From our friends and mentors at the Postural Restoration Institute and The Hruska PT Clinic…..
5 MUSCLES YOU THINK YOU'RE TRAINING... BUT YOU'RE NOT!
What to do when good treatment just doesn't work
If you have seen a Physical Therapist for a rehabilitation program or done any type of strength and conditioning program to improve your strength or performance, with or without the help of a certified trainer, you have been instructed in a program that aims to train specific muscle groups. This is the purpose of rehabilitation or training.
But, what if you are doing everything in that rehab or performance program you should and are just not seeing the results you want. Maybe your back still hurts after weeks or months of “core” strengthening exercises you got from the PT. Or maybe you just haven’t gotten that much faster or stronger in your jumping despite having your butt kicked with all that glute strengthening activity you’ve been doing for months. What’s that all about?
Here’s the deal. Many trainers and Physical Therapists have great knowledge in what needs to get stronger and can give a great program to strengthen specific things to get the results you should get.
They are just missing one really important concept.
Muscles have specific alignment needs in order to be able to work effectively. The position you place a muscle in has a significant impact on how well it can actually contract and do the things you are asking it to do. If it can’t effectively work the way you are asking it to, your brain will automatically ask other muscles, that aren’t as good at the task you are trying to do, to “help out”. This effectively allows the muscles that you are training to stay weaker while at the same time may be allowing other undesirable muscles to get stronger.
Muscles are placed in a specific alignment by the position, or posture, they are placed in either purposely or unconsciously when you are training them. At the Hruska Clinic we understand normal patterns of human movement and posture that renders some muscle groups ineffective at doing their job. Unless this is addressed first any rehab or training program, even programs with the correct activities, will be ineffective at best, and potentially could be actually making you feel worse by doing them.
Here are 5 commonly trained muscle groups that are often not accessible for effective training unless muscle position and posture is addressed first.
1. Glutes
Your gluteal muscles, or glutes, are actually a combination of several muscle groups that attach from your pelvis to your thigh bone at the back and side of your hip. You actually have three glutes on each side (along with some other smaller deep hip muscles)! You have the well known Gluteus Maximus which is a strong outer rotator of the thigh and extender or the thigh. It is the largest of the gluteal group and is your primary pusher (or should be) when doing things like stairs or squats or
lunges. You also have your Gluteus Medius and Gluteus Minimus which are underneath the Gluteus Maximus and are more responsible for turning the thigh bone in and taking the thigh bone out to the side. Their primary role functionally is to stabilize the hip when you are standing on one leg. When you are balancing on one foot (which only happens every step you take) this glute group keeps the hip joint stable so you can balance and push yourself to the next step with your “push” glutes.
These muscles are very
commonly trained and isolated
in rehab programs for general
leg strength like after any leg
surgery or injury. They are
needed for any activity done in standing so if you are having pain or issues with any activity in standing your glutes will probably be trained. For performance purposes glutes are necessary to gain more power and control with running, jumping and other sport specific actions.
Both of these glute groups are strongly influenced in their ability to do their jobs based on the position of the pelvis and the thigh bone. The pattern or position in which you hold yourself up when you stand or walk will have a direct impact on the position of these muscle groups which in turn influences how well or effectively they can do their job. If this position is not ideal, and not addressed, you will compensate to push or stabilize with other muscle groups that may not be as good at that job as your glutes.
For example, if you are doing and activity that requires pushing with your gluteus maximus like a squat, lunge or a ‘glute bridge’ and that muscle can’t work as effectively as you’d like, you will engage some of your other "pushers". If you’ve gotten done with a “glute” workout and your back is sore, or your knee is sore or hurts during those activities, you may not have access to your gluteus maximus muscle the way you’d like. If you are doing a stabilizing activity, or activity on one leg (walking and running included) and you can’t access your stabilizer glutes you will engage other less effective stabilizers. This undesirable compensation can lead to potential issues with your thigh, knee, back or deep hip joint.
What we understand at the Hruska Clinic, based on science taught through the Postural Restoration Institute , is that our body is biased for more stability on the right leg and more push on the left leg. This is based on postural and functional asymmetries that are common human characteristics. What this means for your glutes is that you will have better access to your right hip stabilizers (Medius and Minimus) and better access to your left pushers (Maximus). Unless this imbalance is addressed, glute programs may not give you the desired results you want or may be creating pain patterns in areas you don’t want.
2. Abdominals
When someone is started on a “core” strengthening program the abdominal group is the main (and sometimes only) muscle group people think of. This group of muscles attaches to your pelvis bone and your sternum and rib cage in the front and sides and in the case of the deep layer of muscles runs from one side of your lower back/spine all the way around to the other side like an internal belt or brace. It’s primary job (other than looking good on the beach) is to stabilize your abdominal contents and reduce strain on your lower back as well as to help create movement of your trunk needed for rotation and power along with stabilizing the midsection of your body so your extremities can function to do their jobs effectively.
