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Gluteal progression for back, hip and knee health

3/20/2013

23 Comments

 
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Photo by Gesina Kunkel 
Weak gluteal muscles can be blamed for many low back, hip and knee pain/injuries.  Without the muscular support, the back, hip and knee are subject to increased loads and excessive motion leading to friction and wear and tear. The 3 gluteal muscles: maximus, medius and minimus assist in controlling the trunk and the leg as it is loaded during foot contact to the ground as in walking, running, jumping, going up/down stairs, as well as moving from a sit to a stand or bending. 
When the gluteal muscles are weak, you will notice increased movement of the trunk toward the side of weakness, and the knee will cave in toward the midline.  Are your glutes weak or strong?

Gluteal assessment:  Step down from a stool. 

Start to observe what you do when you go up/down stairs: do you turn your foot out to give yourself more support, does your knee drift to the midline, do you shift your torso over to the planted leg to make it easier to step up? If yes, then your glutes are weak
What happens when you bend down to pick something off of the floor or transition to get in and out of a chair:  do your knees come together?  If yes, then your glutes are weak.  ​​
Gluteal strength assessment: step down from a stool
Stand on a stool. Slowly begin to lower one leg down, tap the floor with your heel and then return back up. Repeat 5 times. Notice if your standing knee collapses toward midline, or if your torso leans to the side. If either or both happens, you need to strengthen your glutes!

Strengthen your glutes: standing progression

Single leg standing balance
1. Start by standing on your left leg. Keep your thighs parallel and bend your other knee so your foot can tap down on the floor like a kick stand if you need it to balance. Check yourself in the mirror. Make sure that your pelvis does not rotate. Keep your ASIS facing forward (that is what I am pointing to). Ideally you want to have your pelvis level. Check your waistband: if the right side is elevated then you are using your back muscles to compensate, if it has dropped, then you are not activating your left glute! Work toward standing for 1 minute. Switch sides.
Single leg balance with vertical leg
From a side view, try to maintain vertical alignment: midpoint of shoulders and hips over ankle bone (I am not quite there, helps if you have a mirror to look into). Keep the standing leg straight, and your quads in front of the thigh relaxed!
Single leg balance with opposite knee flexion
2. Next progression begin to bend your knee as far as you can and then return to start position. Perform 10 reps and then on the last one, keep it bent as you balance for the final minute. Again, make sure that the pelvis doesn't rotate or drop.
Standing hip abduction to strengthen gluteus medius
3. Stand on your left leg. This time your pelvis will elevate because you won't be bending your right knee. Keep your leg straight as you move it out to the side and in. Work toward 1 minute and then switch sides.
Side step with monster band for gluteal strengthening
4. Side step with a light resistance band (if you have had a hip replacement do this without the band). Make sure to keep feet straight ahead and plant your foot with the outside edge straight.
Hip strengthening with resistant band
Make sure not to bend your knees. Most people cheat by bending the knee because the glutes are weak. Don't do it!
Monster walk with band glut med strength
Make sure to land your foot with the outside edge straight, this position engages your glut med and min. Return to normal hip width distance. Make sure to relax your quads between steps!
Standing balance with hip extension
5. Now for the glute max finale! Standing on your left leg, extend your rlght leg behind you. Begin to lower your torso as you hinge at your hips bringing your hips behind your ankle, and then return.
Hip strengthening: standing arabesque
Make sure the movement is coming from your hips, not your spine! Pelvis should stay level. This is challenging, mostly from a balance perspective. If this is hard for you, then get into position and hold.
Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignintegrationandmovement.com.
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Simple Steps to Eliminate SI pain

3/5/2013

16 Comments

 
In healthy movement, the sacrum moves relative to the inominate bones.  When the sacral promontory moves forward into the pelvic bowl, the motion is called nutation; counternutation is the opposite motion.  The optimal position for the sacrum in standing and sitting is slightly nutated between the inominates.  This is the goldilocks position: not too tight and not too loose. 

During sitting and standing, you can diminish stress on the SI joints by maintaining a neutral pelvis.   
In my practice I work with a lot of people who have low back pain, and sacroiliac (SI) pain.  How we stand, how we sit, and how we move in our bodies over time, contributes to our dysfunctions and potential pain syndromes.

Being mindful of HOW we stand and sit are simple steps to begin to unravel the increased loading and compression on the spine and SI joints, as well as the tension and pull on corresponding ligaments and muscles. 

Before going over standing and sitting, let’s look at the anatomy:  The pelvic girdle is comprised of the 2 pelvic (inominate) bones and the sacrum.  The inominate bones join in the front by a thick fibrocartilage disc similar to that of the vertebral discs.  This area is called the pubis or pubic symphysis.  In the back, the inominate bones attach to the sacrum, creating the sacroiliac joints.  

The function of the pelvic girdle is to transfer the loads between the trunk and the lower extremities via the spine and hips (lumbopelvic-hip complex).  There are 35 muscles that attach directly to the pelvic girdle.  Therefore, the mobility and stability of the SI joints depends on the interaction of these muscles, ligaments, fascia and nerves that surround the pelvic girdle.

Learning how to stand

Look around you, most people stand with their pelvis out in front and their shoulder’s and ribcage back (as in the pic below).  
This posture causes the sacrum to fully nutate, meaning that this is the maximally closed position of the SI joints.  This position can create low back and SI joint aching during prolonged standing.
SI compression with poor standing posture
Incorrect Alignment: Anterior Pelvic Sway
Correct your alignment by shifting your hips back, allowing your trunk to move forward so the line of gravity travels through your joints: shoulder, hip, knee and ankle.  Now the pelvis is in neutral: the pubic bone and ASIS line up vertically, and the SI joints are in optimal position.
Improve SI pain by standing better
Joints are in a plumb line.

Learning how to sit

Many people slump their spine and pelvis while sitting watching TV, or sitting slumped at the computer.  In this posture, the weight of the body is positioned behind the SI joints.  This places the SI ligaments under load, the sacrum is tucked (counternutated), and pressure is at the tailbone (coccyx).  
Eliminate SI pain
Photo by Felipe Dias
The stress of this position will stretch the ligaments of the SI joint, and can also create tailbone pain.  Maybe you can relate to having pain while trying to walk after sitting like this for awhile.  The initial steps are excruciating until you are able to walk it out as the ligaments regain their normal position.

Correct your alignment by sitting on your ischial tuberosities (SITS bones).  The pelvis and spine should be in neutral.
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Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignintegrationandmovement.com.
16 Comments

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    Susan McLaughlin,
    Physical Therapist

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Contact:  Susan McLaughlin, PT 801.859.4142
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