Let’s talk about your butt. Why? Because the three gluteal muscles in the buttocks – the gluteus maximus, gluteus medius and gluteus minimus – are crucial for low back health, as well as strength and power in athletic movement. The butt is part of your core!
Weak glutes not only cause low back pain but are related to other conditions like patellofemoral pain, knee injuries (anterior cruciate ligament injuries), iliotibial band syndrome, ankle injuries and Achilles tendinopathy.
Regarding the glutes, it is less about the maximum weight they can lift, and more about the ability to recruit the glute muscles to perform proper hip extension and gait movements.
I use the squat to assess the glutes, and I use other tests to check stabilty of the hip in an extended position with the pelvis held in neutral.
Depending on position you are moving around in, the gluteals need to be able to act as either a prime mover or a stabiliser, depending on the task.
It is common in athletes for the gluteal muscles to become lengthened (chronically stretched), thus reducing the tension in the range around hip extension. This undermines athletic performance – and makes them more prone to injury as well.
Some of my favorite glute exercises are:
Theraband side walk
Side lying hip abduction
Sometimes patients have to take a step backward to move forward, and sometimes their voyage is not so much about discovery as rediscovery. Stiffness is not the major chief complaint I hear from clients, but it is often checked off on their intake forms. Stiffness can be associated with pain, inflammation, fatigue, and any other complaint that bring clients in my office. The most common reason for stiffness is the effects of immobilization of the joints and muscles. The spinal joints, hip joints, knee joints, shoulder joints, and ankle joints are the most commonly involved. Muscle and joint pain commonly originates from bad habits of sitting, standing, sleeping, and walking. Stiffness has real consequences if ignored.
A Functional Workout
It doesn’t matter if my client is young, middleaged, or a senior citizen; I use the functional training approach as part of my treatment, especially for relief of stiffness. I start my rehab recovery teaching patients body-weight maneuvers and floor exercises. Then, I progress patients to use bands. I incorporate Thera- Bands for rehabilitation, functional movement training, sport-specific conditioning, and group classes. The next progression I use is to free weights and Kettlebells. Our profession was inundated with laser therapy and decompression tables, while the strength-training world was invaded by Kettlebells. I like to think that I have access to every kind of equipment out there, but through it all, I am still a big proponent of the minimal and inexpensive need for equipment in “authentic” functional training, like Thera-Bands. Thera-Bands can provide the basis for an authentic functional workout limited only by the imagination and knowledge of the practitioner. Functional exercise is based on its outcome, not how the exercise looks. Don’t ask me how to activate specific muscles (that question was answered years ago). Instead, ask: Why did this person lose the movement pattern in the first place?” Thera-Bands help me get rid of stiffness and improve functional strength, which is usable strength. Functional strength is hard to measure. That’s why I attempt to identify it by using many unorthodox movements, such as assisted posterior reaches. his exercise is one of the best methods of developing functional abdominal strength in overhead athletes, or athletes in sports that bring the arms overhead, such as tennis and basketball. Stand on both legs (eventually progress to one-legged stands) facing away from a Thera-Band firmly held in place. Hold the band in both hands, and extend your arms straight up above your head. Bring the hips forward and the hands back. Lean backward as far as you can without feeling pressure in your lower back. Engage the lower abdominals to return to the starting position. Using the Thera-Bands, I teach movements that train the body to do what it was meant to do. These can simply be broken down into four pillars: 1) Standing and locomotion (gait). One of my favorite exercises that improve the hip rotator stabilizers (gluteus) is to have clients wrap the Thera-Band (usually the green band) around the ankles and walk sideways across the room or down a hall to activate the gluteus. This one maneuver alone has helped more patients improve altered gait than any other. 2) Movements that lower or raise the body’s center of mass, such as squatting, lunging, and climbing. I have clients stand on a band and hold the ends of the band in their hands while doing squats, and perform an overhead press on the way up. 3) Pushing and pulling, such as standing rows and pressing maneuvers. 4) Rotation. These are changes in direction. For example, torso rotation and proprioceptive neuromuscular facilitation (PNF) band chops are a functional way to train the abdominals.
