Welcome to Monday folks and news you can use! Have a patient with weak hip abductors? Here is another great closed chain gluteus medius/ Maximus/minimums exercise we utilize all the time called “"hip helicopters” Try it in yourself, then try it on your patients and clients, then teach others : )

How do your gluteus maximus and gluteus medius exercises stack up?

Looks like side planks (DL=dominant leg) and single leg squats scored big, as did front planks and good old “glute squeezes”

Check out this free full text articlehttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201064/

Yes, we know it was surface emg; yes we know they are not necessarily testing functional movements. The EMG does not lie and offers objective data. Note that the one graph is labelled wrong and is the G max, not medius.

Kristen Boren, DPT,1 Cara Conrey, DPT,1 Jennifer Le Coguic, DPT,1 Lindsey Paprocki, DPT,1 Michael Voight, PT, DHSc, SCS, OCS, ATC, CSCS,1 and T. Kevin Robinson, PT, DSc, OCS1 ELECTROMYOGRAPHIC ANALYSIS OF GLUTEUS MEDIUS AND GLUTEUS MAXIMUS DURING REHABILITATION EXERCISES Int J Sports Phys Ther. 2011 Sep; 6(3): 206–223.

Abs on the UP, Glutes on the DOWN

I had the opportunity to go on my 1st mountain bike ride of the season last Sunday morning. Yes, I am aware it is JUNE, but the snow has finally melted (we had over 7 FEET at arapahoe Basin in May) and you need to understand that I am usually a runner). In the cool morning 44 degree air I was reminded of the importance of my gluteal muscles (rather than just my quads) while climbing a technical hill which was clearly pushing my aerobic capacity. We have the opportunity to perform many bike fits in the office and treat many cycling ailments. We also train and retraing pedal stroke and one of our mantras (in addition to skill, endurance and strength) is “Glutes on the downstroke; Abs on the upstroke”. Meaning use your glutes to extend the hip from 12 to 6 o’clock and use your abs to initiate the upstroke. Quadricep (on the downtstroke) and hamstring dominance (on the upstroke) is something we see often and this mantra often proves useful in the “retraining process”.

I have been a fan of Ed Burkes work (“Serious Cycling” and “Competitive Cycling”) for years and have read (and lectured about) these books many times. In my effort to find a basis in the literature for my mantra, I ran across a paper (1) that seemed to substantiate, at least in part, the mantra. It is a small study looked at elite athletes that explores changes that occur in muscle recruitment as the body fatigues after a sub maximal exercise session.

Their conclusion “The large increases in activity for gluteus maximus and biceps femoris, which are in accordance with the increase in force production during the propulsive phase, could be considered as instinctive coordination strategies that compensate for potential fatigue and loss of force of the knee extensors (i.e., vastus lateralis and vastus medialis) by a higher moment of the hip extensors.”

This makes sense, although may be contradicted by this study (2), which showed LESS gluteal activity at higher mechanical efficiency, with increased tricep surae activity. They conclude “These findings imply that cycling at 55%-60% V˙O(2max) will maximize the rider’s exposure to high efficient muscle coordination and kinematics.”  Although this study looks at mechanical efficiency and the 1st lloks at muscle activity.

Being seated on a bike and having your torso, as well as hips flexed is not the most mechanically efficient posture for driving the glutes, but clinical observation seems to dictate that the less quad and hamstring dominant people are on the down and up stroke respectively, then the more pain free they are. This does not always equte to being the fastest, but it does equate to fewer injuries showing up in the office.

  1. Dorel S1, Drouet JM, Couturier A, Champoux Y, Hug F. Changes of pedaling technique and muscle coordination during an exhaustive exercise. Med Sci Sports Exerc. 2009 Jun;41(6):1277-86. doi: 10.1249/MSS.0b013e31819825f8.
  2. Blake OM1, Champoux Y, Wakeling JM.  Muscle coordination patterns for efficient cycling. Med Sci Sports Exerc. 2012 May;44(5):926-38. doi: 10.1249/MSS.0b013e3182404d4b.

READY

Great Gait: You don’t see this that often

Great gait brought to our attention by one our readers; one his questions was how he had such great “kick back” traveling at the speed he was traveling at. 

 

Here is an efficient gait:  note he mid foot strikes (you may need to watch it a few times to see it) close to under body and does not over stride; he has great hip extension, and a forward lean at the ankles; even arm swing (note elbows do not go forward of and wrists do not go behind body). It all adds up!