They are used ALL the time when you are upright and moving. This is why they are, and should be, a part of any strength and conditioning program and will be involved in just about every lower back rehabilitation program I’ve ever seen. Because of their attachment on the pelvis bone and ribs their ability to function correctly is directly influenced by the position or posture of the pelvis and rib cage. An anteriorly tipped pelvis will lengthen the abdominal muscles and render them less efficient. “Flared” or outer rotated ribs will also limit abdominal efficiency.
If your abdominal muscles are not in the correct position when you are training them you will utilize other muscle groups to provide that “core” stability you require. Commonly over trained “core” muscles that will engage for your abdominals are your hip flexors, which can stabilize your spine and hip in an anteriorly tilted pelvis position, your lower back muscles which will also work harder to stabilize and protect your spine if your abs aren’t helping out, and your diaphragm or breathing muscle that will try to stabilize your spine, ribs, and abdominal contents if the ab group is failing at that. If you get done with a “core exercise” and have front hip pain, lower back pain or can’t breathe well, during or after an activity, you may be compensating and not utilizing your abs well.
Therefore, the position of both the pelvis and rib-cage will need to be addressed prior to and during any abdominal activity. Both of these areas, your pelvis and rib cage, are positioned in a pattern for upright posture by a neurological process in your brain. There are many factors taken into consideration by your brain to ‘set’ this postural pattern, like the surface you are standing on, the activity going on around you and your current strength or fatigue levels. If your upright pattern or posture is imbalanced, this WILL directly affect your abdominal efficiency. We understand those patterns of activity and the myriad of things that may be influencing them, and will address them to ensure you actually develop an effective core for performance and injury rehabilitation.
3. Lower Traps
The lower trapezius, or lower trap, muscle is a muscle that lies on the back of your shoulder blade. It runs from the main spine
of your shoulder blade down and in to connect to many of the thoracic vertebrae on your back. It is a muscle that pulls your shoulders “down and back”. This is a common cue for many programs and exercises to stabilize the shoulder blade, improve forward shoulder posture and to protect your shoulder, or rotator cuff, when doing arm activities. If the lower trap muscle isn't working well the shoulder blade, which is the socket for your shoulder joint, will not be able to allow the muscles of the shoulder and arm to work well. For this reason this muscle is isolated and trained not only for posture, but also for overhead athletes to prevent arm injury, improve arm function for throwing, and is a key scapular stabilizer in shoulder rehab in surgical and non-surgical cases.
If the lower trap isn’t stabilizing the shoulder blade you may develop compensatory muscle activation of the upper trap (neck), latissimus dorsi (lower back), posterior rotator cuff, among others. Another often overlooked impact of the weakness or imbalance between the lower trap muscles is in their ability to stabilize and rotate the middle thoracic spine.
In order to effectively train the lower trap the position of its attachments, the shoulder blade and thoracic spine, must be addressed to ensure proper muscle alignment. The shoulder blade is a large bone that sits on top of the rib
cage. It is not actually attached to the rib cage except through muscle attachment. Therefore the position of the shoulder blade is directly impacted by the position of the ribs underneath it. The thoracic spine moves primarily in the forward and backward or rotational directions. The rotation of the thoracic spine is also directly influenced by, and influences, the position of the rib cage.
Due to this anatomy the primary factor that needs to be addressed to ensure the lower trapezius is in a position to function well is the position of the rib cage and thoracic spine, not just the shoulder itself.
Unfortunately, it too often is not.
Your rib cage moves (expands and contracts) as you breathe. Therefore, breathing and how you breathe with proper rib mechanics directly affects rib position, spine position, scapular position and ultimately,lower trap position. Breathing mechanics along with spine position are too often missed in shoudler rehab or performance training.
If you haven’t gotten the results you want from your shoulder performance or rehab program and no one has looked at your breathing, perhaps that needs to be addressed so your program can actually work.
4. Pelvic Floor
The pelvic floor is actually a group of muscles that are attached to the base of the pelvis and work somewhat like a sling or hammock to support your internal organs as well as giving support to the pelvis bones themselves. There are three main bones that make up the pelvis itself. The sacrum and the right and left innominate bone. The sacrum is the wedge shaped bone at the base of your spine that extends into your tailbone (or coccyx) and the innominates are the “hip” portion of your pelvis that houses your hip socket. That bone is actually also divided up into 3 sections (the ilium, the ischium and the pubic bones.) The pelvic floor muscles are named for which of these bones they attach to. (I.e the pubococcygeus attaches the pubic bone to the coccyx) Functionally it is hard to isolate one pelvic floor muscle from another which is why we group them as your pelvic floor muscles.
