initial exercises for gluteal strains

8/13/2019 Initial Exercises for Gluteal Strains

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Initial Exercises For Gluteal StrainsHip FlexionBegin this exercise lying on your back (figure 2). Slowly take your knee to your chest asfar as you can go without pain and provided you feel no more than a mild to moderatestretch, then lower back down. Repeat 10 - 20 times provided there is no increase in

symptoms. Once this becomes easy, you can use your hands to gently take your kneeto your chest a little further provided the exercise is pain free.

Figure 2 Hip Flexion (left leg)Single Leg KicksBegin this exercise lying on your stomach with your hands underneath your forehead asdemonstrated (figure 3). Slowly bend the knee until the lower leg is pointing upwards.Lift your bent knee just a few inches off the floor without moving your lower back. Slowlystraighten the knee, then lower the leg back down to the floor, returning to the startingposition. Keep your spine and pelvis still throughout the exercise and breathe normally.Perform 10 repetitions on the affected leg provided the exercise is pain free.


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Figure 3 Single Leg Kicks (right leg)Hip Abduction SidelyingBegin this exercise lying on your side with your legs together. Keeping your back andknee straight and foot facing forwards, slowly take your leg upwards tightening themuscles at the side of your thigh / hip (gluteals) (figure 4). Hold for 2 seconds and then

return to the starting position. Perform 10 20 repetitions on each leg provided theexercise is pain free.

Figure 4 Hip Abduction Sidelying (right leg)

Exercises for hamstring origin tendonitisThe following exercises are commonly prescribed to patients with hamstring origintendonitis. You should discuss the suitability of these exercises with yourphysiotherapist prior to beginning them. Generally, they should be performed 1 - 3 timesdaily and only provided they do not cause or increase symptoms.Hamstring Stretch for Hamstring Origin TendonitisBegin this exercise for hamstring origin tendonitis with your foot on a bench or chair.Keep your back straight and your knee bent slightly. Lean forward at your hips until youfeel a stretch in the back of your thigh / knee (figure 2). Hold for 15 seconds and repeat4 times at a mild to moderate stretch pain-free.

Figure 2 Hamstring Stretch for Hamstring Origin Tendonitis


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Hip Extension vs. Resistance Band for Hamstring Origin TendonitisBegin this exercise for hamstring origin tendonitis standing at a bench or chair forbalance and a resistance band around your ankle as demonstrated (figure 3). Keepingyour back and knee straight, slowly take your leg backwards tightening the back of yourthigh (hamstrings). Then slowly return to the starting position. Perform 10 - 20

repetitions as far as possible provided it is pain-free.

Figure 3 Hip Extension vs. Resistance Band for Hamstring Origin Tendonitis (left leg)

Exercises for a hamstring strainThe following exercises are commonly prescribed to patients with this condition. Youshould discuss the suitability of these exercises with your physiotherapist prior tobeginning them. Generally, they should be performed 3 times daily and only providedthey do not cause or increase symptoms.

Your physiotherapist can advise when it is appropriate to begin the initial exercises andeventually progress to the intermediate, advanced and other exercises. As a generalrule, addition of exercises or progression to more advanced exercises should take placeprovided there is no increase in symptoms.Initial ExercisesStatic Hamstring ContractionBegin this exercise in sitting with your knee bent to about 45 degrees (figure 2). Pressyour heel into the floor tightening the back of your thigh (hamstrings). Hold for 5seconds and repeat 10 times as hard as possible provided the exercise is pain free.


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Figure 2 Static Hamstring Contraction (right leg)

Basic Hamstring StretchBegin this exercise sitting with your back straight and your legs hanging over the edgeof a chair or bench (figure 3). Slowly straighten your knee as far as you can go withoutpain, and, provided you feel either nothing, or, no more than a mild to moderate stretch(figure 3). Hold for 5 seconds and repeat 10 times provided the exercise is pain free.