Everyone talks about the core, which includes the major muscles attached to the trunk, above the ischial tuberosity, and below the superior aspect of the sternum. Approximately 87% of the core muscles are oriented either diagonally or horizontally and have rotation as one of their actions. Our body was made for rotation, yet very little rotational training is addressed in today’s standard training protocols. Thera-Bands make rotational training easy. The most annoying things about the bands is getting the latex powder on your clothes and occasionally the bands break while you are in the middle of a set. An advantage to band assessing and training is the observation of symmetrical or asymmetrical movements. The link between uncontrolled spinal and joint intersegmental translation or uncontrolled range of motion, and the development of musculoskeletal pain and degenerative pathology, is well-known. Often, patients are not even aware of the bad movement pattern that they are doing over and over that is causing the stiffness. Sometimes, it is only clearly seen when the muscles fatigue and pain sets in. The inefficient control of muscles and bones, poor movement habits, and poor posture give rise to very subtle and unique imbalances in the body-stability system. This puts mechanical stress and strain on the joints; and the muscular, neurological, and connective tissue systems of the body. This leads to cumulative microinflammation, which leads to pain and pathology. This predisposes joints to early aging and stiffness. A significant amount of injuries and stiffness occurs in clients with right- to left-sided strength and flexibility imbalances. My recommendations with the Thera-Band are to put the core first and to look for the following asymmetries:
and realizes how critical it is for the inner core of the body—namely, those joints closer to the spine, to be supported by the postural muscles designed with strength. You can create strength using the tubing made by Thera-Band. If you don’t tend to strengthen, the natural progression is for the body to lose it.
I usually recommend that stretching is the last thing a person does once he or she is pain-free. I see many patients that injure themselves from overstretching in yoga class and with Pilates. Stretch to increase flexibility, but don’t overdo it. I encourage patients to feel the muscle barrier and don’t go past that point. Otherwise, you start pulling on the ligaments and these were not meant to be pulled apart. Neuromusculoskeletal function involves a complex integration of proprioceptors facilitating; muscles reacting and joints moving simultaneously in sagital, frontal, and transverse planes of motion in a groundforce kinetic chain reaction response. This is facilitated by the moving body in relation to the ground and gravity. Use Thera-Bands to put patients through movements that allow you to see how an individual can control outside forces that are irregular in intensity, speed, load, symmetry, nd direction, just like sports and real life.
The purpose of flexibility varies for the different muscles around the joints. For the major power muscles, it is important that flexibility allows freedom of movement for the pelvis, hips, trunk, scapula, and humerus. Freedom of movement needs to be symmetrical.
General Muscle Strength
Once the foundational issues of consistency, core stability, flexibility, and balance control are being implemented, I then look at the bigger picture of the “outer core.” The rest of your body will need strength to carry you into your 80s and 90s. Performance as you age will be improved
Jeffrey Tucker, DC, DACRB
has been in continuous private practice for over 25 years in Los Angeles. His practice includes stretching, yoga, Kettlebells, & FMS training. He teaches courses in rehabilitation. Contact him at www.DrJeffreyTucker.com
The program I find myself using for most clients is a typical Macrocycle and Microcycle of training using the NSCA standards and guidelines:
The first thing I do is the assessments – I use the Functional Movement Screen (FMS).
My first concern and goal with people is to fix any imbalance and asymmetry of the body. This is done in the first phase of working out. I usually start with foam roll training, stretches, body weight exercises and I have clients perform body weight exercises for a count of 15-20 reps. It’s also the muscle endurance phase, so when I switch them to using free weights I use 12-15 reps per exercise. A beginner would only perform a little of each muscle group in a workout day until they are ready to progress into more of a split routine. Once I feel the person has muscle endurance, form, posture, and muscle balances they can move on to the hypertrophy phase.
During hypertophy I simply add some weight and perform 6-12 reps. The first few weeks is about 10-12 reps and then it progresses to 8-10 followed by 6-8 at the end of the phase. The sets may also increase along with the weight. The split routine also may change to cause overload as well. During this phase muscle mass should be gained as well as some strength. Once certain goals are obtained the client should be ready for the strength phase.
Strength is 1-5 reps with 2-5 minutes rest because it is mainly using testosterone in the phospogen system. Fat loss and whatnot is not much a concern in this phase but only pure strength. It is wise to be patient and wait for ATP and Creatine stores to recover rather than perform another set before that. I mainly perform 1-5 reps for the large multi-joint exercises such as bench press, squat, and dead-lift. As for some shoulders, arms, calves, etc I perform 6-8 reps. You do not want to do 3 rep bicep curls. This phase may last about 6 weeks. I do about 5 sets of 5 the first week, 5 sets of 4 week two, 5 sets of 3 week 3, and then I start mixing it on week 2. I am gradually aiming to get my highest max possible on week 5-6. During this phase I also look for weaknesses such as unilateral strength, eccentric strength, and stopping points. After the strength phase I go right to Power Training which is also the same reps and recovery as Strength Training however it is explosive.