The most common reason that someone may be training the pelvic floor muscles is for what is termed pelvic floor dysfunction (PFD). Pelvic floor dysfunction is associated primarily with incontinence but can be also related with other pelvic pain issues. The gold standard exercises for pelvic floor dysfunction are Kegel exercises which are just exercises to intentionally contract your pelvic floor muscles to strengthen them. Biofeedback units are also often used to train people to ensure those muscles are contracting well. Unfortunately some people just don't seem to make progress despite doing Kegel exercises literally for years!
When Kegel exercises aren’t working as well as we would like what has happened, as with our other challenging muscles, is that the position of the muscles wasn’t addressed prior to starting or performing this program. Because the pelvic floor muscles are attached to the pelvis bones their ability to function in the manner they should is directly associated with the position of the pelvis bones. Anything that affects the position of the pelvis bones has an ability to influence the position, and therefore function, of the pelvic floor muscles. Pelvis bone position is influenced by many things but the things we specifically would address are your postural patterns when standing, your ability or inability to shift your center of gravity from side to side with walking, and your foot mechanics with walking (yes your shoes can have a major impact on your pelvic floor function!) among others.
Another key factor and purpose of the pelvic floor is its role in proper diaphragmatic breathing. Your ability or inability to breathe with a normal diaphragmatic breathing pattern is of primary importance to ensuring correct pelvic floor function. Once we address issues that impact your pelvis position and breathing patterns, the ability for the pelvic
floor to function correctly is dramatically improved. If your Kegels aren’t working, perhaps we should look
at some other things.
5. Hamstrings
One of the most often trained or treated muscles by both Physical Therapists and trainers is the hamstring muscle. This muscle, located on the back of the thigh, is stretched, pounded on, scraped, beat up and can be the bane of existence for most people. The hamstring is actually a group of 3 muscles that attach on the base of the pelvis bone, and the back of the thigh bone and run down to the shin bones. Its primary role is often thought to be bending or flexing your knee, which it definitely does, but it is also a very strongly influential muscle for
control of forward and backward tipping of the pelvis. Tightness, or perceived tightness, in the hamstring on one side or both is often seen with people who have lower back pain, hip pain, and front knee pain. Therefore in order to “treat” those issues hamstring flexibility is often a main goal of programs. Let the stretching begin!
However, this hamstring tension that is felt and seen is often more of a product of the position of the hamstring and the demand placed on it rather than the true length of the hamstring itself. In many people, especially those with lower back pain and tightness, the
pelvis is tipped anteriorly. This position of the
pelvis effectively moves the attachment points of the hamstring (the
knee and the base of pelvis) further away from each other
which actually puts the hamstring muscle into a tighter position before we even start to address it. Whether this happens on one side or both this tilt also increases the demand and need for tension of that muscle as its job is to try and control the pelvis bones. At this point the hamstring is now actually long, overactive and in a poor position. No wonder it feels tight.
Neutral pelvis = Anterior tilt = normal hamstring "tight" hamstring length
This training problem is not that we are addressing the wrong muscle, it is in how we are addressing that muscle. This hamstring does not need to be stretched. In fact stretching it actually places increased demand for tension on the muscle and can have the opposite effect that we are desiring. The position of the hamstring needs to be addressed, especially at the pelvis. If it feels tight it probably actually needs more strength to control the tip of the pelvis, not more stretch. It’s amazing to see a hamstring that only has half of its available motion go to a normal length in seconds, just by getting it a little stronger and in a better position. We do it all the time.
If you’ve been stretching your hamstrings like crazy and they are still “tight” maybe it’s time to try something new.
Conclusion
Nearly every treatment program for rehabilitation or performance addresses and trains specific muscles to try and accomplish their goals. And they should. Unfortunately, for sometimes these well designed programs just don’t give us the desired outcomes whether pain relief or improved performance. Without addressing why certain muscles may not be able to work the way we want them to, even the best programs are doomed to fail.
When you understand some predictable and common patterns of human movement and performance, as well as the factors related to those patterns, you can ensure that the muscles we want to be training can actually be accessed to be trained. Our staff at the Hruska Clinic understands these patterns and everything that influences them, and has the tools available to truly address them. If you have been struggling with these muscles, or others, and your rehab or performance hasn't seen the improvements you would like, give us a call and we will be more than happy to help you access these muscles in a more efficient way.
Visit our website: www.pinnaclephysicaltherapy.org
https://pinnaclephysicaltherapy.org/become-a-patient
For more information from the friends at the Postural Restoration Institute and Hruska PT:
www.hruska-clinic.com Hruska Clinic Restorative Physical Therapy Services 402-467-4545