PRE AND POST TEST:
It is important to get a baseline of what effect dysfunctional lumbopelvic positioning and glut activation manifests as, and this can be different for each client. Understanding what movements or joints are most provocative of pain gives you something to come back and reassess to see the effect of the interventions you have chosen to implement. In other words, are you targeting the correct impairments? It is helpful to identify a one to two of these tests to focus on improving. If you can demonstrate changes with your pre and post testing, it facilitates client buy in and starts to earn their trust.
Spinal Range of motion:
- Often loss of flexion is due to a posture of lumbar extension. If you lack flexion you often move through lumbar extension and have poor glut control. Assess the toe touch.
- Toe touch is also a general movement clearance needed to deadlift or train the posterior chain. If you can not touch your toes your system does not have the capacity to efficiently load the hips without lumbar involvement.
Leg Swing Test:
- This test examines if the client is able to access true open chain hip extension, or if the lumbopelvic region is how the client is able to achieve leg extension during activities like walking and running. Take note of hard end to extension motion, compensation of hip external rotation (toes out) and gross total range of motion. The video example below is a good example of the end range extension coming from the lumbar spine mostly vs the hip. Again notice the inability to achieve extension in its true plane (extension, abduction, internal rotation) and cheating through external rotation.
- Does the hip flex to full range in neutral without a pinch or pain?
- If not likely lack hip/pelvic mobility limiting squat movement patterns and strength development. Oten the hip flexion is not limited from hip capsule tightness rather lack of pelvic (innominate, sacral, and lumbar) flexion. This video is hard to see but I often use the finger assessment to compare flexion ROM counting the number of fingers form upper thigh to trunk. On this clients hip he lacks flexion on the right and if done passively it leads to hip external rotation. If you can’t flex your hip you will not be able to squat using your gluts correctly.
- Does the hip passively extend as seen in the Thomas test position
- If it does not passively extend then the hip can never get into a position of allowing glut function. If you do a simple contract relax and the ROM increases then it is likely a guarded vs stiff hip. A guarded hip would become unguarded with proper glut stability. If hip extension is guarded, stretching it will provide relief but it will not last. Appropriate glut training will maintain hip extension ROM loss.
Glut Manual Muscle Testing:
- First, is the client even able to achieve the required position for a manual muscle test, and if so can they maintain it against resistance without substitutions? Muscle strength testing is a snap shot of strength. However, if you have no ability to isolate a muscle its very unlikely the muscle will naturally work in a functional movement. One great test for glut max strength preventing compensation is what I called the Norweigen hip extension test. This position prevents lumbar spine extension motion and places the anterior fascial line on tension while testing glut strength.
- a bridge is a great way to assess if the glut muscles have an inherent ability to fire without lumbar or hamstring compensation. Listen to the video for instructions on how to perform the test.
One of the first things you need to look at when teasing out glut function and activation is functional movements that require posterior depression of the pelvis. You need to see both the glut muscles function in isolation then see if that carries over to a functional movement. If you have isolated strength but poor functional control it shows training within functional movement patterns is needed. If you can perform the functional test well but have poor glut control in isolation it shows the bodies amazing way to compensate. This will allow for singular control and low intensity movement but once sport or a higher load is needed the lack of glut control will catch up to you. It comes down to output. You body might be able to produce stability in a lower output setting (air squat) and not in a higher output setting (jumping)
- Your first priority will likely be gait, because it is an activity we constantly perform throughout the day, if you don’t observe posterior depression during the toe off phase of gait, the gluts are at a disadvantage and the lumbar spine may be picking up the extra loading with each step a client takes throughout the day. Observe for heavy rotation during gait which is a sign of lack of lift and elongation from the pelvis. Look for a hip dropping during stance phase. Look for lack of arm swing. Look for a toe out or toe in posture. Lastly looking for toe off when the leg is trailing. All signs of glut inhibition. Here is a video of someone walking who is a rotational walker, with hip drop, and lack of elongation or posterior depression on the left leg.
Step Down Test:
Ascending and descending stairs a step will increase and exaggerate the pelvic motion required for a smooth, normal pattern, and therefore can further tease out dysfunction and compensation that may be difficult to discern during normal ambulation. This also highlights the ability of the glut med to control knee alignment, preventing the knee from collapsing inward, during eccentric loading.
- The first test is a step down test. This is a great test of single leg stability incorporating high loads of glut med and glut max. The typical signs of dysfunction are hip drop, knee valgus (knee dive in), foot collapse, tibial external rotation (foot twist out), and/or trunk collapse.https://youtu.be/l04MDPNJXHI
- The second test is observing someone walk up or down stairs. When observing someone walk up stairs, observe for lack of posterior depression or elongation of the pelvis as the leg pushing off the step. The video below shows a prime example of inability to achieve post depression on the left leg. This is a sign of glut not functioning and loading anterior hip and spine structures.
Box jump landing:
If appropriate, this test will assess quick response and eccentric control of lower extremity alignment, in other words, coordination. It is important for clients to have sufficient strength and facilitation of the gluts to support functional movement, but the neuromuscular system also needs to be primed and educated in a way that initiates this activation to control explosive movements and reactions, especially when considering athletes being assessed for return to play or jobs with a high physical demand. Eccentric control is the essence to athletic function as it requires the highest level of strength and specific to change in direction movements. In the video below look on the left lower extremity and the rotation inward during landing and the bias to loading the right lower extremity.
Do you need to perform all these tests when determining glut exercises? No. Do you need to have some baseline test to work off to determine need? Yes. The FMS is a great test of movement but it is difficult to assess specific glut function. The FMS is an entry point. To determine load and output, try to assess both functional movement and tests of isolation. These tests should be re-visited after glut training to determine change in function.