Gluteal muscle weakness in PHT

: today's episode, gluteal muscle weakness in proximal hamstring tendinopathy. Welcome to the podcast helping you overcome your proximal hamstring tendinopathy. This podcast is designed to help you understand this condition, learn the most effective evidence-based treatments and. bust the widespread misconceptions. My name is Brody Sharp. I'm an online physiotherapist, recreational athlete, creator of the Run Smarter series and a chronic proximal hamstring tendinopathy battler. Whether you are an athlete or not, this podcast will educate and empower you in taking the right steps to overcome this horrible condition. So let's give you the right knowledge along with practical takeaways in today's lesson. a nice short episode today, but it's going to be a little bit punchy in terms of the message, but it's a lesson that I think we haven't really discussed yet, so worth doing an episode on it. And I kind of got the idea after reviewing a paper, a research paper that was published, I've got a whole stack of them through a whole bunch of folders. And there was one in 2017 and the title was Gluteus Maximus Inhibition. in proximal hamstring tendinopathy. And so your gluteus maximus is one of your major glute muscles. Uh, the biggest in fact, that, um, produces a lot of force when traveling in a straight line. And so, um, the research paper was by Julio Jesus, I think you pronounce it, um, and colleagues. And, um, yeah, so there's a plenty of things, a lot of limitations with this study. but just gave me the idea to come up with this topic. So this study in particular, they took three people with left-sided proximal hamstring tendinopathy, so very small sample size, but they decided to test out the glute max, the gluteus maximus and its muscle strength, compared to the other side using a handheld diamondometer, which just assesses the amount of force that's produced. And they did so by looking at hip extension. So if you can imagine the participants laying face down on a, like a physio bed or like a massage table and they have the one side, their knee is bent, bent to 90 degrees. So face down, knee bent. And then what they're trying to do is drive their foot or their heel up towards the ceiling. So they're trying to lift the whole thigh off the bed upwards. In the meantime, the dynamometer, that pressure sensor, is on the distal part of the thigh, so almost behind the knee but slightly higher up the thigh and just measuring the um just measuring the amount of force that person can produce and they um I think it was strapped down so they're not moving it's a concentric um it's an isometric sorry um force production uh as they just attach a belt around the thigh around the bed dynamometer just measures how much resistance is applied to that belt. Um, but what they did was quite interesting. So they had the subjects produce as much force as they can drive that foot up to the ceiling, but then they also did what they call a, um, let me see if I can find for the term they used a neuromuscular electrical stimulation of what they call it, a medium frequency. And this was like putting probes on the skin. uh, on that muscle and forcing that muscle to contract. So you're getting its absolute strength without any influence. It's like a involuntary contraction of that muscle to look at the, yeah, the overall contraction of what that muscle can produce. And so they followed a particular formula of, okay, they, all three patients had left-sided proximal hamstring tendinopathy. So they went through, um, the right side first. So they did the right side when the participant was conscious of activating that hip extension. So they did that. Then after a couple of minutes of rest, they put the probes on the skin and did this neuromuscular electrical stimulation. So they stimulated that muscle still on the right side and saw what force it could produce. Then they moved their attention to the left side or the affected side. and repeat the process. So they got the participant to do this hip extension movement, put the probes on again, and got the stimulation, that electrical stimulation to contract that muscle involuntary and yeah, had a look at all those different, those four measurements. And what they found was on average, the deficit was 34% of the torque that was generated was lower. So a deficit of 34% on the left side. when it was non-stimulated compared to all the other three measurements. And, um, it's, it's an interesting study, like all three, it seems like the unaffected side, both stimulated and unstimulated, and then the left side, which was, and the left side, um, non-voluntary. So when they use that electrical stimulation, all those forces were very, very similar. But when the only difference was when you asked the participant, to voluntarily extend that hip and contract that glute muscle, that's where all the deficits lie. And so they found that on average, like I said, 34%. So quite a large, quite a large deficit. Like I said, this study has a bunch of limitations. One is a small sample