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Anterior Pelvic Tilt Influence on Squat Mechanics

anterior pelvic tilt influences squat mechanicsI feel like we’ve been discussing anterior pelvic tilt lately in several articles and an Inner Circle webinar on my strategies for fixing anterior pelvic tilt.  I wanted to show a video of a great example of how a simple assessment really tells you a lot about how pelvic positioning should influence how we coach exercises such as squats and deadlifts.

If you haven’t had a chance to read my past article on how anterior pelvic tilt influences hip range of motion, you should definitely start there.

In this video, I have a great example of a client that has limited knee to chest mobility and with boney impingement.  However, if we abduct the leg a bit, it clears the rim of the hip and has full mobility with no impingement.

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As you can see, because he is in anterior pelvic tilt, he is prepositioned to start the motion in hip flexion, so therefor looks like he has limited mobility.  I have a past article on how anterior pelvic tilt influence hip flexion mobility, which discusses this a little more.

While you are working on their anterior pelvic tilt, you can work around some of their limitations.  I hate when people say there is only one way to squat or deadlift.

Our anatomy is so different for each individual.

Some need a wider stance while others need more narrow.  Some need toes out while some need more neutral.  Do what works best for your body, not what the text book says you are supposed to look like.

 

 

Should We Stop Blaming the Glutes for Everything?

Today’s guest post comes from John Snyder, PT, DPT, CSCS.  John, who is a physical therapist in Pittsburgh, has a blog that has been honored as the “Best Student Blog” by Therapydia the past two years.  He’s a good writer and has many great thoughts on his website.  John discusses some of our common beliefs in regard to the role of the proximal hip on knee pain.  I’ll add some comments at the end as well, so be sure to read the whole article and my notes at the end.  Thanks John!

 

Should We Stop Blaming the Glutes for Everything?

should we stop blaming the glutes

Anterior cruciate ligament (ACL) rupture1,2 and patellofemoral pain syndrome (PFPS)3,4,5 are two of the most common lower extremity complaints that physicians or physical therapists will encounter. In addition to the high incidence of these pathologies, with regards to ACL injury, very high ipsilateral re-injury and contralateral injury have also been reported6,7,8.

With the importance of treating and/or preventing these injuries, several researchers have taken it upon themselves to determine what movement patterns predispose athletes to developing these conditions. This research indicates that greater knee abduction moments9,10, peak hip internal rotation11, and hip adduction motion12 are risk factors for PFPS development. Whereas, for ACL injury, Hewett and colleagues13 conducted a prospective cohort study identifying increased knee abduction angle at landing as predictive of injury status with 73% specificity and 78% sensitivity. Furthermore, as the risk factors for developing both disorders are eerily similar, Myer et al performed a similar prospective cohort study finding that athletes demonstrating >25 Nm of knee abduction load during landing are at increased risk for both PFPS and ACL injury14.

 

Does Weak Hip Strength Correlate to Knee Pain?

With a fairly robust amount of research supporting a hip etiology in the development of these injuries, it would make sense that weakness of the hip musculature would also be a risk factor, right?

A recent systematic review found very conflicting findings on the topic. With regards to cross-sectional research, the findings were very favorable with moderate level evidence indicating lower isometric hip abduction strength with a small and lower hip extension strength with a small effect size (ES)15. Additionally, there was a trend toward lower isometric hip external rotation and moderate evidence indicates lower eccentric hip external rotation strength with a medium ES in individuals with PFPS15. Unfortunately, the often more influential prospective evidence told a different story. Moderate-to-strong evidence from three high quality studies found no association between lower isometric strength of the hip abductors, extensors, external rotators, or internal rotators and the risk of developing PFPS15. The findings of this systematic review indicated hip weakness might be a potential consequence of PFPS, rather than the cause. This may be due to disuse or fear avoidance behaviors secondary to the presence of anterior knee pain.

 

Does Hip Strengthening Improve Hip Biomechanics?

Regardless of its place as a cause or consequence, hip strengthening has proved beneficial in patients with both PFPS16,17,18 and following ACL Reconstruction19, but does it actually help to change the faulty movement patterns?