The warm up for each phase consists of Core muscle work. I like clients to perform planks, side bridges, and glut bridges in all phases. For a new client I focus on plank form and endurance in the endurance phase. During hypertophy I have the client perform a plank for 30-60 seconds with weight on the low back.
Even though there is a system, each client gets a personal program.
Here is a circuit that I provided to one of my clients to help her achieve her New Years resoloution for weight loss and getting back into her favorite pair of jeans:
- Total-body exercise: Four-count squat thrusts
- Upper-body exercise: Push-ups
- Lower-body exercise: Scissor step-ups
- Core/trunk exercise: Abdominal sit-backs
- Total-body exercise: Squats to presses
- Upper-body exercise: 1 Arm rows
- Lower-body exercise: One-leg squats
- Core/trunk exercise: Low-back arch ups
- This circuit has good cardiac demand for weight loss. This program will give her the look she wants and develop strength and mobility in the knees, hip joints and butt; stability and strength in the upper trunk and arm, abdominal, and pelvic regions; and her core strength will improve.
The circuit requires performing each exercise for 60 seconds and moving on to the next exercise – performing one exercise right after another. If she needs a break between exercises it should be as short as possible. At the end of the circiut she can rest for two minutes and then perform the entire circuit again. It should be done 3-4 times per week.
December 21, 2010, 11:42 am
When the Diagnosis Is ‘Dead Butt Syndrome’
By JEN A. MILLER
Jen Miller at the finish of the Ocean Drive 10 Miler in Wildwood, N.J.
My butt, unfortunately, is dead.
“Dead butt syndrome,” the sports medicine doctor said to me after making me go through a series of circus-act contortions that involved swiveling my hip in all directions. His voice was very serious, his tone stern. I wondered if I should start making funeral arrangements for my rear, maybe a New Orleans-style blowout parade?
Hold the tuba. My butt’s not really dead. It can’t be revived with defibrillator paddles, but it can be fixed.
The technical name of the condition I have is gluteus medius tendinosis — an inflammation of the tendons in the gluteus medius, one of three large muscles that make up the butt. It’s a very isolated and painful injury that knocked me out of marathon training in January with stabbing pains in my hip. It’s a symptom related to what running experts hammer at: the need for cross-training and strength training. I was running so much that I told myself I didn’t have time for the exercise machines or weights, so I have no one to blame but myself.
I’ve been running for five years, but I’d never heard of the problem. I ran it by a friend, a former track coach at the University of Pennsylvania, and he was baffled too. I haven’t seen any coverage, though the doctor said it’s fairly common with runners who train for half marathons and beyond. It took him five minutes to figure out the problem.
“A new thought in running medicine is that almost all lower extremity injuries, whether they involve your calf, your plantar fascia or your iliotibial band, are linked to the gluteus medius,” said Dr. Darrin Bright, a sports medicine physician with Riverside Methodist Hospital in Columbus, Ohio, and medical director of that city’s marathon. “In the last five to 10 years, we’ve just realized how much of an important role the gluteus medius plays in stabilizing the hips and the pelvis in running.”
If you think of the pelvis as a cup, the muscles that attach to it, including the three gluteal muscles and the lower abdominals, interact in an intricate choreography to keep the cup upright when you run or walk. If these muscles are strong, the cup stays in place with no pain. If one or more of those muscles is weak, the smaller muscles around the hip take on pressure they weren’t designed to bear.
The cup still stays up, but at a price. First come muscle tears and inflammation, followed by scar tissue in the muscle. If left untreated, this process becomes a cycle that keeps feeding into itself.
“For people who have persistent pain, it’s healing gone wrong,” Dr. Bright said. “That gluteus medius isn’t firing the way it’s supposed to. You’re getting an inhibition of the muscle fibers. It’s kind of dead.”
Some of us run through the pain, which is what I did. And many compensate by adjusting their strides in a way that impedes the gait and can lead to problems in the quads, hamstrings, Achilles tendons, heels, knees, calves, ankles, feet or toes.
“Whether they’re recreational weekend runners up to the elite marathoners, the majority of runners I see have weak gluteus medius and gluteus maximus muscles,” said Dr. David Webner, a sports medicine doctor at Crozer-Keystone Health System in Springfield, Pa.
