Be Well Personal Training

Sunday, September 30, 2012

Bridging, hamstring dominance, and how to find your glutes

Bridging is one of those movements that shows up in multiple systems, with multiple variations, for differing reasons.  There is the post rehabilitation bridge, designed specifically to work hip extension, the yoga bridge, which emphasizes opening up the front of the body, and the Pilates bridge, which focuses on vertebral segmentation.  There is the Cook hip lift, the handstand to bridge in yoga, and the interesting CST bridge involving arm reaches and rotation, which I have only been exposed to once and in no way have mastered.  All of these movements share the basic premise of hip extension and, when done incorrectly, can lead to either compression of the lumbar vertebrae or hamstring cramping/discomfort due to moving from the wrong place.  Today, I am focusing on the latter, although I would argue that learning how to activate the gluteal musculature not only takes pressure off the hamstrings, but also allows the lumbar region to stay stable during hip extension.

The two main muscles involved in hip extension are the gluteus maximus (GM) and the hamstrings muscle group, specifically the long head of the biceps femoris (BF) and the semimembranosis (SM) (Ono, Higashihara, and Fukubayashi, 2011).  In an ideal world, the gluteus maximus would be the prime mover, or main muscle used, and the BF and SM would be synergists, or muscles that help the gluteus maximus do its job.  Unfortunately, what happens often in a culture where we spend a lot of time sitting and is these muscles become, in the words of the wise Sarah Young, "lazy."  As a result, the BF and the SM pick up the slack, and take over as the prime mover.  Why is this bad?  Unlike the gluteus maximus, the BF and the SM aren't designed to generate large amounts of force.  In a case study of a 42 year old triathlete complaining of hamstring cramping, EMG analysis showed excessive hamstring activation during hip extension and GM weakness (Wagner, Behnia, Ancheta, Shen, Farrokhi, and Powers, 2010).  A hip strengthening program focusing on GM activation got rid of the cramping and increased GM strength.  I would argue that an even greater issue with the hamstrings becoming the prime mover is an increased risk of hamstring avulsion.  If the BF and SM are responsible for generating force repeatedly throughout the day, during standing up from a chair, running, and walking up stairs, eventually the wear and tear on the muscle will take its toll.  Research needs to be done in this area to support this hypothesis, but I know I can think of three people off the top of my head who have either strained their hamstrings or experienced a rupture.

What does this have to do with bridging?  It is important when learning how to bridge and teaching bridging to make sure the hip extension is initiated with the gluteus maximus.  For the sake of this blog, I am going to focus on a post-rehabilitation bridge with the ultimate goal being something like the Cook hip lift or some other version of the single leg bridge, although both yoga and Pilates have their own tricks for ensuring proper activation patterns.  I find having the person perform the exercise barefoot helps with GM activation.  There has been surprisingly little (or no) research done on the effects of barefoot training versus shod training on GM activation, so this is purely anecdotal.  The feedback from the floor and the focus on big toe activation seems to help the person find the right area.  Another part of neuromuscular retraining which I find useful is visualization.  Livesay and Samaras (1998) reported a significant increase in forearm EMG activity in subjects who were asked to visualize squeezing a ball with their dominant forearm.  I have individuals focus on planting the foot firmly and evenly into the ground, using the big toe, pinkie toe, and heel to evenly distribute the weight.  Then, I have the person imagine the GM, or butt, is doing the work to lift the hips on the ground.  I have the person think about this while taking 3-5 deep, diaphragmatic breaths, maintaining that sense of grounding with the feet.  After breathing and visualizing, I ask the person to lift up, extending (not squeezing) at the hips.  I am looking for a straight line between the knees, hips, and shoulders.  I make sure there is no compression at the cervical spine and that the lumbar spine stays in a neutral position, not arching.  The person holds for a count of 5 and lowers down, repeating 10-15 times.  Once the person has mastered this, it is time to progress to alternating bridges, which involves moving the feet all of the way together, placing the hands on the hip bones to make sure they stay even, and picking up one foot, and then the other.  There should be no hip rotation and, if the foot and GM are integrated properly, there should be no cramping in the hamstring.  The final progression is the single leg bridge, which can be done by starting in the same position and lifting the right leg off of the ground, the Michael Boyle version, which involves putting a tennis ball between in the hip flexor crevice of the right hip flexor and holding it there, or the Gray Cook way, which involves placing the hands around the shin of the right leg while lifting up.  Everything else remains the same, and it is extremely important to maintain good contact with the ground with the left foot, focusing on extension of the left hip.

And, for the final question, why do we work on bridging?  Hypothetically, if we can master hip extension in a supine position, it should make it easier to transfer the concept of hip extension while standing during movements such as squatting, walking, running, and stepping.  These movements should be initiated with the GM and assisted by the BF and the SM, not the other way around.  Remember: maintaining proper movement patterns allows you to move better and hopefully move more.

