Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
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While I treat a vast number of knee ailments in my practice, the focus of my training and rehab is often more proximally directed at the hip. Understanding the role of hip muscles and how the hips and pelvis work together to impact knee alignment and closed chain function is critical in resolving knee pain and dysfunction.
Below is a “go to exercise” exercise I use for gluteus medius activation and core/pelvic stability training. Using a mini-band provides an adduction force cueing the client to abduct and activate their external rotators to maintain proper alignment. Additionally, they need to avoid a drop on one side of the pelvis (look at the ASIS).
Click here to read my entire column dedicated to this exercise in PFP’s online magazine. I hope you find this exercise and information useful for you and/or your clients.
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:
- Standing stool hip rotation
- Supine double leg bridge
- Supine single leg bridge
- Supine hip flexion
- Side-lying hip ABD with external rotation
- Side-lying hip ABD with internal rotation
- Side-lying hip ABD against a wall
- Hip clam exercise with hips in 45 degrees of flexion
- Hip clam exercise with hips in neutral
- Prone heel squeeze
- Prone resisted terminal knee extension
- Prone resisted knee flexion
- 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.
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
Research has shown that strengthening the gluteus medius is clearly an essential way to reduce anterior knee pain and improve pelvic stability and function. The exercise I am sharing today is useful for improving hip strength and pelvic stability in a closed chain fashion.
In the video below, I demonstrate a very effective way to strengthen the gluteus medius and improve hip stability.
For a full description of the exercise, check out my latest column, Functionally Fit, by clicking here.
Through my clinical practice and sports performance training, I continue to focus on eliminating core and hip dysfunction. I think many of the knee problems I see in runners and females are related to weakness in the glutes and small lateral rotators. There has also been quite a buzz about a recent article written in the Strength & Conditioning Journal on crunches and whether spinal flexion may actually be good for you.
This topic alone could take up several posts so, I will not delve into that today. However, as one who has experienced sciatica and disc injury firsthand, I probably tend to fall a little more in the camp of focusing on a neutral spine and resisting external forces as I feel this helps improve performance and reduce injury risk. In that vain, I have been continuing to develop my own core and hip stability progressions with my advanced clients/athletes.
I have been doing a series of posts for BOSU and PFP in my Functionally Fit Column. In my last post, I covered a 3D mountian climber with hip extension. In today’s post, I am covering a great core exercise with the BOSU Ballast Ball focusing on hip extension with the goal of improving shoulder, core and hip stability while promoting hip extension and disassociation.
In the video below you can check out the progressions (incline and decline)
Click here to read the full article on technique and application. The article reviews a regression for those not ready to tackle this quite yet. I think you will find this exercise challenging and rewarding.
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