size, only three people, they could have found more than that. So there's a couple of reasons why the participant would not produce that amount of force. It could be weakness, but then there could also be potentially anxiety to produce that force. It could be painful to produce that force or, um, there could be worry that it could produce pain. Um, so look, there's a couple of things. Um, however, the limitations aside, it's highly recommended. amongst health professionals that we encourage gluteal muscle strengthening as a, um, in conjunction with building up the PHT, that tendon capacity. And so I thought I'd just share a few things, um, a few ideas that I do have for you, um, in order to make sure you're ticking the box with glute strength in your rehab, as well as obviously addressing the endurance, strength, power of the proximal hamstring tendon. This podcast is sponsored by the Run Smarter series. If you want to take your knowledge building to the next level, I have built out a proximal hamstring tendinopathy video course, which complements the podcast perfectly. Sometimes it's tough delivering concepts and exercises through an audio format, so the course brings a visual component full of rehab exercise examples, graphs and visual displays to enhance your understanding. Even if you sign up now, you'll have access to all current and future modules that I create. Sign up through my link in the show notes, then download the Run Smarter app, and you'll instantly have unlimited access to all the course resources on any device. And to say thanks for being a podcast listener, I want to give you a VIP offer. There will be a link in the show notes in every episode that will provide you 50% off the course price. just click on the link and it will automatically apply your 50% discount. So, um, let's start off with a few glute medius exercises. So, um, it's different to glute maximus. So there's a few glute muscles, but glute medius is an important one. It keeps your hips level when you are standing on one leg. Um, one of them being hip hikes or hip hitches. I'm pretty sure I've mentioned this in the podcast before. If you're not familiar with that. movement what you're doing is just standing sometimes on a step but you're keeping let's say the right leg still on the ground while the left leg and the left hip elevate a couple of inches off the floor and then back down to the ground so all you're doing is activating that right side that right glute to lift up the left side of the body and we can progress this with weights we can hold a weight in that left hand to make it more challenging This is not strengthening the glute maximus, this is strengthening the glute medius. So hip hikes are a good one. I do give this to a number of my runners and a number of my PHT clients. The other one being crab walks. I love crab walks for runners just in general. If you're not familiar with crab walks, thera-band, those resistance bands, either around the feet, around the or around the knees. which one we choose depends on the individual and how their individual technique is, but you're essentially just sidestepping. You maintain a quarter squat and you just take sidesteps keeping a large amount of tension on those bands and the glute mediuses, they fire really, really nice. So both of those examples, those hip hikes and crab walks, they can strengthen your glute medius. So we're already doing... a nice job of attacking your PHT issues. It's good for PHT recovery to obviously address the glutes. But these types of exercises don't necessarily produce a lot of pain for PHT, no matter how severe the symptoms are. If it's purely PHT, these types of exercises don't really produce a lot of pain, so it can be quite nice to at least make a nice start while you are... dealing with very low levels of rehab with your PhD, like your body weight bridges or something. Okay, so then we move on to the glute maximus and a couple of exercises here. Some of them that I suggest, they might produce pain for you. It depends, depends on your, where you're at in your recovery. It depends on whether it's challenging for the tendon, you haven't necessarily addressed tension before. So take this, take these suggestions as just depending on symptoms. So first being hip thrusts. So this is a very similar to a bridge style exercise, but your shoulders are up on a bench, on the side of a bench and your feet are down on the ground and you are thrusting your hips towards the ceiling. And this could be done with weights. You can hold on to a dumbbell on on your hips. We can do a double leg, we can do it single leg, but we're trying to get that hip extension, we're trying to thrust those hips towards the ceiling and activate your glute muscles as strong as we can with that particular exercise. We could just do a bridge or like a weighted bridge, like I said, with the hips, with a weight on the hips. That can be quite nice. It's not probably going to activate as much range of movement or activate the glute. the glutes as much as the hip thrusts, but we do want to