BRISTOL PHYSIOTHERAPY GLUTEAL AWAKENING REGIME
BRISTOL PHYSIOTHERAPY GLUTEAL AWAKENING REGIME
Gluteal amnesia is a very common presentation at the clinic. Today’s modern life style lends itself to the gluteal complex, the biggest muscle in the body being switched off or inefficient especially after hours of prolonged sitting or driving.
Often individuals who have had a long day then take part in vigorous activity requiring efficient gluteal function and the gluteals are often found wanting which leads to inappropriate loading on other areas. E.g. lumbar spine, hip, knee etc.
Clients also present at the clinic with a collection of exercises ‘pulled off’ the internet and proudly announce that they are addressing their gluteal weaknesses. Invariably the client is performing them wrongly, or they are not appropriate exercises for them or what we often see is that the body ‘cheats’. The client performs the exercise of which the movement is correct but the wrong muscles are engaged to perform the task.
E.g. The Bridge – a true example. A patient under the instruction of a personal trainer performs the Bridge. 3 x 20, very good you may say. I asked the patient where he felt the load and he replied a lot in my lower back and quadriceps. I palpated his gluteals (with permission), no activation at all! Like a jelly, this is a patient seeing us for back pain! His body was performing the task but using the wrong muscle group. The Titleist Performance Institute suggest 70% load in buttocks, 30% in hamstrings for a bridge. We also have patients who cannot activate the gluteals at all, clients who can activate one and not the other and clients who can activate in some positions and not in others.
E.g. a runner who bridges correctly but cannot recruit in function i.e. walking and running.
So, we have put together a tried and tested strategy we have used with our clients to challenge the gluteal complex in a number of positions and varying types of contractions. Don’t forget we are also training the neurology here too. We are reacquainting your brain with your gluts via awareness.
Please have a go at these and we would welcome your feedback.
Good Gluteal Health!
1. Lie flat on your back really lengthen through the spine.
· Contract Gluts hard 6 times. Imagine someone trying to remove a £20 note from between your Gluts
· Feel how the contractions of the Gluts will raise your pelvis from the ground
· How strong is the contraction?
· Palpate the Gluts to see which part of the muscle is contracting and which are not. Any difference?
2. Contract right side and keep left side fully relaxed. The pelvis should roll to the left. Switch right side off.
3. Contract and relax right Glut as quickly as possible so that your pelvis jumps to the right side and then falls.
4. Contract and release the right Glut as SLOWLY as possible so your pelvis rises and falls smoothly on the right side. Ensure smooth elegant movement.
5. Repeat on LEFT side.
· Which side is easier to control?
· Which side has a stronger contraction?
6. Move from side to side, contracting one set of Gluts and then the other, so you roll from side to side.
· Move very slowly and smoothly
· Then, very quickly and lightly
7. Contract both Gluts strongly 6 times, note strength/quality of contraction
· Any differences from the first time?
So far our contractions have been:
· Maximum effort both sides at the same time
· One at a time
· Back and forth
· Contract and relax as quickly as possible
· Try these contractions in different positions
· Each position will involve a different orientation of the hip will bias different fibres of the Gluts, stretch different time around the hip (hip flexors, adductors)
So now try these:
Kneeling: Think about using the Gluts to bring the pubic bone upwards.
· Things to notice – do you feel stretches in the hip flexor? One side tighter than other
Kneeling with knees wide and feet together
· Is the contraction stronger or weaker?
Sitting with sides of feet together
· It is often hard to feel Gluts contracting. Persevere for improvement.
Half kneeling: kneel on one knee with opposite foot in front
· Which Glut is easier to contract?
· In which side do you feel more resistance from hip flexor?
Standing: Stand feet shoulder width apart, turn toes out slightly
· Contract Gluts 6 times so pubic bone moves up
· Note if the contraction affects the position of the knees or the contact of the feet with the floor
Now, make a ‘tripod’ connection to the ground with the ball of the 1st toe, ball of the 5th toe and the heel
· Contract Gluts and see if this causes the knee to turn out and the inside area of the foot to shorten and lift
· Can you feel connection between activity of Gluts and the formation of the arch?
Squat: Squat as far as is comfortable. Make the tripod and create an arch in foot by rotating the knees outward and contracting the Gluts
· Once you feel the contraction, use the Gluts to move to a standing position by pushing the pubic one forward and up
· Finish in standing with a full contraction of Gluts. Repeat 6 times
· Level of tension in back
· Walk around and feel the extension of the hip
· Can you feel the Gluts contracting to push the leg back?
· Can you feel hip flexors release to allow the leg to move back?