14

Gluteus Medius eccentric exercises

The gluteus medius , one of the three gluteal muscles, is a broad, thick, radiating muscle, situated on the outer surface of the pelvis.

File:Gluteus medius muscle - animation01.gif    File:Gluteus medius muscle - animation04.gif

Origin:

– outer surface of illium, between the posterior and anterior gluteal lines.

Inseration:

-lateral and superior surfaces of the greater trochanter of femur.

Action : on the tigh ( femur )

– abduction

– medial rotation

-lateral rotation

      

Gluteus medius strengthening

Gluteus medius eccentric loading exercise

The aim of this exercise is to work the tendon of the gluteus medius muscle on the outside of the hip in a very specific way. The tendon and muscle are worked whilst they are being lengthened, not while they are contracting.This is what eccentric loading means.

Stand squarely on the floor next to a wall good leg facing the wall.  ( see pic. 1)

Using your arms and your good leg, but not your bad leg, lift your pelvis up so that you are tipped over towards your bad side. On tip toes on your good side. ( see pic. 2)

Now lift you good leg off the floorbending at the knee. Slowly and gradually lower your pelvis so that you are tipped over to your good side stretching your bad side. Use only the muscles (gluteus medius) only your bad hip to control the decent. You can use your hands to steady yourself, but the idea is that your bad hip is taking all of your body weight as you tip over and gradually lowering you down as far as you can go. ( pic 3 )

Return to the start position using your good leg and arms, but not using your bad leg.   The bad side works only on the way down, not the way up.

Repeat 10 times and have a rest.

Aim for 3 sets of 10 exercises morning and evening, but be guided by your discomfort. It is normal to ‘feel’ the exercise, but it should not be really painful. If it is not to bad you can do more repetitions. If it is very uncomfortable you should do fewer repetitions.

Other exercises :

One leg squat : ( you can help yourself with a chair )

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Side-lying abduction

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Side plank abduction

This is reproduced from Boren et al. 2011 who did an excellent study and also compared their results with earlier work. Their top 3 exercises for Glute Medius were side plank abduction with dominant leg down, side plank abduction with dominant leg up and single leg squat (in that order). Notice again that these positions, despite being “non-functional” do create a lot of activity in Glute Medius and again more so than weight bearing positions such as single leg squat. Of note too is that they found less activity with side-lying abduction than the previous studies. This raises a good point with research and rehab. Nothing is concrete. You simply cannot say “this exercise has no role” as you will find evidence to support your claim and evidence to refute it. Also they used a slightly different technique which might account for the difference.

The Clam

Single Limb Squat

Front Plank

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Single leg balance- focus should be on maintaining a level pelvis without adducting the hip. Use support initially if needed. Aim for 10-15 seconds, repeat 5-10 times (stop if painful).

Running may need to be avoided or at least reduced during a reactive tendinopathy. This is the last thing you want as a runner but may be a necessity in early management of GT. The issue with tendinopathy is that if you continue to overload the tendon it can progress from a reactive tendon, to dysrepair and degeneration during which stages the tendon structure starts to change. Reactive changes are reversible but degeneration of the tendon generally isn’t. That doesn’t mean it can’t be managed it’s just better to prevent it happening in the first place!

In mild cases you may continue to run but try to ensure running remains pain free and there is no reaction for at least 24 hours after. Your Physio should guide you on continuing to run and/ or returning to running after rehab

Tips :

  • Try to find the exercises that best suit you and the ones that bast work for you.  If you find sidelying exercises are getting you results without causing symptoms then great. If not try some of the others above and see which ones seem to work your glutes and get results.
  • Try to do 3 sets of 10-15 reps with a 1-2 minute break between the sets.
  • Then progress up towards 20-25 repetitions, you’re aiming to fatigue the muscle so there will be lots of individual variation in the reps needed to do that. That said if you can do more than 30 reps without fatigue than try to find a harder exercise.

The best advice is to see a Physio who can assess you and provide appropriate exercises and help you perfect the technique.