Gluteal strengthening can cause several favorable outcomes, from improved quality of life to decreased pain, unfortunately however marked changes in biomechanics is not one of the benefits. Ferber and colleagues20 performed a cohort study analyzing the impact of proximal muscle strengthening on lower extremity biomechanics and found no significant effect on two dimensional peak knee abduction angle. In slight contrast however, Earl and Hoch21 found a reduction in peak internal knee abduction moment following a rehabilitation program including proximal strengthening, but no significant change in knee abduction range of motion was found. It should be noted that this study included strengthening of all proximal musculature and balance training, so it is hard to conclude that the results were due to the strengthening program and not the other components.

 

Does Glute Endurance Influence Hip Biomechanics?

All this being said, it is possible that gluteal endurance may be more influential than strength itself, so it would make sense that following isolated fatigue of this musculature, lower extremity movement patterns would deteriorate.

Once again, this belief is in contrast to the available evidence. While fatigue itself most definitely has an impact on lower extremity quality of movement, isolated fatigue of the gluteal musculature tells a different story. Following a hip abductor fatigue protocol, patients only demonstrated less than a one degree increase in hip-abduction angle at initial contact and knee-abduction angle at 60 milliseconds after contact during single-leg landings22. In agreement with these findings, Geiser and colleagues performed a similar hip abductor fatigue protocol and found very small alterations in frontal plane knee mechanics, which would likely have very little impact on injury risk23.

 

Can We Really Blame the Glutes?

The biomechanical explanation for why weakness or motor control deficits in the gluteal musculature SHOULD cause diminished movement quality makes complete sense, but unfortunately, the evidence at this time does not agree.

While the evidence itself does not allow the gluteal musculature to shoulder all of the blame, this does not mean we should abandon addressing these deficits in our patients. As previously stated, posterolateral hip strengthening has multiple benefits, but it is not the end-all-be-all for rehabilitation or injury prevention of lower extremity conditions. Proximal strength deficits should be assessed through validated functional testing in order to see its actual impact on lower extremity biomechanics on a patient-by-patient basis. Following this assessment, interventions should be focused on improving proximal stability, movement re-education, proprioception, fear avoidance beliefs, graded exposure, and the patient’s own values, beliefs, and expectations.

 

John SnyderJohn Snyder, PT, DPT, CSCS received his Doctor of Physical Therapy degree from the University of Pittsburgh in 2014. He created and frequently contributes to SnyderPhysicalTherapy.com (Formerly OrthopedicManualPT.com), which is a blog devoted to evidence-based management of orthopedic conditions.  

 

Mike’s Thoughts

John provides an excellent review of many common beliefs in regard to the influence of the hip on knee pain.  While it is easy to draw immediate conclusions from the result of one study or meta-analysis, one must be careful with how they interpret date.

I think “anterior knee pain,” or even PFPS, is just too broad of a term to design accurate research studies.  It’s going to be hard to find prospective correlations with such vague terminology.  Think of it as watering down the results.  Including a large sample of people, including men, women, and adolescents and attempting to correlate findings to “anterior knee pain” is a daunting task.

Imagine if we followed a group of adolescents from one school system for several years.  Variations in gender, sport participation, recreational activity, sedentary level, and many more factors would all have to be considered.  Imagine comparing the development of knee pain in a 13 year old sedentary female that decided she wanted to run cross country for the first time with an 18 year old male basketball player that is playing in 3 leagues simultaneously.  Two different types of subjects with different activities and injury mechanisms.  But, these two would be grouped together with “anterior knee pain.”

What do we currently know?  We know hip weakness is present in people with PFPS and strengthening the hips reduces symptoms.  As rehabilitation specialists, that is great, we have a plan.  I’m not sure we can definitely say that hip weakness will cause knee pain, but I’m also not sure we can say it won’t.  Designing a prospective study to determine may never happen, there are just too many variables to control.

John does a great job presenting studies that require us to keep an open mind.  I’m not sure we can make definitive statements from these results, but realize that there are likely many more variables involved with the development of knee pain.  Hip strength and biomechanics may just be some of them.  Thanks for sharing John and helping us to remember that it’s not always the glutes to blame!

 

 

Updated Strategies for Anterior Pelvic Tilt

The latest Inner Circle webinar recording on the Strategies for Anterior Pelvic Tilt is now available.

Updated Strategies for Anterior Pelvic Tilt

strategies for anterior pelvic tiltThis month’s Inner Circle webinar was on Strategies for Anterior Pelvic Tilt.  This is actually an update on one of my most popular webinars in the past.  I am doing a couple new things and wanted to assure everyone has my newest thoughts.  In this webinar I go through my system of how I integrate manual therapy, self-myofascial release, stretching, and correcting exercises.  To me, it’s all how you put the program together.  My system builds off each step to maximize the effectiveness of your programs.

