We (physical therapists) often get caught in the habit of saying things that might not be totally true all the time. This isn’t because we don’t know what we’re talking about, but more so as a means of communicating to our patients who may not possess the same depth of knowledge regarding the human body. That’s not any fault of the patient’s. It’s a duty of the physical therapist to be an expert in anatomy. So let’s dive into the anatomy a little bit…
It’s easy to think of a muscle as either ‘on’ or ‘off’. Contracted or relaxed. You bend your elbow and your bicep is ‘on’, you let your arm hang down by your side and your bicep is ‘off’. Simple enough, right?
Well, not exactly.
People who run for exercise occasionally have knee pain which can occur for a variety of reasons.
- Are their quads too ‘tight’?
- Do they lack ankle mobility?
- Did they change their shoes or foot strike pattern recently?
These are all possible answers.
Are their glutes not firing?! Definitely NOT.
(Double negative, the glutes are firing. Just making sure we’re on the same page here, let’s keep going.)
Now, if you’re an individual who has had some knee pain with running or other exercise and went to physical therapy then they probably took a look at your hips (if they didn’t, you need to find a new therapist). They should have checked hip mobility, then hip motor control and/or strength. (Motor control: Your brain’s ability to control a joint and surrounding musculature to perform a skill; in this instance, standing on one leg).
The therapist lies the patient on their side, lifts their leg, asks them to hold it there, therapist easily presses the leg down…BOOM! Problem solved. Therapist to patient: “Your glutes aren’t firing. Specifically, your glute med (pronounced ‘meed’ and short for medius), which stabilizes your hip when standing on one leg. When you’re running your glute med isn’t firing and your knee is having to control all of your body weight and that’s why your knee hurts. Do these clamshells with this band.”
(Disclaimer: I use clamshells with people. I used to think they were dumb, I still kind of think they’re dumb, but they work.)
But wait a second…if my bicep wasn’t firing then I couldn’t bend my elbow, right? (well, technically you still could but just follow along and don’t Google “brachioradialis muscle actions”. Cool. Thanks. Let’s keep going) If my glute med isn’t firing and it’s the muscle responsible for keeping my hip stable when I’m on one leg, then how can I still stand on one leg? The patient just demonstrated some skepticism and I enjoy that. So then what’s actually going on? Let’s step back and take a closer look.
Remember when we said “Well, not exactly.” in regards to the muscle being either ‘on’ or ‘off’? That’s because muscles possess tone which is a resting state of tension in preparation for movement. It’s how we are able to stand upright without really thinking about it. This low level of muscle activation in our legs, trunk and neck keeps us upright when standing. Like a light dimmer as opposed to a light switch.
So maybe the more appropriate thing to say, in regard to your glute med, is that it is in fact firing, to some extent. However, what we need is a higher level of activation in that muscle. It needs to be more active when running to reduce the load transferred down to your knee when your foot strikes the ground.
So, we’ve reached the same result. We know your glute med is likely an issue, so we do some type of activation exercise and reload the system with a simple glute med exercise such as a clamshell. Now what most people, therapists included, might not consider is that a glute med activation exercise shouldn’t just be part of your home exercise program but should be part of your warm up before you run. More on that to come in this series….