Glutes, activate!

Tiger Woods recently continued his injury woes with yet another withdrawal from a golf tournament. When asked about his reason early departure, Woods explained the blame is on his glutes being "deactivated". He went on to explain that when his glutes don't activate, his lower back problems will soon follow. His explanation has been fodder for many a late-night joke, but there is much truth to his stance. In the therapy world, we deal with these types of issues all the time. Additionally, in the therapy world, we firmly (!) understand the value of a well functioning glute muscle.

The glute max is a vital muscle. Not only does it provide an anchor for the hip, but it also is a key stabilizer of the lumbar spine, aka the lower back. For the hip, the glute max provides movement in three different planes. Even for the lay-est of lay people, this should speak to its relative importance. This glute muscle, along with the gluteus medius and minimus, provide are the foundation of stability for the leg below it. We know that stability of the foundation will help the first floor to be stable too. In the case of the glutes, the 'first' floor includes the knees, as well as the lower back. With a muscle in a weakened or dysfunctional state, normal patterns of firing are unlikely to follow. Thus, it is not that difficult to connect the dots in Tiger's case. If the mighty glute is not firing, it is hard to imagine optimal function can happen. Let's also not lose perspective on the game being play. Golf, particularly professional golf, is a sport which requires its participants to generate huge rotational forces during the standard swing movement. If there is a relative instability because of 'core'  muscle dysfunction, excessive strain will follow. Even if this is a microstrain, golf is such a repetitive sport that there is likely to be a cumulative effect that creates a macro issue. The same is often true for runners- a small problem multiplied by thousands of reps leads to a bigger problem.

One might wonder what causes a muscle not to fire appropriately, to not activate? Good question, and one with many answers. Pain tends to have an inhibitory influence on a muscle. Swelling will also shut a muscle down. Many have experienced this combination with a knee strain where the knee feels like it is going to buckle going down stairs as the quad muscle is not working properly. If a nerve's signal is not getting to the muscles, then the message to fire is never received. A muscle will not fire on its own. It needs to be told to fire by the nervous system. This begins to dabble in the space of 'motor control' which involves the brain, the nervous system, and the muscles. We have learned in rehab that just because a muscle can fire, it will fire. We have learned that if a muscle that is not firing, faulty patterns of movement typically result. The faulty patterns of movement do not improve spontaneously, but have to be re-educated into proper firing, control, and movement. This is a great follow-up post to pursue.

One final thought regarding the glutes relates to relevant exercises to 'activate' them. The basic bridge is a great place to start.

The bridge teaches us how to fire the glutes while the hips go into extension as they are lifted off the floor. The bridge also opens the front of the hip through reciprocal inhibition- i.e. when you strongly contract the glutes, the opposing muscles, namely the hip flexors, will naturally be turned off. This is useful as many desk jockeys tend to be tight in this area from hours of sitting. Another great exercise for the glutes is the squat, particularly when done properly. I encourage people to squat such that their hips and knees stay back. This cues the glutes to be active, and also to minimize the strain on the knee joints. Many folks have spent many a minute in the clinic with me relearning how to do some basic movements. Frustration often occurs but recognize that in PT, we are trying to change things that have led to injury. Underusing the glutes is never good but can be corrected with consistent work. So, after two years of being blog free, I leave you with a good looking glute squat. (And thanks to the barefoot wonder for inspiring me to post...)