A very common dysfunction in the HMS occurs due to an individual who possesses dynamic malalignment of the hip and knee causing one condition known as Lower Extremity Movement Impairment Syndrome (Clark and Lucett, 2010). Someone who possesses lower extremity movement impairment syndrome typically has a weak or underactive gluteus maximus and medius muscles that are responsible for the motion of abduction (moving away from the midline of the body). This syndrome leads to possible injuries that include, but not limited to anterior knee pain, lower back pain, neck stiffness and shoulder impingement (Clark and Lucett, 2010). The common traits associated with this malalignment are a weak gluteus maximus, which helps decelerate hip internal rotation, and the gluteus medius helps decelerate hip adduction. Dysfunction of these actions causes the femur to internally rotate and adduct and the tibia to internally rotate, causing a genu valgum or knock knee. Anterior knee pain results from synergistic dominance of the gluteus medius that is weak and relies on the TFL(Tensor Fascia Lattae), adductor complex, and quadratus lumborum to become overactive to compensate for the weakness (Clark and Lucett, 2010). The stress moving down the kinetic chain to the knee create a dysfunction in the arthrokinematics of the patella and femur that fail to operate under a “optimal tracking” which occurs when movement is occurring across the greatest articular surface area of the patellafemoral joint (Neumann, 2008). Strengthening the gluteals requires the activation of each of the three muscles. The gluteus maximus is effective against resistance during hip extension and external rotation. The gluteus medius is effective against resistance during hip abduction and internal rotation for the anterior fibers and external rotation and abduction for the posterior fibers. The gluteus minimus is effective against resistance during hip abduction, flexion and internal rotation (Clark and Lucett, 2010).
- My first exercise, Resistance Band Abduction, which helps strengthen the Lateral Subsystem, focuses on the gluteus complex that works to extend and abduct the hip. In addition, the TFL, adductor complex, and quadratus lumborum work to stabilize the pelvofemoral joint. Abducting the femur utilizing the gluteus medius and minimus as well as the TFL and work to complete 10-12 repetitions in a very slow and controlled manner for 3 sets. At the point of full abduction, I pause and hold the contraction for 1-2 seconds before eccentrically contracting the muscles. The resistance used is body weight.
- My second exercise is Resisted Lateral Walking, which helps to strengthen the gluteus maximus by extending the hip at the beginning and the end of the motion, and the hamstring complex through knee flexion. This exercise also helps focus on the Lateral Subsystem by working to stabilize the pelvofemoral joint during contraction. Press on the heels to further engage and strengthen the contraction in the gluteus maximus muscles. I then go into the eccentric motion of the movement but maintain isometric contraction of the gluteus maximus throughout the entire set. The motion again is very slow and controlled. I complete 10-12 repetitions for 3 sets. The resistance used is body weight.
- My last exercise to strengthen the gluteuls and abductors is a isometric contraction abduction with body weight squats. Using the ankle cuff resistance bands to hold the legs in a wide stance, isometrically contracting the abductors. Pressing on the heals of the foot, perform a slow controlled body weight squat. The movement is slow and controlled and performed for 8-12 repetitions for 3-4 sets. To make this exercise more challenging, hold a dumbbell above the chest for added resistance.
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