3200:01:35
go ahead and have her lay her head down,
00:01:3500:01:37
make sure she's neutral all the way
00:01:3700:01:39
across. The next thing I'm going to do is
00:01:3900:01:41
I'm going to stabilize her pelvis with
00:01:4100:01:45
my webspace from index finger to thumb,
00:01:4500:01:48
by going just over the top of her iliac
00:01:4800:01:51
crest. So I don't want to try to control
00:01:5100:01:52
her from here, I'm going to try to
00:01:5200:01:54
control her from the top of her iliac
00:01:5400:01:56
crest. I think you get a lot more sensory
00:01:5600:01:59
feedback into your fingers as well, you
00:01:5900:02:00
know as we're watching for anterior pelvic
00:02:0000:02:03
tilt or posterior pelvic tilt, or her
00:02:0300:02:07
like rotation of the pelvis. I'm going to
00:02:0700:02:09
go ahead and have her straighten her leg back.
00:02:0900:02:11
Good, and in the in the traditional
00:02:1100:02:14
manual muscle test you'd have the person
00:02:1400:02:17
abduct and then you push down into
00:02:1700:02:19
adduction right, problem with that is is
00:02:1900:02:21
that doesn't just test our gluteus
00:02:2100:02:23
medius, there's other abductors, if she's
00:02:2300:02:25
up here and I just keep putting her up
00:02:2500:02:27
here to make her very tired, she's also
00:02:2700:02:29
going to start trying to use her TFL and
00:02:2900:02:32
gluteus minimus, but I want to test gluteus
00:02:3200:02:35
medius. I know that's a very important
00:02:3500:02:36
muscle. I know it's a muscle that has a
00:02:3600:02:39
propensity to get under active. I want to
00:02:3900:02:41
make sure that's what I'm testing. So how
00:02:4100:02:44
am I going to do that, I'm going to make sure
00:02:4400:02:47
her pelvis is stacked, that she's not
00:02:4700:02:49
rolling back.
00:02:4900:02:50
I'm going to have her go ahead and
00:02:5000:02:52
abduct, and then she's going to have to
00:02:5200:02:55
extend a little bit for me, and you guys
00:02:5500:02:57
as soon as you try to put somebody in
00:02:5700:02:59
this position, you're going to see your
00:02:5900:03:01
first two most common compensations;
00:03:0100:03:04
either they try to go into an anterior
00:03:0400:03:06
pelvic tilt, alright so their pelvis
00:03:0600:03:10
rotates this way, or as I pull them up
00:03:1000:03:13
and back, rather than coming back into
00:03:1300:03:15
abduction and extension of the femur
00:03:1500:03:18
relative to their pelvis, they're just
00:03:1800:03:19
going to roll their pelvis back, so
00:03:1900:03:21
they're leg went in the same direction but
00:03:2100:03:23
they're actually in abduction and
00:03:2300:03:25
flexion, we don't want that either. Those
00:03:2500:03:28
are both big compensation patterns, and
00:03:2800:03:31
big hints that something's not right
00:03:3100:03:34
with their gluteus medius. Let's try this
00:03:3400:03:36
one more time, I'm going to go ahead and
00:03:3600:03:39
pull her up and back into extension,
00:03:3900:03:41
really stabilize her pelvis so I can get
00:03:4100:03:43
her her leg in the position I'm looking
00:03:4300:03:45
for, and we might just start by having
00:03:4500:03:46
her hold this position without
00:03:4600:03:49
resistance. All right you guys can even
00:03:4900:03:51
slide your thumb down since it's right
00:03:5100:03:53
here and see kind of palpate their
00:03:5300:03:55
gluteus medius, is that gluteus medius
00:03:5500:03:57
firing, can you feel those fibers firm
00:03:5700:04:00
underneath your thumb contracting hard.
00:04:0000:04:05
Good, tough. Okay, a little bit all right.
00:04:0500:04:06
So now we get into adding a little bit
00:04:0600:04:09
of resistance. So we're going to go up
00:04:0900:04:11
and back, and rather than just pushing
00:04:1100:04:14
straight down, all right let's go ahead
00:04:1400:04:17
and resist those posterior fibers
00:04:1700:04:20
through all planes, by using a pincer or
00:04:2000:04:23
lumbrical grip over her calcaneus. Rather
00:04:2300:04:26
than just pushing her straight down, i'm going to
00:04:2600:04:28
get fancy and go ahead and push her
00:04:2800:04:31
into adduction with a little bit of
00:04:3100:04:33
flexion. So now she has to extend
00:04:3300:04:35
into my hand, and I'm also going to try
00:04:3500:04:37
to internally rotate her leg a little
00:04:3700:04:40
bit. So relax for a second for me. I'm
00:04:4000:04:42
going to try to push her kind of this
00:04:4200:04:45
way. Don't go too far into flexion, but
00:04:4500:04:47
just like you're trying to take her toes
00:04:4700:04:50
and rather than put them right on top of
00:04:5000:04:51
her other toes, you're trying to put her
00:04:5100:04:54
toes right in front of other toes. All
00:04:5400:04:56
right so go ahead and hold up here for
00:04:5600:04:59
me, hold hold hold hold hold, ready to
00:05:0100:05:05
Alright Melissa is doing a very good job
00:05:0500:05:07
acting right now. If she was able to
00:05:0700:05:09
resist that much force guys, the test
00:05:0900:05:12
would be strong, that would be awesome. It
00:05:1200:05:13
would be great to see somebody with a
00:05:1300:05:15
strong gluteus medius, unfortunately i
00:05:1500:05:17
don't see that test result very often.