Yours in health and wellness,

Ono, T., Higashihara, A., & Fukubayashi, T., (2011).  Hamstring functions during hip-extension exercise assessed with electromyography and magnetic resonance imaging.  Research in Sports Medicine, 19(1), pp. 42-52.
Wagner, T., Behnia, N., Ancheta, W.K., Shen, R., Farrokhi, S., & Powers, C.M., (2010).  Strengthening and neuromuscular reeducation of the gluteus maximus in a triathlete with exercise-associated cramping of the hamstrings.  Journal of Orthopedic and Sports Physical Therapy, 40(2), pp. 112-119.
Livesay, J.R., & Samaras, M.R., (1998).  Covert neuromuscular activity of the dominant forearm during visualization of a motor task.  Perceptual Motor Skills, 86(2), pp. 371-374.

Saturday, September 22, 2012

The 2030 report and why exercise professionals have to work together

There were several topics I considered writing about in this month's blog (pain and how it impacts movement, gluteal versus hamstring dominance and how it affects bridging), but after reading "F as in Fat," a report released by Trust for America's Health, I decided those other posts could wait.  "F as in Fat" paints a rather dark picture of the potential state of America's obesity problem (to read the full report, click here:  The good news is that some progress is being made.  In Mississippi, for instance, the rate of overweight and obesity in public school elementary students dropped from 43% in 2005 to 37.3% in 2011.  That is a substantial difference, and one that should be applauded.  However, over 35% of adults are considered obese (BMI of 30 or greater) and 19.6% of children between the ages 6-11 were considered obese in 2008.  This is tragic, not only from a healthcare cost aspect, but because of the negative impact obesity has on wellbeing.  Obesity has many causes and can be looked at from many different angles, but from a fitness professional's standpoint, increasing physical activity is paramount, both in our children and in our adults.  In California, one of the fitter states with 23.8% of the adult population obese, 19.1% of adults reported they participated in no physical activity in the last 30 days.  And in Colorado (the fittest state, at 20.7% obese), only 29.2% of high school students were physically active for 60 minutes, 7 days a week.

In all fairness, as an exercise professional and one who reads the trending news bits in popular media, it is easy to see how daunting exercise can be.  "How much?"  "What type?"  "Is one better than the other?"  "This fitness professional is showing me the best movement to tone my behind, but I tried to bend like she did and strained my back.  What should I do now?"  "And how come some people say high intensity is the only way to go?"  This, coupled with some of the bootcamp style exercise programs popularized by shows like "The Biggest Loser," is enough to make a person's head spin.  Top that off with the fact that industry experts can't even agree (Running is bad!  Crossfit is bad!  Yoga will hurt you!  You should be doing short burst for 4 minutes a day!  Personal training is a waste of money!  People should be self motivated!) and it's overwhelming, to say the least.  When people come to me and ask me what type of exercise program they should embark on, my first question is always, "well, what do you like?"  Dr. Stuart Brown points out in his book "Play" that often we can reflect on what type of play we enjoyed in our childhood and turn that into a hobby as an adult.  I personally think that the words "exercise" and "workout" conjure up images of drudgery.  As Dr. Brown states in regards to running, "Sometimes running is play, and sometimes it is not.  What is the difference between the two?...Play is a state of mind, rather than an activity," (2009).  As exercise professionals, this should really be the first thing we embrace when encouraging physical activity.  As a result, we should stop focusing on the fact that one type of movement/activity/exercise is better than another and embrace a person's individual motivation for increasing movement.  If someone derives motivation and a sense of play from participating in a Crossfit class, despite the fact it is not my personal movement of choice, I am not going to talk him out of it (although I am going to strongly encourage finding an experienced and educated coach).  And every time I see negative comments by fellow professionals crop up about running or yoga (two of my favorite movement choices), I remind myself that no one but me has to approve of my exercise selection.  But I am an educated, knowledgeable professional in the area.  Think of how this must appear to someone who decides he wants to begin integrating exercise into his life and, when reading multiple blogs on the internet, he learns that fitness professionals have an extremely difficult time agreeing what the "right" type of movement is.  People should be encouraged to try a variety of things until they find something that they enjoy, that makes them lose themselves in the moment the way play does.  Instead of arguing over whose method is right, let's work together.  It never bothers me when I realize I can't provide the type of training or the type of movement a person needs.  I simply point the person in the direction of a professional specializing in that type of movement that I trust and holds a similar philosophy of quality over quantity.  If we want to change the course of America's plunge into a nation of osteoarthritis, diabetes type II, coronary heart disease, we have to start working together and embracing all types of movement as valid and good.  Our country deserves it.

Yours in health and wellness,

Brown, S.B., (2009).  Play, Penguin Group: New York.