Hamstring injuries and their gluteal relationship, the dialgoue.
Yesterday we talked about hamstring tears. One of the frequent findings we see in our hamstring injured clients is under performance of the gluteal group. We all are well aware that the hamstrings can be an assistive piece of the posterior chain hip extension pattern in gait. When the glutes are underperforming, under protecting hip stability or underperforming in pelvis control, that the hamstrings can be called upon to do more. The loads an move into the low back or into the leg, or both, when the glutes are underperforming. This study is supportive in an indirect manner.
Sagittal trunk flexion and extension in patients with chronic low back pain.
The study found the duration of gluteus maximus activity was shorter in the back pain patients than in controls during the trunk flexion (p<.05), and it ended earlier during extension. Nothing new here for many of our followers, but it is always worth discussing.
We have talked about the fatigue factor and endurance factor of the paraspinals in low back pain in previous podcasts, maybe a year or two ago. But, in looking for something else in particular today, I came across this article from 2000.
It once again suggests the critical function of the glutes, all 3 divisions and that they do play multiple parts other than just hip stability and movement. We see plenty of clients who have poor development of the upper iliac and sacral divisions of the glute max. This could be from anterior pelvis tilt presentations, faulty movement patterning, or even failure to get to end range hip extension to work on developing that portion of the muscle. Regardless, this once again proves that we are an under-developed glute species and all this sitting is a problem, and even the standing desk trend, will not fix this. The body must move, it must be loaded through to the full range of motion and we must incorporate compound movements with load if we are to get even close to the opportunity to see folks with healthy glutes and thus healthy hips and spines.
"RESULTS:
During early flexion, lumbar paraspinal and biceps femoris were activated simultaneously before gluteus maximus. At the end of flexion and during extension all investigated muscles were activated and relaxed in order. Lumbar paraspinal and biceps femoris muscles were activated in a similar order in low back pain patients and healthy controls during flexion and extension. However, the duration of gluteus maximus activity was shorter in the back pain patients than in controls during the trunk flexion (p<.05), and it ended earlier during extension. Active rehabilitation did not change the muscle activities of lumbar paraspinal and biceps femoris in the back pain patients, but in the measurements after rehabilitation the onset of gluteus maximus activity occurred later in flexion and earlier in extension."
"CONCLUSIONS:
The activity of the gluteus maximus muscle during the flexion-extension cycle was reduced in patients with chronic low back pain. The gluteal muscles should be taken into consideration in the rehabilitation of these patients." - Leinonen et al
Arch Phys Med Rehabil. 2000 Jan;81(1):32-7.
Back and hip extensor activities during trunk flexion/extension: effects of low back pain and rehabilitation.
Leinonen V1, Kankaanpää M, Airaksinen O, Hänninen O.
https://www.ncbi.nlm.nih.gov/pubmed/10638873
