Regularly in the BodyWorks clinic, I see people with poor movement patterns during a single leg squat. As we run only on one leg, this is a good functional test to assess peoples ability to stablise their pelvis, hip and knee joint during running. Inability to do so is strongly attributed to weakness or rather inactive glutes.
The glutes are three muscles named after their size, gluteus maximus, gluteus medius and gluteus minimus.
If when performing a single leg squat movement pattern in front of the mirror, look at your leg alignment and check the following:
1. Is your knee tracking over your toes? Or does it appear to travel inwards? (B)
2. Does your hip remain stable? Or is it falling outwards?
3. Are you able to keep your upper body upright with your chest facing forwards?
If any of these are happening, then your glutes maybe inactive and targeting them in a pre-habilitation programme might be beneficial with regards to injury prevention. Inactive glutes can cause a multitude of additional problems, from medial (inside) knee instability, lower back pain, Sacro-Illiac joint dysfunction and pain, Piriformis Syndrome to ankle instability problems and Achilles tendinopathy!
There is a rule in pre-habilitation and that is lengthen before you strengthen. In this case, You’ll need to lengthen through the hip flexors before you target your glutes in an isolated exercise. Gluteal activation is naturally enhanced if the hip flexors are stretched in advance primarily because the elongated hip flexors permit a greater range of movement though extension of the hip, therefore encouraging the gluteals to fire throughout their full range. Click here to see a video of how to perform a hip flexor stretch
When strengthening your gluteus maximus, you also need to be aware that hamstrings tend to dominate in hip extension (taking your leg backwards). To activate the gluteus over the hamstrings, we need to choose hip extension exercises that are performed in knee flexion to minimise hamstring involvement.
This single leg shoulder bridge exercise is a great example of how to activate your gluteus maximus in isolation. The knee needs to be bent over 90 degrees, with the foot planted on the floor. Lift your toes so all the weight is taken on the heel as this will minimise quadriceps activation.
The single leg shoulder bridge exercise helps us to activate the gluteus maximus, which in our single leg squat movement pattern keeps our upper body upright and chest facing forwards. What prevents our femur (thigh bone) from coming inwards is an inactive gluteus medius during the same movement pattern, therefore weakness through this muscle can easily result in instability to the pelvis, resulting in lower back pain. (B)
Those with an inactive gluteus medius tend to over rely on their Tensor Fascia Latae (TFL) to generate hip abduction force which then overloads the ITB and can leave up with lateral knee pain (runners knee)! Ow!
To counteract this tendency, in pre-habilitation we need perform exercises which keep our hip joint externally or outwardly rotated, as research suggests that the TFL cannot work if the hip is kept in slight positions of external rotation. Ideally, we also need to keep the hip in extension as again this switches off the TFL and preferentially uses gluteus medius in generating hip abduction. Here is a simple leg abduction exercise, with the top leg externally rotated and the hip held in slight extension in order to help isolate the gluteus medius.
When performing these exercises it’s worth remembering that you’re doing them to prevent injury and so ideally they need to be integrated into weekly gym based strength sessions. The gluteus maximus is a phasic muscle meaning that it’s there to generate power and propel you forwards in running and walking, so I would suggest training gluteus maximus similar to traditional strength training; 3 x 6-10 reps. The gluteus medius however tends to have more of a tonic activity, that is, it works continuously to stabilise the pelvis in one legged stance. Therefore it needs to be trained to satisfy this function. Train gluteus medius in high reps (20 x 2 sets) or constant holds such as 5 x 20 second holds.
Watch out for more videos to be added to the site in order to compliment this article. If you have any questions or would like further information, then please don’t hesitate to contact me at Rebecca@bwtherapy.co.uk or visit bwtherapy.co.uk for more information.