Gluteal Strengthening Exercises: A Review of the Literature

Transcription

1 Common Imbalances Female Athlete Hip Injuries: Exploring the CORE of Patterns and Prevention Kelly McInnis, DO Irene Davis, PhD, PT, FAPTA, FACSM, FASB David Nolan, PT, DPT, MS, OCS, SCS, CSCS Gluteal Exercises: A Review of the Literature Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston MA; Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA Rehabilitation of Hip Dysfunction in the Female Athlete: An Evidence-Based Approach David Nolan, PT, DPT, MS, OCS, SCS, CSCS Clinical Specialist, Mass General Sports Physical Therapy Service Associate Clinical Professor, Northeastern University Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston MA; Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA Bolga LA, Uhl TL. JOSPT healthy subjects (27 yo ± 5) Surface EMG right glut medius Non weight bearing Sidelying abduction (R) Standing hip abduction (R) 0 hip flexion 20 hip flexion Weight bearing Pelvic Drop (L) Standing hip abduction (L) 0 hip flexion 20 hip flexion Gluteal Weakness Altered biomechanics of the pelvis and femur impacting lower kinetic chain movement patterns Valgus and IR Weakness will often lead to compensatory overuse of other muscles Gluteus Medius TFL/ITB Gluteus Maximus Hamstrings Need to look beyond local symptom management Bolga LA, Uhl TL. JOSPT Conclusions Early Rehab NWB abduction Progression SL abduction WB abduction? FWB Most challenging Pelvic Drop Dynamic through abduction and adduction Limitations Trunk position Young, healthy subjects? TFL : Gluteus Medius ratio 1

2 Ekstrom RA. et al. JOSPT healthy subjects (27 yo ± 8) 19 males & 11 females Surface EMG Rectus Abdominus External Oblique Abdominis Longissimus Thoracis Lumbar Multifidus Gluteus Maximus Gluteus Medius Vastus Medialis Obliquus Hamstrings DiStefano LJ. et al. JOSPT Healthy subjects (22 yo ± 3) 9 males & 12 females Physical activity 60 minutes 3x/week Surface EMG of dominant limb Gluteus Medius & Gluteus Maximus Performed 8 reps of 12 exercises Randomized order Ekstrom RA. et al. JOSPT DiStefano LJ. et al. JOSPT Ekstrom RA. et al. JOSPT DiStefano LJ. et al. JOSPT

3 DiStefano LJ. et al. JOSPT Boren K. et al. IJSPT Gluteus Medius Hip Extension 26 healthy subjects Surface EMG of dominant leg Gluteus Maximus & Gluteus Medius Performed 18 exercises Randomized order Gluteus Maximus Gluteus Medius 3

4 10 healthy subjects Presentation of gluteus medius weakness & concurrent iliopsoas tendinitis in hip arthroscopy patients Fine wire EMG Gluteus Medius & Iliopsoas Ultrasound guidance Performed 13 exercises Identify exercises to strengthen gluteus medius and minimize iliopsoas activation Philippon MJ. et al. AJSM Phase Two (subsequent 4 wks) Resisted hip extension Traditional hip clam Hip clam in neutral Stool rotation (IR / ER) Exercises Performed: Double leg bridge Resisted terminal knee extension Resisted knee flexion Resisted hip extension Traditional hip clam Hip clam with hip in neutral Stool hip rotation Prone heel squeeze SL hip Abduction with IR / ER / vs. wall Single leg bridge Supine hip flexion Phase Three (subsequent 4 wks) Prone heel squeeze Sidelying abduction with IR / ER Sidelying abduction vs. wall Single leg bridge Phase One (initial 4 8 wks) Double leg bridge Resisted terminal knee extension Resisted knee flexion Selkowitz DM et al. JOSPT 2013 Activate gluteus medius and superior gluteus maximus while minimizing TFL Fine wire EMG 11 exercises 20 healthy subjects Calculated Gluteal to TFL Index for each exercise Not simply looking at EMG values 4

5 Selkowitz DM et al. JOSPT 2013 Selkowitz DM et al. JOSPT 2013 Selkowitz DM. et al. JOSPT 2013 Selkowitz DM et al. JOSPT 2013 Limitations Healthy subjects CLAM & SIDESTEP used elastic resistance Likely increased EMG amplitudes and GTA Index Did not include gluteus minimus 20% of abductor cross sectional area Selkowitz DM et al. JOSPT 2013 MacAskill MJ et al IJSPT 2014 Surface EMG (Gmax & Gmed) Weightbearing Forward Step-Up Lateral Step-Up Non-Weightbearing 10RM Prone Hip Extension Sidelying Hip Abduction 5

6 Thank You MacAskill MJ et al IJSPT 2014 Clinical Pearls Do the Correct exercises the Correct way Kang SY et al. Manual Ther 2013 Gluteus Maximus Activation Hamstring Activation Summary Gluteal strengthening shown to be critical in lower extremity function Consider the quality of tissue, phase of healing and baseline strength What muscle should be activated and what muscle activation should be minimized Always treat the cause and avoid chasing symptoms 6