On occasion, I will have some patients that cannot improve their glute strength. They typically are neutral and can find and feel the glute, but muscle testing reveals continued weakness and femurs remain internally oriented. I make sure they are getting eversion and have used orthotics for many. Often their add lift scores are not improving beyond 2 or 3. Any thoughts?
This is a great question and 3 things come to mind:
1) They are “Frontal Plane Challenged”: Abdominals are not integrating with adductors (the right adductor and abdominal wall are too strong/active and need to be inhibited, while the left adductor and left abdominal wall are weak or inactive). If the patient continues to be limited with frontal plane integration, there could be a descending influence possibly indicating the need for interdisciplinary integration.
2) They lack reciprocal upper and lower rotation, and likely do fine with counter-clockwise rotation, but usually have poor reciprocal clockwise rotation. The new walking stick program discussed in the Pelvis Restoration course (which will also be on our new exercise CD’s coming out soon) would be an excellent program to perform with an individual lacking reciprocal upper and lower rotation.
3) It is likely an AF (acetabular-femoral) problem, not a FA (femoral-acetabular) problem. FA rotation increases glute strength, but if this has been addressed and they still have weak glutes, then they are having trouble keeping AF position and strength. I would recommend reaching, flexion, squatting activities for improving AF position and strength.
Ron Hruska, MPA, PT