Hip Rotator Cuff

Hip Rotator CuffThe latest Inner Circle webinar recording on the Hip Rotator Cuff is now available.

Hip Rotator Cuff

This month’s Inner Circle webinar on the rotator cuff of the hip was great.  We discussed how our knowledge of the hip has continued to increase over the last decade and has resulted in a much better understanding of how the hip is involved in the mechanics of the lower body and stabilization in multiple planes of motion.  We then broke down the hip musculature as either prime movers or prime stabilizers, and discussed how different positions and exercises impact both of these different muscles groups.

If this sounds familiar, it is, we use the analogy of the shoulder to show the similarities between the hip and the shoulder.

To access the webinar, please be sure you are logged in and are a member 0f the Inner Circle program.

A Simple Dynamic Stability Exercise for the Leg [Video Demo]

This week’s post is a video demonstration of a simple way to integrate reactive neuromuscular training (RNT) into your programming to enhance dynamic stabilization of the lower extremity.

Reactive Neuromuscular Training for Dynamic Stabilization of the Lower ExtremityIn this video, I show a client that has an ankle sprain.  While going through her rehabilitation, it became clear that she also needed balance training to really work her ankle, knee, and hip to stabilize during functional tasks.

To perform this exercise, you simple need a large resistance band (which are great from many stretching, strengthening, and stability exercises – here are the ones I use).  Loop the band around a rack or other object and step within the loop.  Place the band just above your knee.

I show a few exercise ideas in the video, progressing from simple balance, to unstable surfaces, to incorporating functional movements.  By using the band, you can emphasize training the bodu’s ability to stabilize in the frontal and transverse planes while performing a sagittal plane exercise.  This is essential to optimal function and a big key to my Functional Stability Training program.

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Groin Injuries in Hockey Players

Today’s guest post on Groin Injuries in Hockey Players is from Peter Nelson.  Peter is currently working in collegiate hockey and has shown great interest in understanding why groin injuries are so common and what we can do about it.  Peter does a great job thinking outside the box and taking a look at the bigger picture.  Thanks Peter, great article, I’ll add some of my own comments at the end.

 

Groin Injuries in Hockey Players: An All-Too-Common Problem With a Not-So-Commonly Known Solution

going injuries in hockey playersBeing a former competitive hockey player (admittedly not a very good one—fourth line for life!) and working predominately with hockey players in a strength and conditioning capacity for the last few years, it has become clear to me that hockey players and groin injuries go together like the artist formerly known as Ron Artest and his psychiatrist.  Gold star if you get the reference.   (photo by David Shane)

 

Examining the Prevalence of Groin Injuries Among Hockey Players

While this relationship exists at almost all levels of the game, it has been particularly well documented in elite players.  Several studies have been conducted to assess the prevalence of this specific injury at the professional level.  The results have been consistent, and they are troubling.

A 1978 study by Sim et al. concluded that “ice hockey players are at high risk for noncontact musculoskeletal injuries because of the excessive force generated during the acceleration and deceleration phases of skating.”

A 1997 study by Molsa et al. reported that 43% of muscle strains in elite Finnish hockey players were involving the groin region.

A 1999 study by Emery et al. found that “the impact of groin and abdominal strain injury at an elite level of play in hockey is significant and increasing.”  According to their data, the rate of groin/abdominal strains in the NHL increased from about 13 injuries per 100 players per year during the 1991-1992 season to almost 20 injuries per 100 players per year during the 1996-1997 season.  Furthermore, the recurrence rate was 23.5%, meaning that injuries of this nature went on to plague a significant percentage of players for an extended period of time.

More recently, a study by Tyler et al. found that out of 9 NHL players evaluated, all of whom had suffered from groin injuries, four had sustained multiple strains.

 

The Long and Short of Groin Injuries: Muscular Imbalances in Athletes

With the strong correlation between hockey players and groin injuries established, it becomes important to understand why this is the case.  Many would be quick to attribute it to the violent nature of the sport, but research indicates that this is unfounded.  The study by Emery et al. found that upwards of 90% of all groin injuries were non-contact in nature.  Others posit that strains are due to the muscles involved being too short and lacking flexibility.

