Initial Exercises For Gluteal Strains Hip Flexion Begin this exercise lying on your back (figure 2).

Slowly take your knee to your chest as far as you can go without pain and provided you feel no more than a mild to moderate stretch, then lower back down. Repeat 10 - 20 times provided there is no increase in symptoms. Once this becomes easy, you can use your hands to gently take your knee to your chest a little further provided the exercise is pain free.

Figure 2 Hip Flexion (left leg) Single Leg Kicks Begin this exercise lying on your stomach with your hands underneath your forehead as demonstrated (figure 3). Slowly bend the knee until the lower leg is pointing upwards. Lift your bent knee just a few inches off the floor without moving your lower back. Slowly straighten the knee, then lower the leg back down to the floor, returning to the starting position. Keep your spine and pelvis still throughout the exercise and breathe normally. Perform 10 repetitions on the affected leg provided the exercise is pain free.

Figure 3 Single Leg Kicks (right leg) Hip Abduction Sidelying Begin this exercise lying on your side with your legs together. Keeping your back and knee straight and foot facing forwards, slowly take your leg upwards tightening the muscles at the side of your thigh / hip (gluteals) (figure 4). Hold for 2 seconds and then return to the starting position. Perform 10 20 repetitions on each leg provided the exercise is pain free.

Figure 4 Hip Abduction Sidelying (right leg)

Exercises for hamstring origin tendonitis The following exercises are commonly prescribed to patients with hamstring origin tendonitis. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 1 - 3 times daily and only provided they do not cause or increase symptoms. Hamstring Stretch for Hamstring Origin Tendonitis Begin this exercise for hamstring origin tendonitis with your foot on a bench or chair. Keep your back straight and your knee bent slightly. Lean forward at your hips until you feel a stretch in the back of your thigh / knee (figure 2). Hold for 15 seconds and repeat 4 times at a mild to moderate stretch pain-free.

Figure 2 Hamstring Stretch for Hamstring Origin Tendonitis

Hip Extension vs. Resistance Band for Hamstring Origin Tendonitis Begin this exercise for hamstring origin tendonitis standing at a bench or chair for balance and a resistance band around your ankle as demonstrated (figure 3). Keeping your back and knee straight, slowly take your leg backwards tightening the back of your thigh (hamstrings). Then slowly return to the starting position. Perform 10 - 20 repetitions as far as possible provided it is pain-free.

Figure 3 Hip Extension vs. Resistance Band for Hamstring Origin Tendonitis (left leg) Exercises for a hamstring strain The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. Initial Exercises Static Hamstring Contraction Begin this exercise in sitting with your knee bent to about 45 degrees (figure 2). Press your heel into the floor tightening the back of your thigh (hamstrings). Hold for 5 seconds and repeat 10 times as hard as possible provided the exercise is pain free.

Figure 2 Static Hamstring Contraction (right leg) Basic Hamstring Stretch Begin this exercise sitting with your back straight and your legs hanging over the edge of a chair or bench (figure 3). Slowly straighten your knee as far as you can go without pain, and, provided you feel either nothing, or, no more than a mild to moderate stretch (figure 3). Hold for 5 seconds and repeat 10 times provided the exercise is pain free.

Figure 3 Basic Hamstring Stretch (left leg) Bridging Begin this exercise lying on your back in the position demonstrated (figure 4). Slowly lift your bottom pushing through your feet, until your knees, hips and shoulders are in a straight line. Tighten your bottom muscles (gluteals) as you do this. Hold for 2 seconds then slowly lower your bottom back down. Repeat 10 times provided the exercise is pain free.

Figure 4 Bridging

Basic Gluteal Stretches Supine Gluteal Stretch Begin lying on your back. Using your hands, take your knee towards your opposite shoulder until you feel a stretch in the buttocks or front of your hip (figure 2). Hold for 15 seconds and repeat 4 times at a mild to moderate stretch pain free.

Figure 2 Supine Gluteal Stretch (right leg) Long Sitting Gluteal Stretch Begin sitting on the floor with both legs in front of you. Place your foot of the leg to be stretched on the other side of your straight leg as demonstrated (figure 3). Keeping your back straight, pull the leg to be stretched towards your chest, until you feel a stretch in the buttocks (figure 3). Hold for 15 seconds and repeat 4 times at a mild to moderate stretch pain free.

