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Posted 01/10/2012

In my last blog I wrote about feeling the love of the left inner thigh muscle with PRI exercises to help with our ability to shift our body weight to the left to achieve and keep a neutral position of our pelvis.  If you missed it, feel free to read it here.  Hopefully you were able to feel your left inner thigh while shifting your weight from side to side as you stood in line buying (or returning) those last minute Christmas gifts.  I also hope that the abundance of holiday music like “I’m dreaming of a White Christmas” or “Jingle Bell Rock” on the radio and in the stores helped clear the chorus of “Can you feel the love tonight?” from your mind. 
As we shift (get it?) into a new year I want to shift to a new muscle for this blog.  One of the next muscles that we usually emphasize with our programs is the left gluteus medius, or glute med.  This muscle has several important functions that are desirable in having success with a PRI program.  These include turning the thigh bone (femur) in (internal rotation), and probably more importantly stabilizing the pelvis over the head of the femur once we have achieved the proper shift into the left hip with the left inner thigh (adductor) muscle.  This is especially important in standing positions and walking to allow us to keep that proper weight shift to the left and not revert back to the overactive tendency to stay shifted to the right side.  If the glute med is ineffective, due to improper position, or weak, your ability to maintain a neutral pelvis with upright activity or walking will be challenged.  That is why our exercises will progress from just finding and feeling the left glute in a lying down position gradually to an upright position when your therapist feels you are strong enough.  If this is progressed too quickly and the left glute is not felt or strong enough pelvic neutrality will be lost and our program will stall and so will your recovery.  So let’s make sure you can feel it…
If the glute med is appropriately working, it should be felt on the side and back of your hip behind your hip bone (think of your left back pocket), not in front.  If you do not feel that muscle work when we want it to there are a few hints that we give to help you feel it.  First of all you need to be able to fully shift into your left hip with your left inner thigh, so if you cannot feel your left inner thigh you will be challenged to feel your left glute med work properly.  Therefore, all of the issues that can prevent you from feeling your left inner thigh may prevent you from feeling your glute.  This includes things like hip capsule flexibility, right inner thigh over use, and lack of right chest wall mobility.  See my previous blog if you need reminders.  There are a few other issues I want to high-light specific to the left glute med. 
The muscle on the side of your hip in front of the hip bone (the tensor fascia lata, or TFL) will commonly try to help internally rotate your thigh bone instead of your glute if it (the glute) is in an improper position or weak.  If the pelvis is forward, as is common on the left side, the TFL becomes better positioned than the glute to turn the thigh bone in and becomes overactive.  It also will flex the hip and pull the pelvis further forward limiting the ability to keep the pelvis in a neutral position.  This is not what we want, so the TFL is not a muscle we want to feel with any exercise that requires turning the left thigh bone in.  So if you feel the front of your hip working when you turn your left thigh bone in we need to do something to stop that.  First of all we need to make sure you are in the proper position (fully shifted into your left hip, left knee/hip back behind your right).  Then, in order to shut off the TFL, we sometimes will cue an active isometric contraction or muscle squeeze into hip adduction and/or extension by either squeezing the left knee down into the right or pushing the left thigh back into a chair or door frame prior to rotating the thigh bone in.  This should help. 
Another important thing that may help is to make sure that your left ribs are fully pulled down with your left abdominal wall (full left ZOA for you therapists out there) to achieve full stability on your left side and maximize the proper position of the left pelvis and glute.  This will be highlighted more in my next blog. 
As we stated above the left glute med is important for hip stability in standing and walking positions.  Once you have adequate strength in a lying down or seated position we need to get you to feel the left glute work in a standing position.  The most important factor is to make sure that you have achieved a proper standing hip shift back into your left hip with your left hip back, your right hip forward (pelvis pointing to the left) with weight on your left leg (left AFIR position) and without extending your back.  If you are not in that position your glute will not be in the proper position and you will not feel your left glute work as effectively as possible.  One of the cues in stance that we use for this is similar to the left adductor in that we want you to feel your right shoe arch when standing and shifting to the left to inhibit the right adductor and allow the pelvis to fully shift to the left.  This is one of the reasons why proper footwear and foot position is so important with upright activity.  Don’t transition to a single leg activity on the left leg until you are fully engaged and into the proper position or your glute and program will be challenged.
If you are doing your exercises at home and cannot get your left glute to engage or your front hip to relax during exercises aimed for your left glute med be sure to let your therapist know so they can help you find a way to feel it. And hey, no corny song that will get stuck in your head this time.  Besides, the only one I could come up with for the glute was Sir-Mix-A-Lot’s “Baby Got Back…” Oops… sorry.

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Posted January 10, 2012 at 3:57pm by Torin Berge.
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