Sports physicians, physiotherapists, and strength coaches who fall under this category often prescribe stretching of the groin musculature to remedy the issue.  The study by Tyler et al., however, found that preseason flexibility of the hip adductors, the primary muscles that make up the groin region, did not differ between NHL players who went on to sustain groin strains and those who did not.  This indicates that stretching of the groin is probably not an effective approach toward preventing or treating this type of injury.

What the Tyler et al. study did find was that preseason hip adduction strength of the players who sustained groin injuries was 18% lower than that of the healthy players.  They also found that adduction strength was 95% of abduction strength in the uninjured players, compared to only 78% in the injured players.  This suggests that a muscular imbalance between the weak adductors and the relatively strong abductors plays a large role in groin issues.  The Sim et al. study also supports this view, suggesting that “in ice hockey players, adductor strains may be caused by the eccentric force of the adductors attempting to decelerate the leg during a stride.”  The researchers further went on to state that “a strength imbalance between the propulsive muscles and stabilizing muscles has been proposed as a mechanism for adductor muscle strains in athletes.”

 

Detective Work: Delving Deeper to Identify the Root of the Problem

The logical conclusion then should be that the solution is to strengthen the adductors and stretch the abductors, right?  Well, yes, but a more in-depth look at the problem is necessary to determine exactly why this imbalance is present in the first place, that way we can most effectively remedy the issue.  As a sports physician, physical therapist, or strength coach, you are not truly solving the problem unless you address the root cause.

In order to identify the root cause, it is important to first consider three main concepts.  First, it is imperative to understand the biomechanics of skating.  This brief excerpt from the study by Sim et al. sums it up very well:

“During the powerful skating stride the hip extensors and abductors are the prime movers, while the hip flexors and adductors act to stabilize the hip and decelerate the limb.”

 

Janda Lower Body Cross SyndromeThe second concept to understand is that these specific movement patterns have a profound effect on the relative strength—and consequently length—of the muscles involved.  Because hockey players, like most athletes, spend so much time in extension, the spinal erectors become extremely tight.  The same is true of the hip flexors, which become tight due to the constant forward lean seen in an “athletic stance” as well as the strength required to overcome the aforementioned eccentric force needed to slow down the leg in the recovery phase of a skating stride.

Consequently, since the hip flexors pull the pelvis down from the front and the spinal erectors pull the pelvis up from the back, the pelvis becomes tilted anteriorly.  This lengthens the hamstrings, putting them at a leverage advantage and forcing them to take on more of the load in extending the hips than the glutes.  The glutes then become relatively weak, as does the anterior core.  The end result is a player with what Janda called “lower-crossed syndrome”, illustrated below, who is at risk for both low back and hamstring injuries.

How does this play into groin injuries?  In order to make that connection, you need to understand the third concept, which is a central tenet of the Postural Restoration Institute (PRI): while muscles are often prime movers in a single plane, they must actually be considered as having an effect on movement in all three planes—sagittal, frontal, and transverse.

The perfect example of this is the hip extensors.  While the hip extensors are mostly responsible for movement generated in the sagittal plane, these same muscles—most notably the gluteus maximus—function as external rotators and abductors.  This is relevant to hockey because the nature of a skating stride requires players to have strong abductors—they are prime movers in this movement—as well as spend a lot of time in external rotation.  This tightens both the external rotators and abductors and pulls the hips into chronic external rotation and abduction, or in other words causes them to become “flared”.  Adductor muscles like the adductor magnus, which also contribute to internal rotation, become lengthened and, like the hamstrings in the sagittal plane, are put at risk for injury.  This clearly fits the theory of a muscle imbalance as the potential contributor to groin injuries, and it becomes clear from the analysis above that pelvic alignment is important in understanding the root cause of this imbalance.

It also makes it apparent that stretching the groin is not only ineffective; it can actually feed right into the problem!

 

Shifting Into Neutral: Correcting Pelvic Positioning

That brings us to the million-dollar question: how do we fix it?  After coming to the understanding that groin issues are caused by pelvic misalignment in all three planes of movement, you can see why I suggested that strengthening the internal rotators and stretching the external rotators is not a comprehensive solution to the problem.  We must address muscular imbalances with the triplanar perspective in order to effectively prevent injuries of this nature.

