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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!

 

 

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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Working the Glutes in 3D

Working the Glutes in 3DA common limiting factor in program design for both rehabilitation and performance programs is working on isolated movement patterns.  Initially there is often a need to focus on working hip extension or shoulder external rotation, for example, but once strength has improved and the movement pattern is improving, you really need to start thinking in 3D.  I talked about this concept in a past Inner Circle webinar on how we need to look at alignment in three dimensions, but this also is important for muscle function.

Using the glutes as an example, we all know that the glutes do more than extend your hips.  I’m not just talking about the gluteus medius and minimis, but also the gluteus maximus.  If you look anatomically at the glute max, you can see the fiber orientation is ideal to provide hip extension, external rotation, and abduction.  That is the glute max’s function in 3D.  Once you groove your correct movement patterns, progress to exercises that incorporate two dimensions and then finally all three dimensions at once.  Photo from Wikipedia.

Gluteus maximus

Here is a great example.  In this video, we are doing a single leg RDL.  The RDL alone works on hip extension.  By making it a single leg exercise, your body wants to drop at your hip, thus making you abduct.  Finally, to add the third dimension of external rotation, I have the person using a TRX Rip Trainer, which is essentially providing a unidirectional pull into internal rotation, and thus firing his hip external rotators:

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This a big part of my upcoming program on Functional Stability Training of the Lower Body.  Next time you hit a movement plateau, take a step back and make sure you are working the muscle in 3D.

 

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Training Rotational Power in Athletes

Training Rotational Power in AthletesSeveral weeks ago I was in San Francisco and stopped by TRX to see my friends Brian Bettendorf and Pete Holman.  We had a great time sharing thoughts and exercise techniques.

 

TRX Rip Trainer

Pete Holman is the Director of Rip Training at TRX and original creator of the Rip Trainer.   Many are familiar with the TRX Suspension System but TRX also has the newer Rip Trainer device that I have been using a ton.  I’ve shown some exercises that I have incorporated into my programs using the TRX Rip Trainer during presentations, but Pete really takes it to the next level.  His enthusiasm is contagious and his ability to educate is fantastic.  I asked Pete if we could “bottle” some of his thoughts to include as webinars over at RehabWebinars.com.

Pete came through in a big way and sent me three fantastic webinars that were posted over at RehabWebinars.com last week:

  • Training Rotational Power in Athletes
  • The Pitchfork Exercise for the Posterior Chain
  • Shoulder Prehab Exercises for Athletes

The webinars came out so great that I couldn’t resist sharing one of them here with my readers.  Below is Pete’s webinar on Training Rotational Power in Athletes.  Pete discusses the biomechanics and anatomical considerations of transverse plane training, demonstrating several techniques using the TRX Rip Trainer.

I love using the Rip Trainer because it really helps incorporate multiple planes of motion into our exercise techniques.  This 3D muscle training is something I have been preaching in my Inner Circle webinars lately.  As basic as a device this seems, you absolutely need to use it to see the many benefits.  I know just from hanging out with Pete for a day, I have learned many new uses and will continue to learn more.  There are a ton of rehab, fitness, and performance uses.

 

Training Rotation Power in Athletes

These are just a small handful of exercises you can use the TRX Rip Trainer for when designing rotational power programs.  I’ll try to keep trying to share what exercises I come up with, but I want to hear what you think.  Have you used the TRX Rip Trainer and if so what do you like to perform with the device?  If you haven’t checked them out yet, pick up a TRX Rip Trainer.

TRX Rip Trainer

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Top 5 Tweaks to Enhance Hip Exercises

Inner Circle Premium Content

The latest webinar recording for Inner Circle members is now available below.

 

Top 5 Tweaks to Enhance Hip Exercises

In this month’s Inner Circle webinar, I review my top 5 simple little tweaks to really enhance your hip exercises.  I love topics like this as I really feel that the small attention to detail items are what can really help you set yourself apart.

  • Why we want to focus on the hips and maximizing the results of our exercise selection
  • How hip flexor tightness can ruin a great glute exercise and what to do about it
  • My top exercise to turn on the glute max and it’s ability to extend the hip
  • How to maximize sagittal plane hip exercises and make them more functional
  • How to get more out of your hip clam exercise

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

 

Glute Bridge Exercise Progressions for Rotary Stability

Functional Stability Training for the CoreIt is no secret that proper hip extension and glute activation is an important component to optimal movement patterns.  I’ve talked several times about some great glute exercises, including one of my favorite exercises to starting turning on the glutes, the kneeling hip thrust (which was just featured on Greatist.com).

 

Glute Bridge Exercise Progressions

The bridge exercise is one of the most simple exercises you can perform to start training the glutes to extend the hip.  As my patients and athletes progress and learn to master activating the glutes, my next step in the glute exercise progression is to work on stabilizing the core while training the hips to extend.

