Orthopedic & Pelvic Health Physical Therapy and Restorative Exercise Blog

Glute Strengthening

12/9/2016

This October I attended a continuing education course: Functional Biomechanics of the Lower Quarter taught by Christopher Powers, PT, PhD, FACSM, FAPTA.
I walked away from the weekend with much more appreciation for the gluteus maximus. The glute max works in 3 planes at the hip: extension (moving leg back behind the body), abduction (moving the leg away from the body out to the side), and external rotation (rotating the thigh so the knee moves outward).

The glute max is key to controlling the trunk over the pelvis, to the stability of the pelvis and to the lower quarter. When the glutes are weak, you will see increased leaning of the trunk, excessive pelvic drop on non-weightbearing leg, and poor femur control (medial collapse of the knee & internal rotation of the femur). Dr. Powers says, "If something isn't being used, something else is being overused." If you have pain in your back, your hip, your knee, or your foot, stop right now and do this self assessment of your glut max. Video yourself and observe your trunk, your pelvis and your knee as you step down and back up from an 8 inch step.

Step Down Test

My glutes need some work on both sides, but notice that I have less control with my right leg in this test. I have a harder time keeping my trunk upright, my pelvis drops, and my knee collapses in and is wobbly. What I really like about Dr. Powers program is that he provides a systematic 8 level training program for the glut max. You cannot go to the next level until you are able to pass the lowest one with ease and control. I have provided the first level of glute training here. Have fun, and may you be blessed with buns of steel!

Glute Max Activation

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.alignforhealth.com.

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Chair Busting

2/8/2016

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For many of us, our day is spent sitting at work, sitting at school and then we come home, maybe exercise and then sit and watch TV.
How can we minimize the deleterious effects of sitting? Stand more, walk more, and move more throughout the day. In this post I have included 3 chair busting strategies that emphasize strengthening the posterior oblique sling: gluteus maximus, thoracolumbar fascia and the opposite latissimus dorsi. This muscular sling is very important for lumbo-pelvic-hip stability during our gait and rotation patterns.

Get Moving!

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Improving Thoracic Rotation

11/18/2015

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This image demonstrates the opposite rotation of thorax and pelvis during a kick: the pelvis rotates left as the thorax rotates right.

During the gait cycle our spine goes through flexion, extension, side bending and rotation. When we step forward and load onto that leg, the pelvis rotates away from the front leg, the lumbar & thoracic spine extends, rotates and sidebends toward the front leg and the cervical spine flexes, sidebends and rotates away from the front leg. If what you just read is "gobblygook" just look to the picture on the left. This soccer kick is a great demonstration of what the body does during gait: it is like a spiral.
Motion is our friend, and quite often we lose it, especially in the thorax. Look around at people walking, how many people do you see who have an arm swing, much less rotation at their trunk? Not many. Are you one of them?
Test yourself: in sitting rotate your trunk right and left. Ideally you should have moved about 45 degrees. In standing, plant your feet hip width apart and rotate, let your pelvis rotate as well. Ideally you should move the trunk 90 degrees. How did you do? You may notice that you are stiff in both directions, or just on one side. If you are stiff try these exercises below. And then see if you can incorporate arm swing and rotation into gait.

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Get up and down from the floor with ease

10/19/2015

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Can you get up and down from the floor without using something sturdy for support like the coffee table or your knee? A few years back there was a Longevity Test hot in the news that predicted mortality risk. The test participants were told: "Without worrying about the speed of movement, try to sit and then to rise from the floor, using the minimum support that you believe is needed.”
The study found that those who needed to use their hands and their knees to get up and down were almost seven times more likely to die within six years, compared with those who could get up and down without support.
This study tested 2000 subjects ranging from ages 51 to 80. Now I don't know about you, but I know a lot of 20-30 year olds who need to use their hands and knees for assistance!

Lack of joint mobility and decreased strength plague our ability to move well. In order to get up/down from the floor easily we need toe extension, ankle dorsiflexion, knee and hip flexion and leg strength. Below I share with you two movements that are great for your lower extremity mobility and strength.

Split Lunge

Step into a stride position. Allow your back heel to be off of the floor. Make sure your feet face forward (think railroad tracks).

Drop straight down so your front knee bends at a 90 degree, and your back knee is bent at a 90 degrees. Hover just above the ground and then come back up. Repeat 5 times each leg.

Kneeling Toe Extension

Come down into a crouch position with your weight into your foot pads.

Begin to move your knees toward the floor taking your toes into an extension stretch. Moving nice and slow. Shift your weight down and back up 5-10 times. Stand back up and repeat the split lunges. Repeat the sequence at least 3 times.

If it is too intense to come all the way down to the floor you can use a prop to bolster with.

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Freedom From Pelvic Pain

7/6/2015

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Freedom From Pelvic Pain owner, David McCoid and Katy Bowman, creator of Restorative Exercise™

David McCoid, owner of Freedom From Pelvic Pain with Katy Bowman, creator of Restorative Exercise™.