make sure that if you do bridges, that we're generating that full hip extension. Because some people might do a bridge and only do three quarters and not get to that really nice straight line of shoulders, hips, knees. If you don't, you fall short of that, you're not getting any hip extension. Therefore, the glutes aren't really activating to their full potential. Then we have a couple of other things which might produce pain if you're in those early stages of rehab, but if you're further along into some, um, yeah, end ranges, um, in your rehab, then some dumbbell lunges. Lunges can be quite nice to drive through that, um, the glutes and whatever particular weight we choose to do. So you might hold onto, um, each, a dumbbell on each side, on each hand as you go into those lunges. And if you have a gym membership and that gym has a leg press, most people do, or most gyms do, sorry, then yeah, a single leg press can be very nice for generating a lot of force through the glutes. And they're my suggestion, so hip thrusts, bridges, dumbbell lunges, and single leg press. I thought I'd include a couple of power exercises as well, just in case you really are in that. end stage and performing quite well, but just wanting to either prevent PhD from returning or just really focusing on now we're at the running high functioning stages and you just really want to make sure you're ticking all the boxes. So for power, rocket jumps, if you're not familiar with the rocket jump movement, you could probably look it up on YouTube, but a high box like higher than your knees if you're standing next to it. You place one foot. up on that box and that's your starting position and essentially what you have to do is step up onto that box but drive through that foot that's already on the box and launch yourself into the air. Once you launch yourself into the air that foot goes back down onto the box and you land with the other foot on the floor. So we're just launching up into the air and really getting a lot of glute activation. Yeah, so that's why it's power based. Kettlebell swings are very, very nice as an end stage for both the PHT tendon and also for the glutes. So if you wanted to maybe bias the glutes a little bit, I think maybe widening your stance and maybe turning the toes out a little bit slightly, but then just really focusing on squeezing the glutes at the top of this kettlebell swing action can really help generate a lot of gluteal. Yeah, action, muscle activation, and then strength. So let me go through those again. So the glute medius, there was hip hikes, there was crab walks for the glute max. So we've got hip thrusts. I've got a bridge with full extension, dumbbell lunges, a single leg press in the gym. We've got rocket jumps. We've got kettlebell swings. Um, those are the ones I had written down. You might ask me like, where's my starting point or how many sets, how many reps can I do? That's where it all just. is based on the individual. Unfortunately, I can't provide that answer because it'll just depend, depend how strong you are, depend on your form, depend on your technique, depend on what you find difficult. And yeah, just depend on what the tendon can tolerate. And so hopefully you can start off doing some of these just through trial and error and see if you're benefiting from them or if there is a flare up, then perhaps you've done too much. But It's a good overall message for this episode just to make sure we're not just focusing on the hamstring. Um, we do know that in these phase, a stage three, stage four of your rehab that's been set in the research is to focus on the whole kinetic chain, which is just essentially focusing on the entire lower leg and trunk and coordinating all those muscle patterns together in order to return back to sport, uh, or some sort of highly functioning movements. But in the early stages, definitely hamstring, but we want to focus on the glute as well. So yeah, hopefully you enjoyed this. Hopefully perhaps you've noticed some weak points or some chinks in your armor within your rehab and we can use this episode and yeah, start to get to work on a few more practical steps to build your overall rehab. And so next episode, I'll dive into developing a flare-up. plan, what to do with a flare up plan because it's, we all know with life, it's not smooth sailings will encounter flare ups of various degrees. And so, uh, yeah, I thought I'd just write down my thoughts, jot down a few things that I thought you might want to, uh, learn and yeah, we'll catch you in that episode next time. Thanks once again for listening and taking control of your rehab. If you are a runner and love learning through the podcast format, then go ahead and check out the Run Smarter podcast, hosted by me. I'll include the link along with all the other links mentioned today in the show notes. So open up your device, click on the show description, and all the links will be there waiting for you. Congratulations on paving your way forward towards an empowering, pain-free future, and remember... Knowledge is power.