For about 70 percent of his patients, physical therapy that stretches the muscles in the hip and leg and strengthens the gluteus muscles, along with a temporary reduction in the mileage and intensity of running, resolves the problem. Deep tissue massage, which sends more blood to the area to break up scar tissue, along with strength training may also help to break the cycle of inflammation and scarring.
More advanced approaches include ultrasound guided tenotomy, which uses ultrasound to identify the affected muscles and then “poke little holes in the area of the scar tissue,” Dr. Webner said, or platelet-rich plasma therapy, which involves injections of centrifuged blood products and is what Tiger Woods underwent after knee surgery last year.
Fortunately, I didn’t need to take it that far. I’m lucky — the pain has ebbed with physical therapy and changing one of my weekly runs to a cross-training workout.
“Those runners who do multiple types of exercising are less prone to have weakness than runners who do just running,” said Dr. Webner. “Triathletes who come into my office don’t have as much weakness as just solo runners.”
So I’m biking. I row. I sweat through elliptical workouts at the gym.
And I no longer have the feeling that a pin is stabbing my hip every time I drive. I can sit for more than a half hour without pain. And last month I ran the Amish Bird-in-Hand half marathon, and felt no more discomfort than you’d expect to endure running 13.1 miles through the hills of Pennsylvania Dutch country.
To keep my rear alive, I must be vigilant about continuing to strengthen my lower abdominal and gluteal muscles. Last week, I slacked off and the pain came creeping back.
Is it annoying to have to focus so much on these muscles to run? Absolutely. But if it’ll revive my butt, it’s worth every leg lift and crunch.
Jen A. Miller is the author of “The Jersey Shore: Atlantic City to Cape May.”
The most recent research completed on the FMS was performed in Quantico, VA at the Marine Officer Candidate School. They screened over 900 Marines and followed them through basic training and found that the individuals who had a score > 14, were twice as likely to not graduate due to injury than those with higher scores. This goes right along with the previous research found in the NFL. This research is currently being written up for publication.
The principle of core stability has gained wide acceptance in training for the prevention of injury and as a treatment modality for rehabilitation of various musculoskeletal conditions in particular of the lower back. There has been surprisingly little criticism of this approach up to date. The following statements can be said about core training:
It is correct to say that weak trunk muscles, weak abdominals and imbalances between trunk muscles groups are not a pathology just a normal variation. CORRECT. IT IS POOR ENDURANCE OF TRUNK EXTENSORS THAT IS CLINICALLY SIGNIFICANT.Weak or dysfunctional abdominal muscles will not lead to back pain. THERE IS LIMITED EVIDENCE FOR OR AGAINST THIS.
There is evidence that tensing the trunk muscles is likely to provide protection against back pain & reduce the recurrence of back pain.
Core stability exercises are no more effective than, and will not prevent injury more than, any other forms of exercise or physical therapy. THERE IS SOME EVIDENCE THAT THIS STATEMENT IS TRUE, SOME THAT IT IS NOT.
Core stability exercises are no better than other forms of exercise in reducing chronic lower back pain. Any therapeutic in?uence is related to the exercise effects rather than stability issues. WE JUST DON’T KNOW.
Patients who have been trained to use complex abdominal hollowing and bracing maneuvers should be discouraged from using them. I WOULD NOT AGREE. HOLLOWING HAS ITS PLACE & BRACING IS MOST LIKELY A VERY GOOD WAY TO PROTECT THE BACK DURING HIGH LOADS, ESPECIALLY IN SOMEONE W/ EXISTING LOW BACK PAIN.
Are you afraid of getting injured (again)? Can you exercise or play sports without getting injured? (Find out with FMS)
You wouldn’t take your car out on the highway without checking out its basic roadworthiness. But that’s exactly what many men and women do when it comes to subjecting their bodies to the rigours of training for sport or competition. The ‘functional movement screen’ (FMS) developed by Gray Cook & Lee Burton is a great tool that I use in my practice to observe the way clients move when they squat, lunge, hurdle step, push up, perform a straight leg raise, and several other tests.
I’ve see many patients and athletes who have performed high-level workouts and sports activities even though they were inefficient in their fundamental movements. They seemed able to get by with poor movement patterns, for example by training around a pre-existing problem, an asymmetry in movement, or more often than not, simply avoiding training their weaknesses! These potential weaknesses can cause an injury or allow a player to not work out at there full potential.
I have been using the FMS during my evaluations of clients for several years. This summer I was invited by Gray Cook & Lee Burton to teach the FMS course to other practitioners, so that they too can use it as an evaluation tool in there practice.