This is a very important component of core control and a key in preventing low back injuries.  The lumbar spine should be able to stabilize while the lower extremity extends, minimizing the stress on the low back.

Below is a great video example of a glute bridge exercise progression that I discuss in my new educational program with Eric Cressey, Functional Stability Training for the Core.  During the clip, I discuss some of my thoughts of how to train rotary stability during the glute bridge exercise.  I even throw in some manual exercise techniques as well.  I really love this exercise and use it daily!

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Combining Glute Activity with Rotary Stability Training

The exercise begins by bracing and stabilizing your lumbar spine before performing the bridge.  Once the person is ready to progress, you can slowly extend the knee to really turn on the plant leg glute while requiring the lumbar spine and pelvis to stabilize and prevent rotation.  This is a great way to incorporate rotary stability training with an exercise designed to train the glutes.  What a great combo!

This is one of the many great exercise progression Cressey and I discuss in our new online educational program , Functional Stability Training for the Core.  Go to the Functional Stability Training website for more details on the program.  This program is brand new and if you purchase this week during the introductory sale, you can get a great discount on this program!  The special price is $77 but goes up to $97 next week.

The program is completely online (with an optional DVD if you wish) so you can jump right in and start advancing your core training programs immediately!

Functional Stability Training for the Core

[button link=”http://functionalstability.com” size=”large”]Lean More about FST for the Core[/button]

 

Kneeling Hip Thrust

The hip thrust exercise has become a common exercise for strengthening the gluteus maximus. Described by Bret Contreras, The hip thrust has gained popularity over the last couple of years thanks to it’s simplicity and effectiveness. Here is a great clip of Bret demonstrating the proper hip thrust technique:

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While a weighted bilateral hip thrust is an excellent exercise, I have found that some people have difficulty performing the exercises in the rehabilitation setting.  You could start the hip thrust exercise with just body weight, but some people will still have difficulty disassociating hip extension and lumbar spine extension, making the standard hip thrust difficult to perform with proper form even with little to no weight.

In the rehab setting, I typically need to start working on glute training in most patients.  I am a big believer in strengthening the glutes and training them to extend the hip so that the hamstrings and low back take less stress.  However, sometimes I wonder if we are guilty of  jumping right into a glute strengthening exercise, like the hip thrust or a even a single leg deadlift variation, before the patient is truely ready for the movement.  To me, this where the need for glute “activation” prior to “strengthening” comes to mind.

I am always looking for great exercises to “turn on” the glutes and activate proper hip extension firing, so the hip thrust is an intriguing option.  I have started to perform a variation of the hip thrust in the kneeling position. By performing a kneeling hip thrust, it becomes a better activation and lower level strengthening exercise for the more basic patient.

 

Kneeling Hip Thrust

Below is a video demonstration of the kneeling hip thrust, followed by some coaching techniques:

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Kneeling Hip Thrust Technique:

  • To perform the kneeling hip thrust, I most commonly use a dowel with tubing. I will use tubing with handles on both ends so that I can wrap the tubing around a stationary point and slide the dowel through the tubing handles.
  • Position yourself in the kneeling position with the dowel over your lower abdomen and pelvis area. I usually hold on to the dowel for comfort as well.
  • You can also try using cable weights or Keiser resistance as well, but there is a limit to how much weight you can add before the weight is just too much and pulls you backward. Realistically, if you want to weight the hip thrust this much, the kneeling position isn’t for you. This is ultimately an activation and basic motor recruitment exercise that I often use to turn on the glutes before performing or progressing to more advanced glute strengthening, including the traditional hip thrust that Bret describes.
  • Place your knees about shoulder width apart with your feet together.  Your feet and knees should form a triangle.  I will describe the reason for this below.
  • Begin by sitting on your feet and then lift your body up and out, extending your hips.
  • You should squeeze your glutes together at the end range of movement, while avoiding hyperextending the low back.

Benefits of the Kneeling Hip Thrust

I really like the kneeling hip thrust exercise and have found it to enhance our ability to engage the glutes to extend the hip. I find the kneeling hip thrust takes lumbar extension of the equation much more than in the traditional supine bridge position, allowing you to focus on hip extension and glute activation without worrying as much about compensation at the lumbar spine.

As described above, I usually perform the kneeling hip thrust with my feet together, thereby placing your hips in slight external rotation. This is a common modification for the bridge exercise that I utilize for people with tight hip flexors. The greatest amount of glute firing is going to occur towards the end range of hip extension. If the hip flexors are too tight to allow full hip extension, compensation often occurs in the low back with lumbar extension.  You’ll also be able to get a better “glute squeeze.”

In many people you will find that they quickly master the kneeling hip thrust technique and will be ready to move to a more advanced glute strengthening exercise using much better form with less compensation.

Try working this kneeling hip thrust into your rehab programs or as part of your dynamic warmup and let me know what you think!