Brian Schiff’s Blog

Many people struggle to activate their gluteal muscles while running, jumping or performing athletic activities. Turning on these muscles and “priming” the body to utilize the glutes in its normal neuromuscular programming is helpful in improving alignment and reducing injury potential.  The band rotation exercises cue external rotation with the resistance pulling the knees toward one another.

Activating these muscles prior to doing multi-joint lifts, sprinting, plyometrics, etc. is beneficial in promoting optimal activation/stabilization in order to control excessive pronation with deceleration and eccentric training. The rotations can easily be added to the dynamic movement prep or even used as part of the normal training program. I also like to use them prior to incorporating side stepping and forward/backward walks with the bands.

The video below is one I created as part of my Functionally Fit series for PFP Magazine.  It is a staple in our rehab programs and movement prep routines for our athletes at EXOS Athletes’ Performance at Raleigh Orthopaedic as well.

This is the second installment of corrective “go-to” exercises I am highlighting here and in my online column for PFP magazine. Click here to read the post on resisted overhead squats.  The in-line lunge allows for the observer to pick up flaws or asymmetry by placing the body in a narrow stance with a wide stride to assess hip, knee, ankle and foot mobility and stability of the client.  It places the upper and lower extremities in alternate asymmetrical patterns.

Limited mobility or hip disassociation will produce movement dysfunction with the in-line lunge (see picture below for how it is assessed during the FMS).

A common corrective exercise prescribed to improve mobility is the leg lock bridge.

Execution: Begin in supine flexing one leg up to the chest.  Hold the flexed leg against the chest while keeping the extended (down) leg in line with the center of the body and the knee flexed.  A small ball (pictured below), pillow or towel roll may be placed between the thigh and chest for tactile feedback regarding the lock position.

Next, push down through the extended leg on the floor to elevate the hips off the ground into a bridge.  The height of the bridge should be limited to the point where contact can be maintained between the thigh of the flexed hip and the chest keeping the extended hip/thigh in the in-line position.  Perform 2-3 sets of 10-15 repetitions.

Application:  The ability to stride in a lunge position without forward trunk lean during the in-line lunge can be inhibited by tight hip flexors.  Soft tissue work and stretching is certainly helpful, but this active mobility exercise will improve reciprocal movement and facilitate hip disassociation.  It is a great exercise to include as part of your corrective exercise series and/or movement and pillar prep work with your clients.

If clients struggle or experience hamstring cramping, consider adding a small step beneath the foot of the extended leg to increase the hip flexion starting position.  Modifications and adjustments to sets, repetitions and distance between the flexed thigh and chest as well as the extended foot and ground should be considered with exercise prescription.

Weakness in the gluteus maximus and gluteus medius is often cited in contributing to patellofemoral pain, IT band problems, hip pathology and even back pain.  Furthermore, activating the glutes and minimizing tensor fascia lata (TFL) activation is preferential to avoid synergistic dominance with abduction exercises.  This is a common finding on my clinical exams.

Photo from Myers

In the February 2013 issue of the Journal of Orthopaedic and Sports Physical Therapy (JOSPT), Selkowitz et al. examined several exercises to determine which ones had the highest gluteal-to-TFL muscle activation (GTA) index. The clam exercise proved to be the best with an index value of 115.  The second highest exercise was a sidestep with elastic resistance with a value of 64.

The other three exercises to score a GTA index of 50 or higher were: Unilateral bridge (59), quadruped hip extension w/knee extended (50) and quadruped hip extension with knee flexed (50).  Below is the clam executed against a wall as described in the study referenced.

Clam with resistance

Additional research done by Wilcox and Burden (published in the May issue of JOSPT) suggests that a neutral spine alignment and 60 degrees of hip flexion is the best position for gluteal activation during the clam.  This study was done without resistance but offers additional insight to positioning.  I try to mimic this hip flexion angle in the standing single and double leg versions I employ with mini-bands as part of my gluteal activation series in the clinic as well.

Single Leg ER (left)

In the Selkowitz study, participants performing the sidestep were instructed to step to the left replacing 50% of the distance between the feet in the start position and follow with the right leg also stepping at this 50% increment.  This was then repeated to the right to return to the starting position for a total of 3 cycles.

This exercise has one of the lowest TFL activation and reinforces proper frontal plane mechanics and can be used with clients and athletes to reduce anterior knee pain and injury risk.  To increase resistance and/or difficulty, bands can be moved to the ankles or a band can be applied above the knees and at the ankle.  In my practice, I typically have clients sidestep for 10 yards in one direction (using the 50% rule) and then repeat moving back to the other side for 10 yards.

Sidestep

Another option is to perform the sidestep exercise with a staggered stance.  For example, lead with the right leg forward moving to the right and vice versa.  Again, small steps replacing 50% of the original stance is best to ensure quality work.

Staggered sidestep

For additional information on execution and application for these exercises, click on the links below for the online columns I wrote for Personal Fitness Professional Magazine:

Resisted side lying clam

Sidestep with elastic resistance

I thought a fitting way to kick off the new year would be to share the top 10 things I learned or embraced that have most shpaed and impacted my training and rehab this past year.  In no particular order I will rattle these things off.  I hope at least one of these little pearls has a positive impact on your training and/or rehab as well.

1. Often times it appears necessary to perform a biceps tenodesis or tenotomy in active adults undergoing a SLAP repair to ensure more predictable pain relief.  I heard this at a sports medicine conference last May and I can tell you those patients having this done alongside their shoulder surgeries seem to recover quicker with less pain relief.  With that said, keep in mind that SLAP tears are difficult to define and operate on as surgeons still do not have great agreement across the board on defining the extent of injuries and how to deal with them (operative vs. non-operative).
2. Performance on the Functional Movement Screen (FMS) has little to no correlation with athletic performance.  I screened an NBA player and an NFL player this year who both failed the screen.  However, they obviously have mad athleticism and genetic ability.  Keep in mind the FMS is a valuable tool used to assess movement and expose injury risk patterns based on the 7 tests.
3. Soft tissue therapy is undervalued and misunderstood by most lay people.  Assessing tissue restrictions and educating our clients to perform self myofascial release techniques is essential if they want to compete and remain healthy day in and day out.  Specific problem areas I have increased my focus on this year have been the psoas, soleus and posterior rotator cuff/joint capsule.  Click here for my soleus blog post.
4. Core training is probably as much about not moving as it is about generating force with movement.  I read work from Stuart McGill and other smart people in the field, and the concepts of anti-rotation and anti-extension are sound concepts to explore and look more closely at.  Many times, performance in sport and life require us to resist movement and maintain position so strengthening the core to resist potentially harmful and stressful motions is and should be an important part of training and rehab programs.  Understanding how to facilitate and activate core musculature in the training to protect the spine and improve mobility/strength is key.  Click here for more on my core training.
5. Hip dissociation is an important element to train as the lack of it can impact function and performance in a negative way.  We assess it on the active SLR in FMS and I see the lack of it show up on clinical exams all the time.  Whether it is HS tightness, hip flexor weakness or simply poor neuromuscular control, clients who are unable to effectively dissociate the hips are more prone to injury and limited performance.
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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.