The first plan of attack should be to rectify the imbalances in the sagittal plane.  The reason being is simply that extension limits rotation, and since I already explained that hockey players—and athletes in general—tend to live in chronic extension, it makes sense to resolve that problem first in order to maximize the effectiveness of attempts at repositioning an athlete in the other two planes.  I group the frontal plane with the transverse plane, even though I am talking about rotation being limited, because there is significant overlap between the prime movers in abduction/adduction and internal/external rotation.

Addressing the imbalances in the sagittal plane is fairly straightforward.  I like the approach Mike Robertson takes in identifying two “force couples”.  The posterior force couple consists of the anterior core and the posterior chain (primarily the glutes and hamstrings), and these two will be weak in athletes living in extension, as I previously mentioned.  Hammering the glutes and hamstrings with exercises like hip thrusts (demonstrated by Bret Contreras below) and Romanian Deadlifts, respectively, will strengthen the posterior chain and tilt the hips posteriorly by pulling them down from the back, the net result being a more neutral alignment since the athlete was in anterior tilt to begin with.  With the anterior core, it is important to note that it is the internal obliques, external obliques, and transverse abdominis that are usually weak, as opposed to the rectus abdominis.  Strengthening these muscles will tilt the hips posteriorly by pulling them up from the front, also resulting in a more neutral alignment.

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The anterior force couple consists of the spinal erectors and the hip flexors, and these two will be tight.  Stretching the hip flexors is crucial; this can be accomplished with stretches like the Bench Hip Flexor Stretch, illustrated by Tony Gentilcore.  Self-myofascial release can also be useful.

groin injuries

With the Bench Hip Flexor Stretch, the harder the athlete squeezes the glutes and extends at the hips, the greater the stretch on the rectus femoris.  Be careful, however, not to allow the athlete to extend at the lumbar spine, as this reinforces the incorrect movement pattern we are trying to move away from.

Stretching the spinal erectors can be accomplished with “prayer position”-type stretches.  Self-myofascial release with a lacrosse ball peanut can also be effective.  In working with Head Strength Coach Rob McLean and the Pennsylvania State University Men’s Ice Hockey team, we tend to use exercises with movement patterns that inhibit the paraspinals while also activating the anterior core, such as the exercise from the Postural Restoration Institute shown below, demonstrated by Kevin Neeld.

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In this case, we are killing two birds with one stone in strengthening the weak muscles and teaching the athletes to inhibit the tight muscles (notice how Kevin’s back is rounded; this helps to inhibit the spinal erectors) at the same time.  You can also see that in the video there is a ball between Kevin’s knees—this is to activate the internal rotators/adductors, which I will discuss next.

Addressing the frontal and transverse planes when it comes to fixing pelvic alignment is overlooked too often.  Again, we want to strengthen the internal rotators and adductors—the muscles might largely overlap but it is important to pattern both movements individually—and stretch the external rotators and abductors.  For internal/external rotation, med ball crushes is a good one to strengthen internal rotation (note that this exercise can also pattern the adduction movement, depending on how it is performed), and knee-to-knee mobilization is good for both activating the internal rotators and stretching the external rotators.  Any exercises that target the semimembranosus (the most medial hamstring muscle) will also help strengthen the internal rotation movement.  An easy modification to an already great exercise, which I mentioned earlier, that will help in this regard is having athletes internally rotate the legs during the hip thrust.  Here at Penn State we have started doing band-resisted hip thrusts with internal rotation, and Coach McLean and I both like how it hits the internal rotators.  Considering that it also strengthens the posterior chain, you’re really killing two birds with one stone in repositioning the pelvis with this small tweak.

There are also a number of good exercises for patterning and strengthening the adduction movement.  Adductor Side Bridges, demonstrated below by Kevin Neeld, are great in this regard.

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The adductor pullback exercise from PRI, demonstrated below also by Kevin Neeld, is another good one.

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We have our players perform the adductor pullback exercise only on the left side (so they would be lying on their right side, as Kevin is in the video) to address the left AIC alignment that I mentioned earlier.  Doing the opposite by lying on your left side and shifting your right hip forward and externally rotating it (since the right leg tends to be internally rotated) also helps correct this particular alignment.

