Do her hips get weak, fatigue, or both when she runs?

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“ Both healthy and injured runners demonstrated decreased gluteus medius strength following the run to fatigue (p = 0.01), but there was no interaction between groups (p = 0.78). EMG onset activation timing did not differ between groups for the gluteus medius (P = 0.19) and tensor fascia latae muscles (P = 0.52). Injured runners demonstrated decreased gluteus medius initial median frequency values suggestive of fatigue (P = 0.01). These findings suggest that the gluteus medius muscle of female runners with ITBS does not demonstrate gross strength impairments but does demonstrate less resistance to fatigue. Clinicians should consider implementation of a gluteus medius endurance training regimen into a runner's rehabilitation program. “

Dr Ivo Waerlop, one of The Gait Guys

#gait, #gaitanalysis, #fatigue, #gluteusmedius, #gluteusminimus, ITB, #ITbandsyndrome, #thegaitguys

Brown AM, Zifchock RA, Lenhoff M, Song J, Hillstrom HJ. Hip muscle response to a fatiguing run in females with iliotibial band syndrome. Hum Mov Sci. 2019 Feb 8;64:181-190. doi: 10.1016/j.humov.2019.02.002. [Epub ahead of print]

So, what attaches to that hip capsule anyway....

I was trying to figure to which muscles attached to the labrum of the hip, as I see many folks where theres has gone south. I had always wondered if the iliopsoas attached, since many people with labral pathology have hip flexor dysfunction, where they use their psoas and iliacus as hip flexion initiators (or sometimes the rectus femoris, TFL and sartorius), instead of the abdominals. It turns out that NO MUSCLES attach to the labrum, but some attach to the capsule. 

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Have you noticed that many of the muscles on the list below (not the obturator internus) are internal rotators AND work during the 1st part of stance phase? Remember "glide and roll"? With internal rotation of the hip comes posterior translation of the femoral head. If these are dysfunctional, you may get capsular "pinching". Think about it with the next patient with hip joint pain from initial contact to midstance. 

"An updated knowledge of the intricate relationship of the pericapsular and capsular structures is essential in guiding our treatment of the hip. Following dissection the authors were able to discern that the iliocapsularis, indirect head of the rectus, conjoint tendon (of the psoas and iliacus),  obturator externus and gluteus minimus all have consistent capsular contributions whereas the piriformis did not have a capsular attachment."

 

Walters BL, Cooper JH, Rodriguez JA New findings in hip capsular anatomy: dimensions of capsular thickness and pericapsular contributions.
Arthroscopy. 2014 Oct;30(10):1235-45. doi: 10.1016/j.arthro.2014.05.012. Epub 2014 Jul 23.

The Gluteus Medius: Its not just for abduction anymore...

It would logically follow that the gluteus medius is important for generating both forward progression and support, especially during single-limb stance suggesting that walking dynamics are influenced by non-sagittal muscles, such as the gluteus medius, even though walking is primarily a sagittal-plane task. After midstance, but before contralateral preswing, support is generated primarily by gluteus maximus, vasti, and posterior gluteus medius/minimus; these muscles are responsible for the first peak seen in the vertical ground-reaction force. The majority of support in midstance was provided by gluteus medius/minimus (NOT the maximus), with gravity assisting significantly as well. The gluteus medius has also been highlighted as an abductor of the pelvis, working in concert with the contralateral quadratus lumborum (2), involved with keeping the pelvis level and abducting the pelvis on the stance leg side, such as when ascending stairs. 

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Seemingly, the gluteals appear important for extension of the thigh during gait. One of the most common scenarios appears to be a loss of ankle rocker and resultant weakness of the gluteals (personal observations). Lets look at an example. 

Have you ever sat at the airport and watched people walk? I travel a great deal and often find myself passing the time by observing others gait. It provides clues to a plethora of biomechanical faults in the lower kinetic chain, like a loss of ankle rocker with people who wear flip flops or any other open backed shoes.

What is ankle rocker, anyway? According to Jaqueline Perry (THE Matriarch of Gait Analysis) during normal gait, the stance phase (weight bearing) foot depends on 3 functional rockers (pivots or fulcrums) for forward progression (3).