Figure 3 Basic Hamstring Stretch (left leg)BridgingBegin this exercise lying on your back in the position demonstrated (figure 4). Slowly liftyour bottom pushing through your feet, until your knees, hips and shoulders are in astraight line. Tighten your bottom muscles (gluteals) as you do this. Hold for 2 secondsthen slowly lower your bottom back down. Repeat 10 times provided the exercise ispain free.


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Figure 4 Bridging

Basic Gluteal StretchesSupine Gluteal Stretch

Begin lying on your back. Using your hands, take your knee towards your oppositeshoulder until you feel a stretch in the buttocks or front of your hip (figure 2). Hold for 15seconds and repeat 4 times at a mild to moderate stretch pain free.

Figure 2 Supine Gluteal Stretch (right leg)Long Sitting Gluteal StretchBegin sitting on the floor with both legs in front of you. Place your foot of the leg to bestretched on the other side of your straight leg as demonstrated (figure 3). Keeping yourback straight, pull the leg to be stretched towards your chest, until you feel a stretch inthe buttocks (figure 3). Hold for 15 seconds and repeat 4 times at a mild to moderatestretch pain free.


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Figure 3 Long Sitting Gluteal Stretch (left leg)


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What are the Gluteal Muscles?

The Gluteal Muscles comprise of three muscles which make up the buttocks: GluteusMaximus, Gluteus Medius and the Gluteus Minimus.

Tortora et al (1990 )[1]

describe the function of the gluteal muscles:

Gluteus Maximus extends and rotates the thigh laterally Gluteus Medius and Minimus abduct and rotate the thigh medially

Are your Gluteal Muscles Weak or Inhibited?

An inhibited muscle means that the muscle is not firing properly (the neural signal is notreaching the muscle) and a weak muscle indicates the muscle is firing normally (notinhibited) but is lacking strength.

A way to determine if the gluteal muscles areinhibited is to perform a prone hip extensiontest.

To perform this test lie on a table face downand keeping the leg straight lift it up off thetable. If on lifting the leg the knee significantly
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flexes or if a "dipping" is noted in the lumbarspine, indicating lumbar extension, the glutealmuscles are inhibited.

Hip Extension Test

Liebenson (2006 )[2] states that if a lack of coordination is seen when walking backwardsit indicates the gluteus maximus is weak.

What causes weak or inhibited gluteal muscles?

If you spend long periods of time sitting in a chair then the front of the hips (hip flexors -psoas) become short and tight, while the back of the hips (gluteal muscles) becomelong and weak. Soon the body forgets how to use the gluteal muscles because it willdivert the neural signal intended for them to a stronger muscle close by to do the jobinstead. If the neural system is now asking less powerful muscles to perform the taskthat requires the potential power of the gluteal muscles then this is likely to lead toinjury.

What is the impact of weak or inhibited gluteal muscles?

Weak or inhibited gluteal muscles can result in overactive hamstrings and be the reasonfor low back pain, tight iliotibial bands (ITB syndrome) and patello- femoral pain (runnersknee).

Without a strong gluteus medius to align the femur, knee and ankle, you are likely toover pronate your feet, which can lead to plantar fasciitis (heel pain), achilles tendinitisand shin splints.

The gluteus medius holds our pelvis upright as we stand. When it gets weak thepiriformis has to compensate and as a result the piriformis gets bigger and tighter andyou may experience piriformis syndrome.

How can I get my gluteal muscles functioning correctly?

The following exercises will help develop gluteal activation and core stability.

