lumbar vertebral damage . Furthermore , lower limb injuries such as ankle sprains can also decrease the coordination of firing or reflexive inhibition of the gluteus maximus muscles .
Reflexive inhibition refers to a ‘ switching off ’ reaction of the muscle due to either an injury to the muscle , a fracture in a nearby bone or a problem in the spine at the level from which the nerve supplies that particular muscle . It is a protective mechanism to relax the muscle and reduce severity of trauma . Unfortunately , the reflexive inhibition doesn ’ t necessarily turn back on once recovery begins , and the compensatory patterning of using co-existing muscles will start to become habit . For example , in a left sided L5 / S1 lumbar spine disc injury , the nerve supply to gluteus maximus can become affected , and the gluteus maximus muscle on the left side can become inhibited . Consequently , the hamstrings on the left will start to get loaded , as will the left lumbar erector spinae muscles . Slowly , the piriformis muscle may tighten as a response to decreased pelvic stability and hip flexors will take more workload as a result of the inhibited gluteus maximus .
So , how do we address this vicious cycle of instability , spasm and inhibition ? First , get the gluteus maximus working !
1 Educate your clients
Teaching your clients to focus on particular muscles with each exercise , and to be able to understand and feel when they are using
The 30-second article
• Many otherwise fit , healthy and strong clients suffer low back pain
• Learning to activate the gluteus maximus during exercise can help clients prevent the vicious cycle of instability , spasm and inhibition that can lead to low back pain
• The first step to getting the gluteus maximus working is teaching your client to consciously focus on the muscle during each exercise , raising awareness of its activation – or lack of
• A series of simple stretches and adjustments can help strengthen the gluteus maximus at the beginning of an exercise program
• Don ’ t add load or speed to client ’ s sessions until they have mastered the gluteus maximus activation . certain muscles , is an extremely important connection . Show your client a picture of the muscle and explain its function so they understand why it is important to activate it .
2 Place a hand on the muscle
Placing a hand on the muscle you want to activate facilitates that muscle . Ask your client to stand up , place both hands onto their gluteus maximus , and squeeze their bottom muscles together to feel the movement and contraction . Sometimes this results in a good connection .
3 Lumbar spine rotation stretch
Get your client to perform this stretch with knee bent and in a high hip flexed position . Ask them to lie on the floor , bring one knee in towards their chest and then slowly rotate the knee across to the other side of their body . This will open the facet joints , helping to take pressure off the inferior gluteal nerve . Following the stretch , repeat the gluteus maximus exercise to see if there is any better activation .
4 Lumbar spine side-to-side gentle rocks
Performing mild side-to-side rocking motions addresses lower lumbar facet joint tightness and reduces compression on spinal nerves . It does this by massaging the lower back into the floor , gently opening the facet joints either side of the lumbar spine , and reducing external oblique gripping and rigidity in the trunk . Again , repeat the gluteus maximus exercise to see if there is any better activation .
5 Piriformis stretch
This stretch can help reduce muscles spasm compression on nerves . If gluteus maximus is wasted and weak , then the piriformis muscles can be loaded and become chronically shortened to help with stability around the pelvis . The piriformis needs to sometimes be ‘ downtrained ’ and lengthened to allow the gluteus maximus to start firing up again .
6 Hamstring stretch
Get your client to perform a hamstring stretch to reduce involvement and lengthen hamstrings . As a secondary hip extensor , the hamstring is the first muscle to be recruited to assist a weak gluteus maximus muscle . Again , downtraining or reducing tension via stretching , foam roller releases or PNF ( proprioceptive neuromuscular facilitation ) stretching can help focus on getting gluteus maximus to start working functionally .
7 Hip flexor stretches
Performing hip flexor stretches , to help reduce lumbar erector spinae tension and facet joint compression , may reduce pain in the back and help facilitate a good gluteus maximus contraction .
8 Involve the latissimus dorsi muscles
Involving the latissimus dorsi muscles will help facilitate the posterior oblique system . The gluteus maximus works functionally with the latissimus dorsi muscle via thoracolumbar fascia in the posterior oblique system . Some clients feel they have a stronger gluteus maximus connection when they gently exercise lats whilst doing a gluteal exercise , e . g . pushing hands into the floor when performing a pelvic roll .
9 Change posturing to involve gravity
I have found that when clients are lying on the floor with full support , it is more difficult to activate their ‘ antigravity ’ muscles , such as the hip extensors . Therefore , instead of starting the client in supine on the floor to activate their gluteals , a better contraction can be achieved in standing or performing standing up from a chair .
10 Change foot position
This could involve : positioning the feet closer to , or further away from , the gluteals , making sure their feet are in good alignment or slightly externally rotating their feet . Don ’ t be shy to slightly change the way your clients weight bear through their feet in order to help that gluteus maximus to strengthen !
All of these tips will help strengthen the gluteus maximus at the beginning of an exercise program . Before adding in load or speed to your client ’ s sessions , they must master the gluteus maximus activation . Forget the squats , lunges and leg press until they ’ ve nailed the glutes !
Failure to do so will result in structures such as the low back being unnecessarily loaded , and training for those ‘ buns of steel ’ will be a waste of time . Switch on the gluteus maximus and your clients will feel stronger , be in less pain and be able to continue exercising without the frustration of recurring pain .
Merrin Martin , BAppSc ( Phty ), BAppSc ( Ex . Sc ) is the founder of Active Anatomy Physiotherapy & Health Professional Workshops in Sydney . An experienced physiotherapist , exercise scientist , health educator and qualified Pilates instructor , Merrin is a highly respected expert in exercise rehabilitation . activeanatomy . com
50 | NETWORK WINTER 2016