Brian Schiff’s Blog

I utilize bridging as an assessment and exercise tool in my training and rehab programs.  Posterior chain/hip stability is poor in many clients.  The ability to maintain a neutral spine, engage the glutes and fight rotation is NOT an easy task by any means. So, coaching and cueing proper bridging is a great way to enhance pillar strength and reduce injury risk, while facilitating better movement patterns in sport.

I wrote a recent column for PFP magazine entitled iso bridge with alternate knee extension.  Click here to read the column and the application, regression and progression of the exercise.  In addition, I have included a short video below showing double leg and single leg bridge exercises that can be used to work on the hips and core.  The second exercise is the dynamic version of the iso alternate knee extension bridge I write about. I show you some of the single leg progressions that come after mastering the iso bridge as well.

I hope this video and article is useful to you.  I also want to take this opportunity to thank you for reading my blog and wish you a very Happy New Year!

I have been a bit behind on blogging as of late.  I try to aim for one per week, but I also strive to deliver sound and relevant content.  Additionally, I do not seek outside contributors so finding time to write can be tricky with work and family life too.  So, forgive me for any apparent inconsistency in posting.  Just know that I will always try to provide valuable content.  Today’s post centers around an article in the July 2012 edition of AJSM.

My work at the Athletic Performance Center has provided me an increased opportunity to work with FAI and athletic hip injuries.  This is an area of evolution and growth in our field, so I find it particularly interesting to see rationale and thought processes centering around the timing, contribution and selection of hip exercises for active patients/athletes.

This article comes from the Steadman Philippon Research Institute in Vail, CO.  The purpose of the study was to measure the highest activation of the piriformis and pectineus muscle during various exercises.  The hypothesis was that highest pectineus activation would occur with hip flexion and moderate activity with internal rotation, whereas the highest activation with the piriformis would be with external rotation and/or abduction.

Methods: 10 healthy volunteers completed the following 13 exercises:

1. Standing stool hip rotation
2. Supine double leg bridge
3. Supine single leg bridge
4. Supine hip flexion
5. Side-lying hip ABD with external rotation
6. Side-lying hip ABD with internal rotation
7. Side-lying hip ABD against a wall
8. Hip clam exercise with hips in 45 degrees of flexion
9. Hip clam exercise with hips in neutral
10. Prone heel squeeze
11. Prone resisted terminal knee extension
12. Prone resisted knee flexion
13. Prone resisted hip extension

All of these exercises have been reported to be used in hip rehab following arthroscopy or recovery from injury.  The exercises were executed slowly and methodically with a metronome to reduce EMG amplitude variations.

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There seems to be consistent questions, debate and studies done with respect to stretching.  As the thought of more closely analyzing the quality of movement (FMS, Y-Balance testing, SFMA for example) moves to the forefront in the PT and fitness world, many search for the right mix of exercise to maximize mobility.

I count myself as a supporter and follower of the work of Gray Cook and Stuart McGill.  While I may not agree 100% with all of their ideas, I generally consider them to be brilliant minds and ahead of the curve.  I have been using the FMS in my practice for some time now and have also begun to incorporate Y-Balance testing as well (see pic below courtesy of the IJSPT)

The Y-Balance test may not have significant relevance to hip mobility as much as it does limb symmetry, but I included it here to illustrate my point in observing kinetic chain movement to help determine where the weak link or faulty movement pattern may be.  It gives us valuable information with respect to strength, balance and mobility.

With the revelation that FAI is more prevalent than we knew (click here for my post on FAI), I am always interested in hip mobility and how to increase movement in the hip joint.  Limitations in hip mobility can spell serious trouble for the lumbosacral region as well as the knee.

I currently use foam rolling, manual techniques, dynamic warm-up maneuvers, bodyweight single leg and hip/core disassociation exercises and static stretching to increase hip mobility.  However, I am often faced with the question of what works best?  Is less more?  How can I make the greatest change without adding extra work and unnecessary steps?

Well, Stuart McGill and Janice Moreside just published a study in the May 2012 Journal of Strength & Conditioning Research that sought to examine three different interventions and how they improve hip joint range of motion.  Previous work has been focused on the hip joint alone, and they wanted to see how other interventions impacted the mobility of the hip.  Click here for the abstract

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So, conventional wisdom and research continues to point to the need for promoting increased gluteus medius and maximus strengthening to promote better knee stability and ward off many other kinetic chain breakdowns.  While there are many examples of how to train these muscles, the question is what are the best exercises to promote hypertrophy of these groups.

Whether training or administering rehab, it is important to understand how best to activate these muscles as time may be limited.  I think it bears mentioning that core function is closely tied to pelvic posture/alignment so it will be no surprise as you see the best exercises in this post according to recent research released in the International Journal of Sports Physical Therapy.  To promote muscle strength, higher MVIC correlates to better strength gains.  So, looking at the %MVIC of exercises clinicians and fitness pros alike can better rank the order and appropriateness of certain exercises to maximize health and performance of their clients.

According to a the study at Belmont University, the authors looked at 18 different exercises using surface EMG to study activation of the gluteus maximus and medius.  Below is a summary of the top 5 exercises stimulating greater than 70% MVIC for each muscle group:

Gluteus Medius

1. Side plank abduction with dominant leg on bottom (103% MVIC)
2. Side plank abduction with dominant leg on top (89% MVIC)
3. Single leg squat (83% MVIC)
4. Clamshell 4 (hip clam - 77% MVIC)
5. Front plank with hip extension (75% MVIC)

Gluteus Maximus

1. Front plank with hip extension (106% MVIC)
2. Gluteal squeeze (81%)
3. Side plank abduction with dominant leg on top (73% MVIC)
4. Side plank abduction with dominant leg on bottom (71% MVIC)
5. Single leg squat (71% MVIC)

Click here to read the abstract of the study.  I think it is fairly obvious based on the data presented in the article that core stability and training should be integrated with hip strengthening.  I presented a column in Functionally Fit last year on plank with hip extension and abduction using a BOSU.  This is more advanced concept than just the traditional plank, but a very good exercise.  See the picture below:

Click here to read the entire column on the BOSU plank with hip extension/abduction.  This particular exercise requires hip disassociation and core stability.  I just finished a new column for PFP Magazine on BOSU clamshells so stay tuned for that one as it reveals a side lying progression to optimize hip strength as well.