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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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For the health of your knees: don't lock your knees! Learn how to stand with straight and relaxed knees.

8/7/2012

46 Comments

 
Hiking your shoulders
Collar bone at rest
Have you ever checked into your body to notice how much tension you carry in your muscles?  Constant muscle contraction reduces the amount of blood flow in and out of the area, as well as compresses the joints that the muscles cross.  Compression of the joint causes decreased mobility, friction, misuse of the limb, and potentially arthritis. 

We tend to carry a lot of tension in many of our muscles, but many of us are more aware of our neck and shoulders.  Feel your neck and shoulders now, are they tense? Look in the mirror, and see if your shoulders are elevated. Notice if your collar bones are angled up at a diagnal to your shoulder.  Let your neck and shoulders relax.  Take a breath in, and on your exhale allow the shoulders to relax and come back down.
Now let’s check the tension in your legs.  We should be able to stand without clenching our butt cheeks together, or gripping our quadricep muscles in the front of the thigh.

In order to check the tension in the legs, we need to have a straight leg.    When I teach this in my classes many people get confused because they have been told, “don’t lock your knees!”  The leg isn’t locked if it is straight.  It is “locked” when the quad muscles are contracted.
 help for hyperextended knees
There are people who are able to hyperextend their knees, it looks like this. Photo taken from: wikimedia commons.
standing with knees slightly bent
There are people who stand with constant knee flexion (bent knees). It looks like this.
standing with a straight leg
To assess the tension in the quad, the leg should be straight like this. A straight leg means that the midpoint of the hip, the midpoint of the knee and ankle bone should line up vertically.
If the quads are relaxed, you should be able to contract your quads (notice your knee cap lift up) and return to the relaxed state.  If you can’t tell if your knee caps are lifting, more than likely your quads are already in a contracted state (this means that your patella is compressed against your femur, creating decreased mobility and friction which can lead to arthritis). Check out the videos below:  On the left she is able to lift and lower her knee caps, so her quads are relaxed.  If you weren't able to release your quads, go lean against the wall for support with your feet about 2-3 feet from the wall.  Notice the knee caps in the video on the right.  As you are able to contract and relax the quads, move closer to the wall until you are 3 inches away. If you are still able to relax, then move away from the wall and check again.  This is a big deal!  Chronic contraction decreases blood flow, compresses the joint, decreases mobility, increases friction and can lead to arthritis. Practice this a few times a day until you can stand 100% of the time with your quads relaxed.
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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