Optimal Function Blog: 
Buns of Steel!
10 Top Tips to Gluteus Maximus Strengthening 
following low back injury
My motivation to write this article is due to the increasing amount of recurring low back pain in fit, healthy and strong clients. As health professionals, we have a duty to observe our clients' movement patterns and identify the key muscles for prevention of injuries in the future. For example, people have treatment for lumbar disc injury, yet not one exercise has been prescribed for the key preventer muscles such as core & pelvic floor activation. Others may come in with shoulder bicep tendon pain, yet not one rotator cuff exercise (key preventer muscle) has been advised to offload the biceps tendon. This is a reminder to look at the whole body when thinking about an exercise program for our clients and closely observe their bodies when exercising to prevent injuries and ultimately keep them exercising and fit!
sport, bodybuilding, lifestyle and people concept - young man and woman with barbell flexing muscles and making shoulder press lunge in gym  
This brings me to think about one of my recent clients with chronic lumbar pain, who came to me with a program  o f lunges and squats, hip flexor stretches, & mid back strengthening - to help reduce her lumbar l ordosis and address her lower back pain. On paper this would have been a good program addressing leg strengthening, stretching tight hip flexors and strengthening the mid back. The problem is, however, the client was arching and extending her lower back with each exercise increasing her low back pain, she was not aware to activate her core & pelvic floor with the exercises and there was no gluteus maximus activation during her functional exercises such as squats and lunges. She was frustrated and ready to give up the gym even though she loved it.

In this article I want to address one common problem that many clients have following lumbar injury and share with you some tricks and tips to facilitate the gluteus maximus to help prevent recurring back pain and rehabilitate your client.

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GLUTEUS MAXIMUS FUNCTION
Gluteus Maximus needs special attention to ensure it is actually being activated and used during an exercise program. G luteus Maximus is a hip extensor, bringing a flexed thigh in line with the trunk. It prevents the forward momentum of the trunk in standing and supports the hip during gait. It is active in functional movements such as walking, cycling, running, sit to stand, rising from a stooped position and in climbing stairs. It is continuously active in strong lateral rotation, extension and abduction of the thigh. The inferior gluteal nerve supplies the gluteus maximus muscle, the nerve originates at the lower lumbar and sacral areas L5/S1/S 2. Therefore damage to the lumbar spine structures at these levels can therefore affect the Gluteus Maximus function.

Gluteal atrophy can be caused by poor neural activation as a result of nerve damage, stenosis or lumbar vertebral damage. Furthermore, lower limb injuries such as ankle sprains can also decrease the co-ordination of firing or reflexive inhibition of the gluteus maximus muscles.


REFLEXIVE INHIBITION         
Reflexive inhibition is a term that is used to describe 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 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. Eg: 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 sided can become inhibited. As a result, the hamstrings on the left will start to get loaded, as well as 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.

GET IT WORKING!
So how do we address this vicious circle of instability, spasm and inhibition? Firstly, get the gluteus maximus working!

   

 

1.    Educating your clients to focus on particular muscles with each exercise, and be able to understand and feel when they are using certain muscles is an extremely important connection. Eg: show your client a picture of the muscle and explain its function so they understand why it is important to activate.

 

2.    Placing a hand on the muscle you want to activate always facilitates the muscle. Eg: Ask your client to stand up and placeboth hands onto their gluteus maximus, now squeeze your bottom muscles together to feel the movement and contraction. Sometimes this results in a good connection.

 

3.    Lumbar spine rotation stretch with knee bent and in a high hip flexed position. Ask you client to lie on the floor, bring one knee in towards your chest, then slowly rotate the knee across to the otherside of the body. This will open the facet joints helping to take pressure off the inferior gluteal nerve. Following the stretch, repeat gluteus maximus exercise to see if any better activation following the stretch.

 

4.    Lumbar spine side to side gentle rocks to address lower lumbar facet joint tightness and reduce compression on spinal nerves. Performing mild side to side rocking motions is beneficial for a number of reasons. Firstly it massages the lower back into the floor, it gently opens the facet joints either side of the lumbar spine and it reduces external oblique gripping and rigidity in the trunk. Retest exercise to see effect on activating gluteus maximus.

 

5.    Piriformis stretch to help reduce muscles spasm compression on nerves. If gluteus maximus is wasted & 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 to reduce involvement and lengthen hamstrings. As a secondary hip extensor, this 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 stretching can help focus on gluteus maximus to start working functionally.

 

7.    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 to help facilitate 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 activate lats whilst doing a gluteal exercises. Eg: pushing hands into the floor when performing a pelvic roll.
 

9.    Change posturing to involve gravity more. I have clinically found when people are lying on the floor with full support, it is more difficult to try and 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 can be anything from positioning the feet closer to the gluteals or further away, 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 the above mentioned tips will help strengthen the gluteus maximus at the beginning of an exercise program. Before adding in load, or speed, or music to your clients sessions, they must master the gluteus maximus activation. Forget the squats, lunges and leg press until there is a good activation of gluteus maximus with leg movements. Otherwise I fear, that structures such as the low back will be 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 rest due to recurring pain!

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