 

Conclusion

Simply put, pelvic positioning is an important piece in preventing groin injuries, which affect athletes in all sports, but are especially a problem amongst hockey players.  The three main concepts to remember in assessing pelvic positioning in any athlete are 1) understanding the biomechanics of the sport, 2) identifying the effects these movements have on the muscles involved, and 3) considering muscles as contributors to movement in all three planes, even if they are not prime movers in one or more of those planes.  These concepts can be applied in order to identify imbalances in an athlete and the effects they have on the position of the pelvis. Once this is accomplished, a program can be designed so that the imbalances can be corrected and the pelvis returned to neutral.  After all, neutral is where we want our athletes to be, as that puts them at the lowest risk for injury.  And any reputable strength coach knows that keeping athletes healthy is the primary objective in any program.  You can’t translate gains in strength and power to the playing field if you’re stuck on the sidelines.

 

Mike’s Thoughts

I think Peter did a great job with this article, highlighting the need to start thinking about alignment and triplanar function of the body.  These are often missed in our critical thinking.  The only thing I would add to this great article is that the real goal of working to enhance alignment is to then allow you to train the body in better neutrality.  We may not function in neutral, but you don’t want to be stuck in our poor alignment.  You want to be able to get out of your asymmetry when needed.

Every athlete I have worked with that is “stuck” in their asymmetry is prone to recurrent injuries.  We’ve all had them, right?  The person that just keeps straining their groin, or hamstring, etc.  Take a step back and think of the 3 principles that Peter summarizes in his conclusion.

If you like information like this, I’ve discussed concepts like triplanar training of the glutes.  These are some of the fundamental principles in my Functional Stability Training of the Lower Body program with Eric Cressey.  We discuss a lot of concepts related to alignment, triplanar function of the body, and training the body in 3D.

Functional Stability Training for the Lower Body

About the Author

Peter Nelson is a Strength and Conditioning Staff Intern with the Pennsylvania State University Men’s Ice Hockey Team.  He graduated in 2012 from Phillips Academy Andover, and is currently a sophomore at Penn State’s University Park Campus.  Peter is a former competitive hockey player, having played for Andover’s Varsity Hockey Team for three years in Division 1 of the New England Prep School Ice Hockey Association.  While he no longer plays competitively, his longtime involvement in sports has driven his interest in research fields such as nutrition and strength and conditioning.  He has previously interned at NIKE SPARQ-affiliated Athletic Evolution in Woburn, MA.  Peter is greatly looking forward to continuing to work under Head Strength and Conditioning Coach Robert McLean of the Penn State Men’s Hockey Team and continuing his education in pursuing a career in the health and fitness realm.

Note: I’d like to thank Coach Rob McLean, Head Strength and Conditioning Coach for the Pennsylvania State University Men’s Ice Hockey Team, for taking me under his wing and introducing me to and helping me understand important concepts like those presented by the Postural Restoration Institute.  Much of this article reflects what I have learned over the course of the past year while working with him and the hockey team as an intern.  I sincerely appreciate the opportunity.

 

Referenses

  • Sim FH, Simonet WT, Melton LJ III, et al: Ice hockey injuries. Am J SportsMed 15: 30–40, 1987.
  • Molsa J, Airaksinen O, Näsman O, Torstila I. Ice hockey injuries in Finland: a prospective epidemiologic study. Am J Sports Med. 1997;25(4):495-499.
  • Emery CA, Meeuwisse WH, Powell JW. Groin and abdominal strain injuries in the National Hockey League.. Clin J Sport Med. 1999;9(3):151-156.
  • Tyler TF, Nicholas SJ, Campbell RJ, McHugh MP. The association of hip strength and flexibility on the incidence of groin strains in professional ice hockey players. Am J Sports Med. 2001;29(2):124-128.
  • Robertson, Mike. March 3, 2007. “Hips Don’t Lie: Fixing Your Force Couples.T Nation.

 

 

 

 

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Simple Tweak to Maximize the Hip Clam Exercise

This week I wanted to share a quick video of a very simple tweak to maximize the hip clam exercise by really firing the glutes.  Rather than perform a standard hip clam exercise, the tweak is what you do after you lay down on your side with your hips bent to 45 degrees and knees at 90 degrees.  From this position, I want you to push your top knee outward, as if it were longer than the bottom knee.

Hip Clam Exercise with a Plus - Mike ReinoldI like to coach this by placing the hand on your hip to assure that you stabilize the upper half of your body from rolling too much.  In this position you can also really palpate the glutes with that hand while they are firing.  I also like to again coach them to push their knee out at the top of the clam, as well.