Back in May I travelled to the Netherlands to be a teaching assistant for the Restorative Exercise™ Specialist (RES) Certification Week. I was fortunate to meet so many amazing people from all over the world! One person that made a big impression on me was David McCoid (pictured here on the left). David certified as a RES back in April 2014 and was in the Netherlands for a few days to soak in the learning.
I got to chat with him on our commute one morning and was so blown away by his personal journey out of pelvic pain. As a pelvic health specialist, his experience really lit up for me: David lived with pelvic pain for 14 years, he travelled to see specialists in Italy for prostate injections, and in the US for pelvic PT treatments with renown therapists, and finally had pudendal nerve surgery (3 different times!).
Eventually he found Restorative Exercise™ and he was able to move himself out of pain! I was so inspired by his story that I wanted share his experience. David has asked me to delete his interview because he is not practicing the Katy Bowman method anymore.

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How to release the inner thigh muscles

8/20/2013

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The inner thigh (adductor group) is made up of five muscles:

Pectineus
Adductor brevis
Adductor longus
Adductor magnus
Gracilis

When the foot is not planted on the ground, the adductors will bring the leg toward the midline, and flex the hip when the thigh is in an extended position as in the swing phase of the gait (walking) cycle.
The adductors play a significant role during walking and are active in all phases of the gait cycle. The adductors are a part of two important functional kinetic chains:

Lateral Sling: comprised of the adductors, same side gluteus medius/minimus, opposite side quadratus lumborum. This chain is responsible for frontal plane stabilization of the lumbo/pelvic/hip complex during single leg stance (stance phase of gait), squatting and lunging.
Anterior Oblique Sling: comprised of the adductors, same side internal oblique, opposite side external oblique and hip external rotators. This chain is responsible for transverse plane stabilization during trunk rotation in gait, throwing, swinging, twisting activities.

Dysfunction within the slings can result in overuse of the adductor group leading to over facilitation, increased tension and bound up connective tissue, and potentially pain. Here is a videoblog demonstrating how to release the adductors using a foam roller.

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Pregnancy: How to get your body ready for birth

9/7/2012

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If I said that I was going to run a marathon in 9 months, it is common knowledge that I would need to get ready for it. I would have to set a training schedule to prepare my body for the long distance: 26.2 miles, average completion time 4 hours.

What if I said that I was pregnant, and I was going to give birth in 9 months. Would the expectation be that I would train for this? Probably not. Why is that? For many first time mothers, labor can last for hours, with the average length of active labor being 12 hours give or take. Preparing the body to sustain increasing mass during pregnancy and preparing the hips and the pelvis for vaginal delivery should be part of the “mother to be” training.

In order to have a pain free pregnancy and complication free vaginal delivery here are some requirements:

Strong thigh muscles to support the weight of the torso
Hip mobility
Moveable sacrum
Strong deep abdominal muscles
Pelvic floor muscles that will yield

Your training program should include:

Walking
Walking with a reciprocal arm swing incorporates whole body movement which enhances circulation, strengthens the legs, and frees the pelvis. Work up to walking 5 miles a day (this does not have to be done all at once).

Optimal postural alignment
We tend to carry our pelvis out in front of our ankles.
A forward pelvis affects:

the stability of the pelvic girdle which can create pubic pain or sacroiliac dysfunction

the function of the pelvic floor which can cause the muscles to become shortened and unyielding
the position of the sacrum relative to the pubis which decreases the distance of the pelvic inlet.

Ideally we want to have the skeleton stacked so that we have the line of gravity going through the ear lobe, midpoint of shoulder, hip, knee and ankle.

Footwear choices affect alignment. Any shoe with a heel will angle the body forward. The body compensates for this by tucking the pelvis under, bending the hips and knees. Over time this can shorten the muscles on the back of the leg which can pull the pelvis out of alignment creating back pain and pelvic floor dysfunction. Choose shoes that are flat and allow your toes to wiggle.

Optimal standing alignment

Hip mobility and leg strengthening
Squatting improves the mobility in the hips, strengthens the glutes and legs, promotes a wider pelvic outlet and allows the pelvic muscles to yield.
Exercises to address lateral glute strength will prevent the pregnancy waddle and decrease the instability and excessive motion at the pelvis.

Maintain a vertical shin as you lead with your butt to come down into a squat. This protects the knees and engages the glutes. Go down into a deep squat to improve hip mobility.

Deep abdominal and pelvic floor training
Learn how do activate your deep abdominal muscle transverus abdominus without holding your breath. Learn how to utilize this muscle for the pushing stage of labor. The TRA is best activated during the exhale of the breath cycle: draw your belly button to your spine.

Learn how to let the pelvic floor relax in order to allow the baby to pass through without tearing (yes, this takes practice). The pelvic floor should relax/yield on the inhale of the breath cycle. Imagine the ischial tuberosities (SITS bones) widening as the pelvic floor relaxes.