The underlying premise is that we should all be working on developing quality of motion before quantity of motion. The FMS consists of seven tests that assess mobility and stability as an indication of a person’s functional status and injury risk.
Are you seeing more people train on balls while working out in the gym? Training with unstable surfaces such as Thera-Band® exercise balls, stability trainers, and balance boards do promote activation of core muscles. The “core” can be defined as the axial skeletal and its muscular and fascial attachments, including the pelvic and shoulder girdle.
Canadian researchers David Behm PhD and colleagues published a comprehensive review on the use of instability to train the core. Research has shown that exercises performed on unstable surfaces produce higher levels of muscle activation in both the core and extremity muscles compared to stable surfaces. However, force and power outputs are decreased while exercising on unstable surfaces, sometimes up to 70%. Interestingly, increasing levels of core muscle activation can also be achieved with free weight exercises such as squats and Olympic lifts without added instability.
In their article, the authors made several recommendations for both athletes and non-athletic conditioning based on their review of the literature. Dr. Behm et al. noted that athletes should emphasize “higher-intensity ground-based lifts” (such as Olympic lifts, squats and deadlifts) while including resistance exercises with unstable devices, as well as unilateral exercises that provide “transverse stress to the core musculature.” Furthermore, they stated that “unstable exercises should not be used when hypertrophy, absolute strength, or power is the primary training goal.”
Similar recommendations were made for the general population, noting the benefits of both free weight and instability training on promoting spinal stability. It’s important to remember to decrease resistance loads on exercises performed on unstable surfaces.
During rehabilitation, unstable surfaces can be effective at improving muscle reaction time and co-contractions that protect joints. In addition, resistance training on unstable may provide localized muscle endurance training, beneficial for the high proportion of Type I “aerobic, slow-twitch” muscle fibers found in core muscles. Dr. Behm and colleagues recommend core endurance training exercises generally be performed at higher repetitions (greater than 15 per set), while athletes requiring more strength and power perform less than 6 repetitions per set. The authors further noted that unstable surfaces can provide musculoskeletal health benefits such as decreased injury risk and increased spinal stabilization as opposed to using free weights.
In summary, unstable exercise devices such as Thera-Band Exercise Balls and Stability Trainers should be included as part of a well-rounded conditioning program for athletes and non-athletes, but not for increasing primary strength and power. In addition, resistance exercises performed on an unstable surface should be performed at a reduced intensity level because of the reduction in force output.
Behm DG, et al. The use of instability to train the core musculature. Appl Physiol Nutr Metab. 2010 Feb;35(1):91-108.
Behm DG, et al. Canadian Society for Exercise Physiology position stand: The use of instability to train the core in athletic and nonathletic conditioning. Appl Physiol Nutr Metab. 2010 Feb;35(1):109-12.
What is the FMS?
The Functional Movement Screen (FMS) is the product of an exercise philosophy known as Functional Movement. This exercise philosophy and corresponding set of resources is based on sound science, years of innovation, and current research.
How it Works – Simplifying Movement
Put simply, the FMS is a ranking and grading system that documents movement patterns that are key to normal function. By screening these patterns, the FMS readily identifies functional limitations and asymmetries. These are issues that can reduce the effects of functional training and physical conditioning and distort body awareness.
The FMS generates the Functional Movement Screen Score, which is used to target problems and track progress. This scoring system is directly linked to the most beneficial corrective exercises to restore mechanically sound movement patterns.
Exercise professionals monitor the FMS score to track progress and to identify those exercises that will be most effective to restore proper movement and build strength in each individual.
What it Does – Widespread Benefits
The FMS simplifies the concept of movement and its impact on the body. Its streamlined system has benefits for everyone involved – individuals, exercise professionals, and physicians.
Communication – The FMS utilizes simple language, making it easy for individuals, exercise professionals, and physicians to communicate clearly about progress and treatment.
Evaluation – The screen effortlessly identifies asymmetries and limitations, diminishing the need for extensive testing and analysis.
Standardization – The FMS creates a functional baseline to mark progress and provides a means to measure performance.
Safety – The FMS quickly identifies dangerous movement patterns so that they can be addressed. It also indicates an individual’s readiness to perform exercise so that realistic goals can be set and achieved.
Corrective Strategies – The FMS can be applied at any fitness level, simplifying corrective strategies of a wide array of movement issues. It identifies specific exercises based on individual FMS scores to instantly create customized treatment plans.
If you would like a FMS course for your local Chiropractic Society or State Association meeting, please contact Dr. Tucker @ firstname.lastname@example.org.