Thanks for all of the shares for my rant about rehab for glureus medius…and I promised I would back up my rant with a few of my strategies for gluteus medius. I think I’ll use the same 3 points as the last post and describe my strategies within each.
- It’s a Conscious, Isolated Movement
- That’s not how the Glute Med. Works in Function
- Poor Carryover from the treatment
1. It’s a Conscious, Isolated Movement
So if I don’t like the conscious, isolated movements we need to find another way to fire the glute medius. I like pivots if the patient is able to do them. I would use all planes of motion as actually I don’t want to focus on one muscle, but to generate good hip movement and as a result of the good hip motion you can fire the glute medius. The frontal plane pivot will have the biggest direct effect, but you gain good co-ordination through the other movements, so they are definitely worth doing.
The big advantages I see in firing the muscle in this way is that you:
- Fire the muscle in a functional pattern that directly translates into the patients everyday function
- The timing of the contraction is controlled subconsciously, so will be perfect
- The strength of contraction will be controlled subconsciously, so will be perfect
- Fire the muscle in coordination with both local and global muscle, joints, fascia, etc etc
- and many more!!
2. That’s not how the Glute Med. Works in Function
To a degree most of the bases are covered by the strategies in point 1. But if for example you want to get closer to a specific function (gait, tennis, golf?) I would either adapt the pivots or use different drivers to fire the glute med. Lets say for instance they are a golfer and your trying to fire their right glute med. How would you make golf specific glute med. exercises? Here’s one way I might try:
I know the glute med. will fire with hip flexion, adduction and internal rotation, which is great, but in the back swing of golf that should be happening…so we need to do something more. Assuming you’ve already done your assessment, I would fire the glute and then re-test. For golf I would try just using hand drivers, using the left hand to drive a normal golf swing, but then use the right hand to drive over-head towards the left. The right hand will therefore drive a lot more hip adduction in the right hip and encourage a greater reaction from the right glute med.
I would then re-test and see what’s changed. If I needed to change things a little more I might start tweaking the foot position, use either a slightly narrow, right foot forward, right foot turned in…etc…etc. You can change so many parameters your imagination is your only limitation. Again, I tend to re-test after each change to the movement as what works is important to know.
3. Poor Carryover from Treatment
The carry over is fundamental to me, it’s no good repeating the same treatment week after week only for them to consistently regress within a short period of time. If you can encourage the muscle to fire with the above strategies they are far more likely to continue firing the muscle when they leave your clinic. If we continue with the gold example. Once I’ve tweaked the movement and found a way to fire the muscle I will then gradually decrease the tweak until you are back at just doing the pure function.
If you are wanting to bullet proof the person I would then disadvantage the glute medius and make them go through their functional movement again. If you can fire their glute med. even when it is disadvantaged they are far more likely to continue firing the muscle ongoing.
Hopefully that gives you plenty of alternatives to the side lying hip abduction 🙂
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