Notice that the amount of hip opening is not that much.  Essentially, by pushing your top knee outward, you are rotating your pelvis and placing the hip in a more abducted and externally rotated position.  This will allow the posterior fibers of the gluteus medius to really turn on, and also kick in the external rotation fibers of the gluteus maximus.  But you also preposition yourself in some external rotation, so the amount of clam opening will be less.  You should avoid opening the knees too much and rocking your upper body backward.  This is a common goal in the PRI world, who often describe this exercise and use it for pelvic reposition and integration exercises on the right side.  (For the PRI clinicians reading, this will obviously be familiar, for the fitness enthusiasts reading this, I recommend you get evaluated to see exactly what your body needs).

I’ve talked about how important the hip clam exercise is in the past and my past videos were pretty popular on the Mike Reinold Youtube page, so this is just another tweak you can add to your toolbox.

Simple tweak, right?  Try it!  Do a set of standard clams and then another with your top knee pushed outward, your glutes will be on fire!

If you are wondering, I called this the “Hip Clam Exercise with a Plus” in an article in Men’s Health, sort of like the “Push Up with a Plus” exercise for the serratus anterior.

 

Hip Clam Exercise with a Plus

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Did you try it?  Are your glutes on fire?  What did you think about this simply variation of the hip clam exercise?

 

 

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Are Leg Strength and Power Important to Baseball Pitching?

Baseball pitching appears to the general public to be mainly an upper-body movement. However, researchers have found that like many rotational movements such as golf swings and tennis serves, it involves the lower body and trunk musculature extensively. In fact, according to a theory known as proximal-to-distal sequencing, the pitching motion is actually initiated by the lower body and progresses through the core before accelerating the arm and finally the hand.

 

What is proximal-to-distal kinematic sequencing?

Researchers have suggested that rotational movements such as the baseball, golf or tennis swing follow proximal-to-distal kinematic sequence. Proximal to distal kinematic sequencing is where a motion is initiated by the larger, central body segments and then proceeds outward to the smaller, more distal segments, such as the arms.

While the concept is relatively clear, the terminology varies. Callaway (2012) has noted that researchers have referred to proximal to distal sequencing as kinetic linking or the kinematic sequence and in a recent article, Spaniol (2012) referred to the same principle as “sequential kinetic linking.”

In any event, where optimal proximal-to-distal kinematic sequencing occurs in sport, the pelvis is rotated using the leg and hip muscles. The pelvis accelerates but then quickly decelerates as it transfers energy to the torso. The same pattern is repeated with the torso and the arm and then the arm and the hand, club, bat or racket. Where the kinematic sequence is out-of-order, it is thought that energy is lost, performance decreases and other body segments step in to compensate, which can lead to injury.

 

What do we know about the role of the lower body in baseball pitching?

While the principle of proximal-to-distal kinematic sequencing indicates that there is a sound theoretical basis for the role of the lower body in baseball pitching, few studies have actually investigated either the forces or the muscle activity involved.

In fact, there are only four studies regularly referenced when discussing the role of the lower body muscles in baseball pitching: MacWilliams (1998), Yamanouchi (1998), Campbell (2010) and Oliver (2010). The studies by MacWilliams and Oliver investigated aspects of proximal-to-distal kinematic sequencing that are seen in baseball pitching, while the studies by Campbell and Yamanouchi looked more generally at the involvement of the leg musculature.

 

What does the research say about proximal-to-distal kinematic sequencing in pitching?

Is leg drive correlated with wrist velocity?

MacWilliams (1998) investigated the full-body kinematics and kinetics of 7 baseball pitchers using force plates to record leg drive and a five-camera motion analysis system for recording the joint angle movements. Most significantly, they found that wrist velocity correlated significantly with leg drive.

[quote]Pitchers with greater leg drive produced greater wrist velocities.[/quote]

The researchers therefore concluded that the lower body has an important role in increasing the speed of the throwing motion and supports the use of the proximal-to-distal kinematic sequencing model in any biomechanical analysis of baseball pitching. They therefore proposed that strengthening the lower body is important for enhancing pitching performance and avoiding injury.

 

Are the gluteals correlated with torso rotation during pitching?

Oliver (2010) investigated the muscle activity of the gluteals and explored the relationship of the gluteals to pelvis and torso kinematics during baseball pitching. The researchers found that the activity of the gluteus maximus was directly related to the rate of axial pelvis rotation and also that it was indirectly related to the rate of axial torso rotation.