So what causes such great hip extension? Largely 2 factors: forward momentum and glute (all 3; max, med and min) activation. From the last post and EMG studies, we know the glute max contracts at initial contact (foot stance) through loading response (beginning of mid support) and then again at toe off to give a last “burst”; the gluteus medius and minimus contract during most of stance phase. initially to initiate internal rotation of the femur (a requisite for hip extension);  the former to keep the pelvis level and assist in extension and external rotation during the last half of stance phase to assist in supination and creating a rigid lever to push off of. This is, of course, assisted by the opposite leg in swing phase.

Forward lean and momentum move the axis of rotation of the hip behind the center of gravity, assisting the glute max to extend and prepare the lower limb for the bust at push off. The stance limb, now in external rotation, makes it easier to access the sacral (especially) and iliac fibers of the glute max and the posterior fibers of the gluteus medius.

What a orchestration of biomechanics resulting here, in a symphony of beautiful movement.

The Gait Guys. Bringing you great gait, when available…..

Not another Cross over runner ! Yup, and some new pearls on the topic.

Watch this video (and we will post her second video shot from the side in a separate blog post) so you can see some of the components we will talk about today.

Quite often in the Cross over gait the runner has great difficulty getting into the glutes (max and medius) effectively.

In this video today from Runblogger, we see yet another runner who is lacking skill and strength in the appropriate muscles and patterns to run efficiently.

  1. In this video it is clear that she has the classic Cross-Over stride flaw. This video is nice because there is a line present to support our cause, the feet at basically falling on a line instead of below the hips. We see the typical far lateral foot strike in this runner that is classic for Crossing over.  This more lateral strike, even though it is a nice midfoot strike (see the side video shot in the other video of her we post), causes pronation to occur quicker and longer than normal and can create an abductory twist when the heel departs from the ground. However, we do not see the abductory twist like we saw in the Lauren Fleshman videos.  Why not ? because this runner has the foot progression angle at zero, perhaps negative 5 degrees (what we are saying is that she is toe’d-in). This is appears to be from her having mild internal tibial torsion. And a negative foot progression angle will help hold the arch through pronation and in this case is protecting from the abductory twist of the foot at heel rise. There is most likely a forefoot varus here as well (note the inversion at strike). Most likely it is functional; she appears to have inadequate motion in the rear and midfoot, so the pronation must occur somewhere and we see it here in the forefoot.

 Pretty cool to see how a subtle change in one’s anatomy can play out differently.  Go back and watch the Fleshman video blog of weeks ago and watch for the abductory twist of the feet.

2. In this runner, what we really wanted to discuss however is the poor motor control of the gluteus medius and maximus (maximus will be in #3). We can clearly see in this video that during all phases of stance, the pelvis is dipping on the contralateral side. This downward drop is creating a greater gluteus medius lever arm and thus greater demand on the gluteus medius, and in this case a failed attempt (if the opposite hip were hiked, the lever arm would be reduced and put lesser demand on the gluteus medius, less fatigue factor). New to this concept ? Click here.Think now about the reciprocal pairing with the adductors and you could understand why her adductors are probably shortened as well; the adductor magnus especially, as it has a secondary motion of external rotation, and it is probably being substituted here to help decelerate the internal spin of the lower extremity

As the longer lever pairs with the body weight factor, there is a vertical descent of the body and this must be made up by eccentric control of the gluteus maximus (the option of optimal choice) or it is dumped into the quadriceps and they are expected to cope with the body mass descent by slowing knee flexion.  She appears to be opting for the later, not a good choice.

3. Now switch over to the frontal plane (side) shot of this runner in the other blog post. Can you clearly see that the quadriceps are being asked to control the decent? Look at the vertical oscillations of her body. Look at the amount of knee flexion occuring at impact.  It is clear that the gluteus maximus is not dampening this drop and this can be seen by the amount of hip flexion noted here. We always think of the glutes as extensors but in gait they are huge dampeners of the rate and degree of hip flexion.

This is very inefficient running.  She could be much more effective and faster if she works on these issues.  If she can just pair improved gluteus medius to control the frontal plane pelvis drop, and improve the maximus to control the sagittal drop there would be more energy to move forward and less wasted into overcoming the ground reaction forces (which she is maximizing) as dictated by Newton’s Laws.

are we the only ones seeing this stuff ?  hopefully you are starting to get real good at this stuff. 

The Gait Guys, saving one runners life (and hips and knees) one day at a time.

Shawn and Ivo