It’s Not All About Glute Strength: New Moves for Knee and Hip Problems


I have had some questions from my last Facebook post post regarding gluteal timing vs gluteal strengthening and this relationship to knee pain. See here for the link:

https://www.ncbi.nlm.nih.gov/pubmed/22945929?dopt=Abstract

From David Garcia of Kinesio Edu in Argentina comes this question: “considering the big issue appears to be “timing” should we focus here on selective activation rather than strength? And if so, what are your preferred exercises to do so?”

Thank you David for your question.

Every week I encounter a patient who has been given gluteal strengthening to do by every rehab or training professional that they have sough help from. Considering that they have been seeking help sometimes for years, it is unlikely that gluteal strength is the primary problem.

Gluteal activation is another story however.

For the gluteals to activate, first the person must be able to stand with their femoral head centred. Very few can manage this first step, and even fewer these days, as so many people are taught to squeeze their glutes and push their hips forward. When you ask these people to move forward onto one leg, they often move into strong hip extension, with the pelvic slightly posteriorly tilted, the knee slightly flexed, and the glutes, quads and hamstrings co-contracting like crazy. This is antimovement – a non dynamic, inefficient strategy. The glutes are working but it is going nowhere.

Here’s the thing. Moving forward onto one leg should put you into hip neutral. This means that the hip’s axis of rotation is centred, and the loading stress is shared over the surface of the femoral head. If you can’t put your hip into neutral and stand on it, then your gluteals won’t work as hip extensors when they should. They aren’t going to work as extensors because the hip is already in extension.

The craziness continues then, because they are given even more glute strengthening to do in order to improve. It isn’t going to work, because it is not a strength problem.

Occasionally you see someone who fixes into hip flexion instead when challenged to move onto single leg stance. With the body stabilising itself with the hip flexors, the extensors are inhibited. Even if you strengthen the extensors, as far as the brain is concerned, it already has a solution for securing the pelvis on the leg, so why make the change?

The person gets stronger, but the function doesn’t improve.

So where do we start?

First, let go of the old myths and cheap solutions that have no basis in normal human function. “Tighten the core and squeeze the glutes “ is a biomechanical disaster for the hips – you feel strong standing still but there is little that is natural about it, either for quiet stance or for dynamic movement. Just remember that effective posture is that which uses least muscular activity. Also remember that the hips are a major absorber of breathing induced motion. This means that the person needs to understand how to carry their body in balance and without excessive tension, such that all this pushing and shoving is unnecessary if they are to breathe and move well.

Simply, the person need to be able to put their body on their leg.

It isn’t a sexy start, is it? It is however, the foundation upon which you will build. No foundation, no progress.

My absolute best solution is Heaven and Earth, whereby using myofascial connections, reflex activity and basic mechanics the person learns how to place themselves.

Extend both wrists, press the fingers out straight, and press one hand upwards and the other down to the floor. Then lift one knee (it doesn’’t matter which, because we are doing each side for different reasons). Press out through the stance leg strongly, as you continue to press out with the hands. You will find yourself seeking a better position for your pelvis over your leg, and your ribs over your pelvis. Return the lifted leg, and switch sides, lifting the other knee. Keep pressing out with the hands. Return to the start position and switch arms.

OK, so you can stand on one leg. That’s more clever than you give yourself credit for!

Now you need to be able to move onto that leg, which requires the hip moving up and onto the foot. This is what triggers the activation.

We will use Lunge Drive. You start in an upright posture, partial split squat position, opposite arm forward to the front leg. Let your head float upwards, creating some space at the back of your neck. Scrunching the back of your neck will switch off the postural reflexes that you need for this.

 

You will move up and onto your front leg, switching arms as you go. You will finish with your body aligned upright, rib cage level over pelvis, and relaxed on your stance leg, just as you were in Heaven and Earth. If you feel tension, then you are not in balance.

Your hip is moving from flexion to neutral. If you kept going with your body, the hip would keep moving into extension.

This is what triggers autoactivation. I have had countless athletes tell me that their glute is going to fall off with exhaustion after only a few reps of this, despite all that strengthening that they had done before.

This is the key to timing: getting the right part to the right place at the right time.

So to get your gluteal timing online, quit with the squeezing and thrusting, and get your body effortlessly balanced over your leg.

 

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