00:05:1700:05:22
What i usually get is somebody who has a
00:05:2200:05:23
hard time even holding this position
00:05:2300:05:26
right, which then would we just put weak,
00:05:2600:05:29
that's that's a weak gluteus medius. Of
00:05:2900:05:30
all I have to do is like put a couple
00:05:3000:05:32
fingers like this and I can push them
00:05:3200:05:34
over, that's a weak gluteus medius. I
00:05:3400:05:36
think the sign you guys are going to get
00:05:3600:05:39
most commonly though is with
00:05:3900:05:42
compensation, and here's the two big
00:05:4200:05:44
compensations you're going to see; either
00:05:4400:05:46
you're going to go to push down just
00:05:4600:05:48
like we were talking about right, so that
00:05:4800:05:50
down, a little bit forward, a little bit
00:05:5000:05:52
of internal rotation, you're going to go to
00:05:5200:05:54
push like that, and their pelvis is going
00:05:5400:05:56
to try to flip back on you. If their
00:05:5600:05:58
pelvis tries to flip back on you, now
00:05:5800:06:00
what they've done is they have
00:06:0000:06:03
relatively put their femur in flexion, so
00:06:0300:06:05
now they're trying to use those
00:06:0500:06:09
abductors that are also flexors, which is
00:06:0900:06:12
her TFL and gluteus minimus, to try to
00:06:1200:06:15
resist you. The other thing you might see
00:06:1500:06:17
is when you go to push down, you can
00:06:1700:06:21
actually feel her leg slide away from
00:06:2100:06:23
you into flexion. Once again trying to
00:06:2300:06:26
bias the test into flexion, trying to
00:06:2600:06:30
use that TFL and gluteus minimus to try
00:06:3000:06:34
to resist you. So you have weak where you
00:06:3400:06:36
just push down, but then we have the most
00:06:3600:06:39
common thing I see which is this with
00:06:3900:06:41
compensation, and I think you guys got
00:06:4100:06:44
the hint there from both of my examples
00:06:4400:06:46
with the pelvis turning forward, the leg
00:06:4600:06:48
sliding forward, that somehow flexion is
00:06:4800:06:51
involved. Well if we kind of go back to
00:06:5100:06:53
our general human movement science, we go
00:06:5300:06:54
back to those predictive models of
00:06:5400:06:56
dysfunction, we kind of know that
00:06:5600:06:57
inhibition of the gluteus medius is
00:06:5700:06:59
going to lead to synergistic dominance
00:06:5900:07:03
by the TFL and gluteus minimus, and this
00:07:0300:07:05
is not a great thing. TFL and the gluteus
00:07:0500:07:07
minimus are also internal rotators, we
00:07:0700:07:10
know internal rotation at the hip is is
00:07:1000:07:12
related to both hip dysfunction as well
00:07:1200:07:13
as knee dysfunction;
00:07:1300:07:16
and so if we get a sign of with
00:07:1600:07:19
compensation on our provocative gluteus
00:07:1900:07:20
medius test here, we know we've got some
00:07:2000:07:22
work to do. We probably need to calm down
00:07:2200:07:25
the TFL and gluteus minimus with things
00:07:2500:07:27
like release of lengthening techniques,
00:07:2700:07:29
and we know we're going to have some
00:07:2900:07:32
work to do on that gluteus medius to get
00:07:3200:07:35
it active, and to get it taking over the
00:07:3500:07:36
role it's supposed to be taking over,
00:07:3600:07:39
which is the prime mover of abduction. I
00:07:3900:07:42
hope you guys can see from doing this
00:07:4200:07:44
test, alright so I'm going to stabilize
00:07:4400:07:47
her pelvis, up you know abduction and
00:07:4700:07:50
extension here, that this definitely
00:07:5000:07:53
biases the test more towards gluteus
00:07:5300:07:55
medius; and instead of just doing that
00:07:5500:07:56
abduction test where people will often
00:07:5600:07:59
trust very strong, because they can use
00:07:5900:08:01
those overactive synergists, we're
00:08:0100:08:04
basically taking those out. And all of a
00:08:0400:08:07
sudden that's where I think everybody
00:08:0700:08:09
will start saying their movement
00:08:0900:08:12
assessments match their manual muscle
00:08:1200:08:14
tests, because all things being equal
00:08:1400:08:18
shouldn't they match up. All right if I
00:08:1800:08:20
see knees bow in, my gluteus medius
00:08:2000:08:22
should probably test weak in most
00:08:2200:08:24
individuals. And I think doing it this
00:08:2400:08:26
way that's what you'll start to find. I
00:08:2600:08:30
hope you guys enjoy testing the gluteus
00:08:3000:08:32
medius, I think you'll find with a lot of
00:08:3200:08:35
individuals they're not as strong as
00:08:3500:08:37
they think they are, and then start doing
00:08:3700:08:39
some of those gluteus medius activation
00:08:3900:08:42
exercises, and see if this test changes.
00:08:4200:08:45
You could start doing an assessment for
00:08:4500:08:47
gluteus medius, do your activation
00:08:4700:08:49
circuit and then immediately reassess,
00:08:4900:08:51
and I think you guys will start to see
00:08:5100:08:54
how this test can change. I think you'll
00:08:5400:08:57
see how gluteus medius activation
00:08:5700:08:59
exercises can really have a big benefit,
00:08:5900:09:01
and I think you'll see a huge
00:09:0100:09:02
improvement in your outcomes. I look
00:09:0200:09:03
forward to talking to you guys again