Bridge

Form a bridge as in Figure 1 (startposition)

Engage the core muscles Push the hips higher and hold for 30

seconds Lower the hips to the start position Repeat 3 times

Figure 1
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Bridge with leg extension

Form a bridge as in Figure 1 Engage the core muscles Extend the left leg as in Figure 2 Ensure there is no tilt in the hips Hold for 30 seconds Repeat 3 times Repeat with the right leg

Figure 2

Glute Kick

Assume the position on hands andknees as in Figure 3

Engage the core muscles Push the left heel up approx 2 inches

towards the ceiling (Figure 4) Ensure no hip tilt Hold this position for 30 seconds Return the left leg to the start position

as in Figure 3 Repeat 3 times Repeat with the right leg

Figure 3

Figure 4


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Leg lift

Stand tall and erect Lift the left foot off the ground Assume the position as in Figure 5 Engage the core muscles Push the left heel up back as in Figure

6 keeping the left leg straight Ensure there is no hip tilt Hold this position for 30 seconds Return the left leg to the start position

as in Figure 5 Repeat 3 times Repeat with the right leg

Figure 5

Figure 6

Lunge

Stand tall and erect Engage the core muscles

Lung forward with the right leg toassume the position in Figure 7 Check right knee is above the right

ankle and the back is straight Hold this position for 30 seconds Push back with the right leg to bring

you back to the standing position Repeat 3 times


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Repeat with the left leg Figure 7

Squat

Stand tall and erect Engage the core muscles Lower the body to assume the

position in Figure 8 Hold this position for 30 seconds Push down through the heels to bring

you back to the standing position Repeat 3 times

Figure 8Superman

Stand tall and erect Engage the core muscles Lower the upper body and raise the

left leg to assume the position inFigure 9

Hold this position for 30 seconds Return slowly to the standing position Repeat 3 times Repeat with the right leg

Try to get into a position so that there is astraight line through the arms, neck, backand rear leg

Figure 9

What is Piriformis Syndrome?

If you have a short tight Piriformis muscle then you may experience low back pain,pelvic pain, pain in the buttock or hip. As the piriformis gets bigger it may trap thesciatica nerve which can cause numbness and tingling going into your leg or foot; it mayhurt to sit, walk or lie down.

Exercise to lengthen the Piriformis


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Supine Stretch

Lie on your back with knees bent Cross the right leg over the left leg

as in Figure 10

Pull the left leg toward your chest The right will also move closer

toward your chest, stretching thepiriformis

Hold the stretch for 30 seconds Repeat 3 times Repeat with the other leg Figure 10

What is the impact of a short/tight Psoas?

The rectus femoris acts as a hip flexor and knee extensor. The synergists are the psoasand the tensor fascia latae (TFL). Once the femur reaches about 90 degrees of hipflexion (Figure 11), the psoas takes over because the rectus femoris has shortened andis incapable of applying the necessary force to move the knee above the 90 degree offlexion (Figure 12).

Psoas Test

Stand up tall and while maintaining posture attempt to lift one knee past hip height(Figure 12). If your psoas is short/tight you may find that you experience cramp in theTFL, as your TFL attempts to carry the load, or your hips tilt back as the quadratuslumborum's attempts to carry the load.

Figure 11 Figure 12

Exercise to lengthen the Psoas


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Psoas and Quadricep stretch

Kneel on the ground with the left kneewell behind you

With the left hand grab the left leg justabove the ankle

Engage the core and glutes Assume the position in Figure 13 Keep your back straight and vertical Keep your hips square Hold the stretch for 30 seconds Before the next stretch move the left

knee further back Repeat 3 times Repeat with the other leg

Figure 13

and finally

This exercise strengthens your weak hip muscles, glutes and core while challengingyour hip flexors

Form a bridge as in Figure 1 Engage the core and glutes Extend the left leg as in Figure 2 Lift your left foot off the ground and pull

your left knee toward your left shoulderas in Figure 14 Lower left your foot to the ground and

do the same with your right leg Maintain the bridge position the entire

time you do the exercise Complete 15 lifts with each leg

Figure 14

How Often?

Suggest the above exercises are performed 3 times a week with at least 24 hoursrecovery between sessions to allow the muscles to adapt

initial exercises for gluteal strains

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