[quote]Greater gluteus maximus activity increases rotational speed[/quote]

This study therefore also supports the use of the proximal-to-distal kinematic sequencing model in any biomechanical analysis of baseball pitching. Additionally, it implies that training the gluteals should be a specific focus of baseball pitchers. Optimal exercises for the gluteus maximus include the squats, trap bar deadlifts, hip thrusts, and back raises. However, the gluteus maximus can and should be strengthened in the transverse plane via core rotational movements such as the band hip rotation.  See Mike’s article on training the glutes in multiple planes of motion.

 

What does the research say about leg muscle activity in pitching?

Are the adductors active during pitching?

Yamanouchi (1998) investigated the muscle activity of various upper and lower body muscles during a baseball pitch performed by 10 baseball players and 10 untrained subjects. He used surface electrodes to measure the electromyographical (EMG) activity and normalized the signal against a maximum voluntary isometric contraction (MVIC). He separated the baseball pitching movement into just two phases divided by the point at which the non-pivoting leg landed. The activity of the thigh muscles reported by Yamanouchi is shown in the chart below. Unfortunately, he did not record the activity of the gluteals or hamstrings.

leg strength baseball pitching

Yamanouchi concluded that his findings were consistent with reports that pitching can lead to problems with the adductor muscle group. He therefore suggested that strengthening the adductor and the antagonist abductor groups could therefore be useful for enhancing pitching performance and avoiding injury.

Most leg muscles are very active during pitching

Campbell (2010) investigated the muscle activity of the biceps femoris, rectus femoris, gluteus maximus, vastus medialis and gastrocnemius during the baseball pitching motion. The researchers used surface electrodes to measure the EMG activity in 11 highly skilled baseball pitchers and normalized the data against MVICs. Rather than the two-phase division used by Yamanouchi, they divided the pitching action into four phases, although the data can be restated to be comparable with the two phases used by Yamanouchi, as shown in the chart below.

Leg Power Baseball Pitching

The researchers concluded that muscle activity in both the stride and pivot legs reached extremely high levels during the baseball pitch and was generally very high throughout. They therefore suggested that since pitchers must perform over 100 pitches per game, this implies that pitchers need a high level of maximal strength/power as well as a high degree of muscular endurance. They therefore recommend training the lower body of baseball pitchers to increase strength, explosive power and muscular endurance.

 

What can we conclude?

From this admittedly small body of research, we can suggest that:

  1. Proximal-to-distal kinematic sequencing seems to occur during baseball pitching, with the movement being initiated by the legs, transferred through the pelvis to the torso, through the arm and finally into the hand.
  2. Leg drive is therefore important for pitching velocity. Improving the strength and power of the legs should consequently transfer to faster pitching performance.
  3. Since pitchers may have to perform approximately 100 pitches per game, some degree of muscular endurance training for the legs could be beneficial.
  4. While all leg muscles are very involved in the pitching action, the activity of the gluteals is strongly correlated with pelvic axial rotation velocity, suggesting that specific gluteal training may be worthwhile. A variety of gluteal exercises from multiple vectors is needed for optimal performance.
  5. The adductors may be more involved in the pitching movement than in most standard resistance-training exercises, suggesting that specific exercises should be used to focus on these muscles to help improve performance and avoid injury.

 

Mike’s Thoughts

Chris wrote an outstanding article as usual.  Obviously, as you can see, the leg strength and power is pretty important to baseball pitching.  The concept of the proximal to distal kinetic chain sequencing is likely one of the many important factors involved with baseball pitching.  Why is it that some of the brightest people in the world can flawlessly understand baseball pitching biomechanics yet can’t pitch successfully!  Heck, I am one of the guilty!  It’s not that I do not understand how to throw, it’s that I have an imperfect sequence of events that result in a less than ideal fastball!  So, while leg strength and power are important to baseball pitching, we can’t forget about training this sequence.  This is why proper coaching at a young age and proper strength and conditioning programs that understand this concept are necessary.

In regard to our training programs, these studies demonstrate the need to emphasize the legs, and should give guidance on what specific muscles to focus on.  Chris states it well, however, I will further reinforce his comments that we need to train the legs, but also focus on leg work outside of the sagittal plane.

 

About the author

Chris BeardsleyChris Beardsley is a biomechanics researcher and author of a book about scientific posterior chain training. He also writes a monthly review of the latest fitness research for strength and sports coaches, personal trainers, and athletes.  Thanks for contributing this article on Why are Leg Strength a Power Important in Baseball Pitching!

 

 

 

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