Ok, I am a bit nervous putting this one out there.
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So, at the risk of looking totally stupid & having a backlash of comments from the smart people out there.......:butcher:
I seem to have had a number of athletic patients (mainly walkers/runners) that have been diagnosed by their physio with "glutes not firing" & have been referred for orthoses.
What does this terminology really mean? Surely the glutes have to be firing for the patient to be walking or am I being too literal & totally missing something here? And if the muscles are in fact just weak, is this just a case of poor terminology?
If I have totally missed something here I would appreciate some help as I feel some extra knowledge would be beneficial for my patients. And for me :eek:
Thanks in advance!
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The physio may mean "weak" or "misfiring" as in not in correct sequence or a combination of both. This may for example be due to an anterior pelvic tilt in compensation for Functional Hallux Limitus although this is not the only possibility.
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Activating the gluts is extremely important for good running technique, but it is also the latest snake oil as it supposed to cure everything.
See this thread: Activating the gluteal muscles -
Thanks Craig. I missed that thread.
I did wonder if this was a new cure-all as weak glutes didn't seem to be the only issue with these particular patients. -
Lisa - I'm curious whether the referring physio/s really expected that an orthotic was going to get the glut firing?
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Ian Griffiths sent me some good gluteal recruitment exercise once, perhaps he might post them up this way.
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I generally do these glute exercises while posting on Podiatry Arena....saves time......;)
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Interesting paper reviewing the effect of hip strengthening ie sidelying hip extension, resistance band clamshell , bilateral squat with resistance band targeting
HER, contralateral pelvic hike (HABD) against wall, single leg squat....etc... on running
Results suggests that hip strengthening exercises will improve hip strength when performing single leg squat however there was no significant changes in running mechanics following the hip strengthening program.
The Effect of a Hip-Strengthening Program on Mechanics During Running and During a Single-Leg Squat
Richard W. Willy, Irene S. Davis
DOI: 10.2519/jospt.2011.3470
STUDY DESIGN: Block randomized controlled trial.
OBJECTIVES: To investigate whether a strengthening and movement education program, targeting the hip abductors and hip external rotators, alters hip mechanics during running and during a single-leg squat.
BACKGROUND: Abnormal movement patterns during running and single-leg squatting have been associated with a number of running-related injuries in females. Therapeutic interventions for these aberrant movement patterns typically include hip strengthening. While these strengthening programs have been shown to improve symptoms, it is unknown if the underlying mechanics during functional movements is altered.
METHODS: Twenty healthy females with excessive hip adduction during running, as determined by instrumented gait analysis, were recruited. The runners were matched by age and running distance, and randomized to either a training group or a control group. The training group completed a hip strengthening and movement education program 3 times per week for 6 weeks in addition to single-leg squat training with neuromuscular reeducation consisting of mirror and verbal feedback on proper mechanics. The control group did not receive an intervention but maintained the current running distance. Using a handheld dynamometer and standard motion capture procedures, hip strength and running and single-leg squat mechanics were compared before and after the strengthening and movement education program. RESULTS: While hip abductor and external rotation strength increased significantly (P<.005) in the training group, there were no significant changes in hip or knee mechanics during running. However, during the single-leg squat, hip adduction, hip internal rotation, and contralateral pelvic drop all decreased significantly (P = .006, P = .006, and P = .02, respectively). The control group exhibited no changes in hip strength, nor in the single-leg squat or running mechanics at the conclusion of the 6-week study.
CONCLUSION: A training program that included hip strengthening and movement training specific to single-leg squatting did not alter running mechanics but did improve single-leg squat mechanics. These results suggest that hip strengthening and movement training, when not specific to running, do not alter abnormal running mechanics.
LEVEL OF EVIDENCE: Therapy, level 2b.
J Orthop Sports Phys Ther 2011;41(9):625-632, Epub 12 July 2011. doi:10.2519/jospt.2011.3470
KEY WORDS: biomechanics, gluteus, knee, lower extremity -
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Dennis -
The flat foot created by the flexible forefoot FFT relates to a "flat butt".
The powerful and massive glutes of the ballet dancer is the result of a well trained peroneus longus attached to a rigid rearfoot/flexible forefoot FFT.
In this postural chain, the subtalar joint is merely a conduit joint as is the ankle and the knee and IMHO, it is the FHL and compensatory threshold training of the inhibited muscle engines that need to be addressed.
Dennis -
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Dear All
The late great Vlad Janda describes gluteal inhibition and changes in firing patterns between
1. hamstring/gluteus medius and erector spinae
2. gluteus medius/TFL and quadratus lumborum
He also described muscle inhibition in the gluts secondarily to an immobile sacro-iliac joint on that side.
releasing the SI joint gives immediate and dramatic power increase.
The changing of firing sequences to improve efficiency and thus timing and power is another story. Some never get the sequence back.
All have heard of athletes that explode from the blocks but die about the 70 metre mark while others come from behind.
This all relates to sequence firing. In the first instance all is good until lactate hits and turns the gluts off while in the second group the gluts turn on to produce power. Mostly it these cases is the gluteus maximus.
Raining here. we need it. high fire danger for the south coast
regards
Paul conneely
www.musmed.com.au
poser: why do babies lie on their backs? -
We put them there - there is a dramatic amount of plagio and brachycephaly as a result
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there is a clue in pyramidal and extra pyramidal origins
Paul Conneely
www.musmed.com.au -
After this guy quit running barefoot and in minimalist shoes, and then started wearing foot orthoses and Brooks Beast shoes, he finally started to develop these phenomenal glutes...is there a link between glutes and orthoses...?;)
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Benching 230lbs these days -
Glutes weakness, lack of endurance, and lack of control is the new trend in physio to explain knee problems (PFPS and ITB). Same focus on the consequences of this 'weakness' (dynamic knee valgus and pelvis drop) than the famous pronation 15 years ago. A lot of cross-sectional study (aprox 30) but just 3 prospectives and inconclusive studies... some interesting stuff but over look by physios.
My opinion : nothing to do with orthotics.
Blaise
Physio -
As Eric Fuller DPM admits on another thread, a RF Varus wedge, or any other heel cup correction, as he calls it, will not change the position of the foot in stance. It only alters the forces that it can exert on the foot, in this case, mainly the rearfoot.
The way to impact the POSITION of the foot is to alter its structure. As I have been suggesting, that lives in the realm of architectural, not physics.
If I have a structure that is collapsed, I do not tilt the entire structure to one side or the other, I raise it up and shore it foundationally. In other words, I fix it on the sagittal plane and to a lesser extent, the transverse plane.
When I then, secondarily, add tilt so as to force functional change, it will have more impact (I will need to add less force!).
In any foot with too much motion in the truss-tie beam system that is leading to a collapse (lengthening, widening and/or flattening of the foot, vaulting of the foot changes its position and eventually reduces the excess motion via Wolfs and Davis's Laws (positive structural change) so that forces applied are more productive.
The Foot Centering Theory of Structure and Function is such a theory as is Dr Roots and Dr. Dananberg.
IMHO Tissue stress and SALRE and hence The Podiatry Arena are too weighted in in the function portion of biomechanics and need to add more structural biomechanics in order to provide the research that they demand of others but cannot themselves provide.
Dennis