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Glut Training Part 3: Glut Training Progression Tier 1

WHERE TO START:

As mentioned before, training over dysfunctional anatomy or neuromuscular coordination is not likely to impart any long term effects, and this means it is important to start at the basic level. Start by isolating the patterns and muscles you wish to target before implementing strengthening exercises that require multidirectional, multi joint, power, or speed control. Just like you don’t want to start with planks for core strengthening, you don’t want to start with dead lifts for glut strengthening.

 

ISOLATION:

The most important focus of isolation exercises is the positioning, the client must achieve and maintain the correct alignment of the spine, pelvis, and hip to optimally activate and stress the targeted muscle(s). A great principle to follow with neuromuscular control and endurance training is the concept of a prolong hold. You want to hold in a position of weakness to a point of fatigue (hold in a position they fail at). This will allow the re-mapping of the brain to muscle connection improving future contractions.  For instance, put in a position of weakness (shaking, loss of balance, etc) and own the position vs do dynamic arm or leg motions.

 

RESTORE EXTENSION

Anterior Soft Tissue Elongation
    1. Keeling psoas (use of dowel to reduce lumbar extension compensation and visual vertical hip loading)

Hip Extension ROM

    1. Kneeling hip ext with foot elevated 3D
      • Here the person does not have the front foot elevated but placing the front foot on an elevated surface and working that position in 3D is a great modification to reduce lumbar compensation
      • Here we are doing 3D motions of the movement pattern of one hip flexion and the other hip extending.  Likewise we are adding 3D drivers from the upper extremity of UE elevation, trunk side bend, and/or trunk rotation.

Innominate Extension

    1. Kneeling innominate rocks
      • Here we are doing a mobilization with movement of either pressing on the sacral or the innominate (pelvis bone) as your do a hip extension rock.  The sacrum and innominate rotation forward with extension and the hand pressure facilitates this motion.

Sacral Extension and Lumbar Extension

    1. Prone TKE lock outs
      • here we are locking out the lower extremity by locking the hip into extension.  Then we are doing a prone press up motion extending the lumbar spine.  The lumbar extension with hip lock will create a downward force on the pelvis helping with extension of the pelvis.

 

OKC FRONTAL AND SAGITTAL

  1. Pelvic PNF pattern:
    • There are two diagonals of the pelvis as discussed in prior sections.  Anterior Elevation (up and forward) to Posterior Depression (down and back) AND Posterior Elevation to Anterior Depression.  These two patterns must be restore for full pelvic control.  Posterior Depression is essential to facilitate glut function.

Pelvic drops

    • Pelvic Drops can be used to mobilize and stabilize pelvic patterns.  If the hip is below 90deg it will work the A/E to P/D pattern.  If the hips are 90 deg or above it will work P/E to A/D.  Often these are utilized eccentrically to elongate a QL and reduce pelvic upslip

Sidelying Abduction

    • Here we are isolating glut med but it is almost more of a core exercise.  We are again working on pelvic depression to reduce lumbar involvement with glut recruitment.  This exercise is COMMONLY done wrong.  It often is driven from the spine vs the hip.

Single leg ab series

    • This is a unilateral core activation exercise.  Here we are putting the hip into a position where hip muscles are put on a deficit so it helps facilitate core muscles.  The hip is put into the PNF pattern of flexion, adduction, external rotation.  Then manual force is added to the knee in the opposite direction with cervical flexion.

Glut Set:

    • Prone knee lock out is a basic way to facilitate the gluts.  The cures here would be can you extend your knee without driving your pelvic/belly into the ground and hold.

Clamshell:

    • Neutral: we are stressing different fibers of the glut and often weaker fibers with the hips in neutral vs flexed.  You can progress by adding a plank lift to the exercise.
    • 40deg hip flex: here you will isolated more posterior fibers of the glut.
    • wrong form: pelvis rocking back, lumbar extension

Glut Bridge:

    • The key with the glut bridge is to perform the bridge bilaterally, unilaterally, or with any variation with minimal to no hamstring tension and no low back tension as those are indicators of the glut not working.

Prone leg extension:

    • Unilateral and bilaterally: Like a on your stomach knee lock out you are looking to maintain neutral spine and not allow any pelvic movement with a leg extension motion.  I will start with holds in position of weakness then progress to dynamic movement.  The video before is the higher level progression starting with both legs, the legs elevated and descending from above.

Prone external rotation:

Simply placing someone in prone, place a theraband around their ankle with the band pulling the leg away from mid line, and having the person rotate the shin inwards (external rotation) will provide great rotation hip stability and SIJ stability.

 

MODIFIED CKC

Fire Hydrant:

    • Looking for ability to maintain neutral spine, pelvic stability while doing a combined hip extension, ER, and Abd (all three motions the glut max controls).  Think of it as a close chain clam shell.

Single leg hip thruster:

    • A hip thruster is a progression from a bridge and can be done on one leg.  There are similar cuing to performing a bridge.  I often do an extension pattern on one leg with the hip thruster and a flexion pattern on the other leg with a core activation knee push as seen in this video.

Side plank clam

    • This is a progression from a clam shell to include dynamic stability and core stability.

bird dog

    • If done correctly this exercise is challenging.  You must have a narrow stance. You must correct for increase thoracic kyphosis, scapular positioning, lumbar extension, and pelvic rotation.  The motion itself is simply, controlling it throughout the whole body is tough.  The addition of ankle DF with the movement can make it easier to control lumbar position.

 

INITIAL CKC

Standing fire hydrant

    • A good way to think through a progression would be a clam shell to side plank clam shell, to a fire hydrant, to a standing fire hydrant as you are progressing load, planes of movement, and degrees of freedom.  The standing fire hydrant is really tough to control pelvic stability and stance leg knee position.

Single Leg RDL

    • This should be a foundational exercise for all providers.  The keys are to have a soft knee, a posterior weight shift, level pelvis, and relaxed lumbar paraspinals to indicated acceptance of load into the LE.

Kneeling Hip Thruster

    • This is a way to progress form a bridge but not yet ready to do a standing hip hinge motion.

Wall hip push

    • A progression from sidelying abduction.  You can add different planes of motion depending on foot alignment and which leg your raise.  All the same pelvic and trunk cues are given as for the sidelying abduction exercise.

SL Squat

    • This is another foundation exercise.  Depending on how you cue the trunk angle it can be a heavy glut exercise or a heavy quad exercise.  It is also a great foot stability exercise and a tool to teach posterior weight shift.

 

POST ACTIVATION RESPONSE:

Time to look at those tests you identified during the baseline assessment. How did your baseline findings change after your interventions? Did the range of motion improve? Did the symptomatic response change, or disappear? Is the performance of functional movements improved? Which assessments were most significantly changed, can you reason out why your interventions may have created the observed responses, and was it the improvement you were shooting for?  Next up in our glut series…how to now carry over all the activation and isolation into function.

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