Information and Pictures courtsey of :

6

Osteoarthritis

Osteoarthritis (OA) is one of the most common forms of arthritis.  It is a chronic condition in which the material that cushions the joints, called cartilage, breaks down. This causes the bones to rub against each other, causing stiffness, pain and loss of joint movement. The cause is not fully understood.

Signs and symptoms :

Osteoarthritis symptoms usually develop gradually. At first, there may be soreness or stiffness that seems more like a nuisance than a medical concern. 

Common symptoms include:

  • Sore or stiff joints – particularly the hips, knees, and lower back — after inactivity or overuse
  • Stiffness after resting that goes away after movement
  • Pain that is worse after activity or toward the end of the day.

Signs :

  • pain with activity, but relieved with rest
  • joint stiffness,especially in the morning when the body is cold
  • crepitus- a grating sensation
  • mild joint swelling

Osteoarthritis, or OA, may also affect the neck, small finger joints, the base of the thumb, ankle, and big toe. The pain may be moderate and come and go, without affecting the ability to perform daily tasks.  Some people’s OA will never progress past this early stage. Others will have their OA get worse. The pain and stiffness of more severe osteoarthritis may make it difficult to walk, climb stairs, sleep, or perform other daily tasks. 

Causes :

  • changes in joint mechanincs
  • repeated trauma to the joint ( lifting,running )
  • direct blow
  • aging – common amoung older patients and progresses with age

Diagnosis :

If you are suffering of OA ,the doctor will ask questions about your medical history and perform a physical exam and, possibly, take X-rays to confirm the diagnosis. 

Treatment :

  1. medication
  2. heat and / or cold treatments
  3. streching to maintain flexibility
  4. water exercises to maintain mobility
  5. low or no impact cardiorespiratory conditioning 
  6. physical therapy
Self-Care

Staying physically active and maintaining a healthy weight are the keys to living well with osteoarthritis. Too little movement can lead to stiffness and weak joints. Losing one pound can take four pounds of pressure off your knee joints.  Overall fitness improves health in many ways. Strong muscles protect joints. An OA management plan also involves eating a nutritious diet, managing stress and depression, and getting a good balance of rest and activity each day.

 

 

 

 

 

0

Bursitis

Bursitis is the inflammation of one or more bursae (small sacs) of synovial fluid in the body. The bursae rest at the points where internal functionaries, such as muscles and tendons, slide across bone. Healthy bursae create a smooth, almost frictionless functional gliding surface making normal movement painless. When bursitis occurs, however, movement relying upon the inflamed bursa becomes difficult and painful. Moreover, movement of tendons and muscles over the inflamed bursa aggravates its inflammation, perpetuating the problem. Muscle can also be stiffened.

Bursae- are fluid filled membrane sacs that serve as buffers between tendon and bone, skin and bone or between two bones.  They act as lubrificators to decrease friction.

Causes :

  • repetitive movement and excesive pressure : shoulders, elbows and knees are the most commonly affected
  • Inflammation of the bursae might also be caused by other inflammatory conditions such as rheumatoid arthritis and gout
  • traumatic injuries : the inflammation irritates because the bursa no longer fits in the original small area between the bone and the functionary muscle or tendon. When the bone increases pressure upon the bursa, bursitis results.

Signs :

  • pain due to increased fluid production : as fluid accumulates,pressure builds causing pain
  • swelling
  • decreased ROM ( range of motion )
  • loss of function

Treatment :

– follow the inflammation treatment protocol ( ITP  )   -> u can revise it in the Inflammation topic of my blog

Bursae that are not infected can be treated with rest, ice, elevation, physiotherapyanti-inflammatory drugs and pain medication. Since bursitis is caused by increased friction from the adjacent structures, a compression bandage is not suggested because compression would create more friction around the joint. Advanced massage therapy techniques can also be employed to help with the inflammatory process of bursitis.Bursae that are infected require further investigation and antibiotic therapy. In cases when all conservative treatment fails, surgical therapy may be necessary. In a bursectomy the bursa is cut out either endoscopically or with open surgery. The bursa grows back in place after a couple of weeks but without any inflammatory component.