Tuesday, August 31, 2010

Getting the Glutes To Function Optimally

Dysfunctional hips are an epidemic in our western society. I see it everyday. Yesterday, was a great example. I was asked by a runner "how do I use my glutes? My physical therapist told me I have weak glutes." Her condition was easy to identify even before testing her glutes. She did not have much gluteal tone, but as a long-time runner I can see she had very well developed hamstrings. Additionally, she has pulled her hamstrings many times in the past with distance running. She was very aware of her problem and asked if she should do more squats and lunges to help her develop her glutes.

She has developed synergistic dominance of the hamstring muscles over the gluteus maximus as a hip extensor. And she does a lot of hip extending with running. Synergistic dominance is when one muscle or group takes over as the dominant muscle at a joint. This leads to inefficient use of the hamstrings, poor hip joint stability, and over-use of the hamstrings (which is probably why she experienced strained hamstrings). With testing, I found almost no contribution of the glutes during her hip extension; the hamstrings were doing all the work. Squats and lunges were not a good idea, at this time. She may be able to do them, but would simply be compensating with other muscles, not really fixing the problem.

So how do we get the glutes working and contributing like they should during squatting, lunging, or running? Learning how to use the glutes is the first step. Then, they can be progressively strengthened. Ultimately, they will be integrated into the running pattern with appropriate, progressive drills. We used the barbell hip bridge on a roller to get the glutes going. Lying face up, with the upper back on the roller allows you to focus on the glutes and get helpful feedback. In the video below, a (different) client performs the barbell hip bridge on a roller. In order to perform the exercise appropriately, you need a good, thick pad for the pelvis, and a hard roller (which allow you to pivot your upper body upon). The hips are extended by focusing on squeezing the glutes. The set is stopped if there is any arching of the lower back (synergistic dominance of the lower back muscles over the glutes), or if the hamstrings feel like they are overworking (such as burning or cramping). Also, the client in instructed to "push through the heels", and "spread the knees" as she extends the hips. At the top range of motion, encourage the client to try to get even higher and "push the hips to the ceiling." The last part of the range of motion is crucial, as this is where the glutes contribute the most. The contribution of the glutes should be tested by having the client feel their glutes with their fingers for a strong contraction. This touching gives them feedback on each repetition. It is common for a client to find it difficult, at first, just to get a full lock-out with body weight only. You are changing motor recruitment patterns after all. Over time, with correct technique, it should be easier and easier for the client to powerfully lock-out the hips. The hips can then be progressively overloaded with barbell weight. Below, a client performs the barbell hip bridges with 75 pounds. Notice the smooth, powerful, full, lock-out at the top of the repetition. Once a client is able to lift an appreciable amount of weight (>50% of body weight) and gets the feel of using their glutes, progression to deadlifts and split squats would be appropriate. Ultimately, I would add skipping and bounding drills to help this runner get more glute contribution during running.

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