  • heel rocker: at heel strike, the calacaneus acts as the fulcrum as the foot rolls about the heel into plantar flexion of about 10 degrees . The pretibial muscles must contract eccentrically to slowly lower the foot and help, along with forward momentum, pull the tibia forward
  • ankle rocker: next, the ankle acts as at fulcrum and the tibia rolls forward due to forwardmomentum, with a maximum excursion of approximately 15 degrees. The gastroc and soleus should eccentrically contract to decelerate the forward progression of the lower leg.
  • forefoot rocker: the metatarso-phalangeal joints act at the finalfulcrum in the stance phase of gait. Note that the 1st metatrso-phalangeal joint must dorsiflex65 degrees for normal forward progression, otherwise the individual will usually roll off he inside of the great toe. Tibial progression continues forward and the gastroc/soleus groups concentrically contract to decelerate the rate of forward limb movement. This, along with passive tension in the posterior compartment muscles, forward momentum , and the windlass effect of the plantar fascia result in heel lift.

Now watch someone walking in flip flops or open back shoes. There is no pivot past 90 degrees at the ankle (i.e. the tibia never goes beyond 90 degrees vertical). At this point the heel comes up (premature heel rise) and the motion must occur at the metatarso-phalalgeal joint. The only problem is that this joint usually has a maximum of 65 degrees extension, with 50 degrees needed for "normal" ambulation. Since more is now needed, the body borrows from an adjacent joints, namely the knee (which increases flexion) and the interphalangeal joints (which should be remaining flat and now must claw to “create” more available extension at the middle joint, as the proximal is nearly fully extended, through overactivity of the flexor digitorum longus. The tibialis posterior, flexor hallicus longus, and gastroc soleus groups also contract in an attempt to help stabilize the foot . Overactivity of these groups causes reciprocal inhibition of the long toe extensors and ankle dorsiflexors (tibialis anterior for example), causing the toes to buckle further and a loss of ankle dorsiflexion; in short, diminished ankle rocker function.

So there you have it. Glutes. They are a beautiful thing! Now get out there and improve their function!

 

1. Presswood L, Cronin J, Keogh J, Whatman C (2008). Gluteus Medius: Applied Anatomy, Dysfunction, Assessment, and Progressive Strengthening. Strength and Conditioning Journal, 30 (5), 41-53

2. J. Porterfield, C. DeRosa (Eds.) Mechanical low back pain. 2nd ed. WB Saunders, Philadelphia; 1991

3. Perry J, Burnfield JM, eds. Gait Analysis: Normal and Pathological Function. Journal of Sports Science & Medicine. 2010;9(2):353.

 

A cool paper on taping and reciprocal inhibition. “Hip extension increased significantly with gluteal taping (p < 0.05) for both walking speeds at late stance phase of walk compared to sham taping and control. The mean absolute difference between…

A cool paper on taping and reciprocal inhibition. 

“Hip extension increased significantly with gluteal taping (p < 0.05) for both walking speeds at late stance phase of walk compared to sham taping and control. The mean absolute difference between gluteal and control conditions for self-selected velocity was 14.2 degrees (95% CI 8.6 to 19.8) whereas the difference between sham and control conditions was 2.0 degrees (95% CI –2.0 to 6.0). Also, for both speeds, step length on the unaffected side increased significantly with gluteal taping compared with either the control or placebo” conditions. 

link to full text: http://www.sciencedirect.com/science/article/pii/S0004951406700629

Aust J Physiother. 2006;52(1):53-6.Gluteal taping improves hip extension during stance phase of walking following stroke.Kilbreath SL, Perkins S, Crosbie J, McConnell J.

Welcome to Monday folks and news you can use! Have a patient with weak hip abductors? Here is another great closed chain gluteus medius/ Maximus/minimums exercise we utilize all the time called “"hip helicopters” Try it in yourself, then try it on your patients and clients, then teach others : )

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How do your gluteus maximus and gluteus medius exercises stack up?

Looks like side planks (DL=dominant leg) and single leg squats scored big, as did front planks and good old “glute squeezes”

Check out this free full text articlehttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201064/

Yes, we know it was surface emg; yes we know they are not necessarily testing functional movements. The EMG does not lie and offers objective data. Note that the one graph is labelled wrong and is the G max, not medius.

Kristen Boren, DPT,1 Cara Conrey, DPT,1 Jennifer Le Coguic, DPT,1 Lindsey Paprocki, DPT,1 Michael Voight, PT, DHSc, SCS, OCS, ATC, CSCS,1 and T. Kevin Robinson, PT, DSc, OCS1 ELECTROMYOGRAPHIC ANALYSIS OF GLUTEUS MEDIUS AND GLUTEUS MAXIMUS DURING REHABILITATION EXERCISES Int J Sports Phys Ther. 2011 Sep; 6(3): 206–223.