Figure 3 Long Sitting Gluteal Stretch (left leg)

What are the Gluteal Muscles? The Gluteal Muscles comprise of three muscles which make up the buttocks: Gluteus Maximus, Gluteus Medius and the Gluteus Minimus.

Tortora et al (1990)[1] describe the function of the gluteal muscles:

Gluteus Maximus extends and rotates the thigh laterally Gluteus Medius and Minimus abduct and rotate the thigh medially

Are your Gluteal Muscles Weak or Inhibited? An inhibited muscle means that the muscle is not firing properly (the neural signal is not reaching the muscle) and a weak muscle indicates the muscle is firing normally (not inhibited) but is lacking strength. A way to determine if the gluteal muscles are inhibited is to perform a prone hip extension test. To perform this test lie on a table face down and keeping the leg straight lift it up off the table. If on lifting the leg the knee significantly

flexes or if a "dipping" is noted in the lumbar spine, indicating lumbar extension, the gluteal muscles are inhibited.

Hip Extension Test

Liebenson (2006)[2] states that if a lack of coordination is seen when walking backwards it indicates the gluteus maximus is weak. What causes weak or inhibited gluteal muscles? If you spend long periods of time sitting in a chair then the front of the hips (hip flexors psoas) become short and tight, while the back of the hips (gluteal muscles) become long and weak. Soon the body forgets how to use the gluteal muscles because it will divert the neural signal intended for them to a stronger muscle close by to do the job instead. If the neural system is now asking less powerful muscles to perform the task that requires the potential power of the gluteal muscles then this is likely to lead to injury. What is the impact of weak or inhibited gluteal muscles? Weak or inhibited gluteal muscles can result in overactive hamstrings and be the reason for low back pain, tight iliotibial bands (ITB syndrome) and patello-femoral pain (runners knee). Without a strong gluteus medius to align the femur, knee and ankle, you are likely to over pronate your feet, which can lead to plantar fasciitis (heel pain), achilles tendinitis and shin splints. The gluteus medius holds our pelvis upright as we stand. When it gets weak the piriformis has to compensate and as a result the piriformis gets bigger and tighter and you may experience piriformis syndrome. How can I get my gluteal muscles functioning correctly? The following exercises will help develop gluteal activation and core stability. Bridge

Form a bridge as in Figure 1 (start position) Engage the core muscles Push the hips higher and hold for 30 seconds Lower the hips to the start position Repeat 3 times

Figure 1

Bridge with leg extension

Form a bridge as in Figure 1 Engage the core muscles Extend the left leg as in Figure 2 Ensure there is no tilt in the hips Hold for 30 seconds Repeat 3 times Repeat with the right leg Figure 2

Glute Kick

Assume the position on hands and knees as in Figure 3 Engage the core muscles Push the left heel up approx 2 inches towards the ceiling (Figure 4) Ensure no hip tilt Hold this position for 30 seconds Return the left leg to the start position as in Figure 3 Repeat 3 times Repeat with the right leg

Figure 3

Figure 4

Leg lift

Stand tall and erect Lift the left foot off the ground Assume the position as in Figure 5 Engage the core muscles Push the left heel up back as in Figure 6 keeping the left leg straight Ensure there is no hip tilt Hold this position for 30 seconds Return the left leg to the start position as in Figure 5 Repeat 3 times Repeat with the right leg

Figure 5

Figure 6 Lunge

Stand tall and erect Engage the core muscles Lung forward with the right leg to assume the position in Figure 7 Check right knee is above the right ankle and the back is straight Hold this position for 30 seconds Push back with the right leg to bring you back to the standing position Repeat 3 times

Repeat with the left leg

Figure 7

Squat

Stand tall and erect Engage the core muscles Lower the body to assume the position in Figure 8 Hold this position for 30 seconds Push down through the heels to bring you back to the standing position Repeat 3 times Figure 8

Superman

Stand tall and erect Engage the core muscles Lower the upper body and raise the left leg to assume the position in Figure 9 Hold this position for 30 seconds Return slowly to the standing position Repeat 3 times Repeat with the right leg Figure 9

Try to get into a position so that there is a straight line through the arms, neck, back and rear leg What is Piriformis Syndrome?

If you have a short tight Piriformis muscle then you may experience low back pain, pelvic pain, pain in the buttock or hip. As the piriformis gets bigger it may trap the sciatica nerve which can cause numbness and tingling going into your leg or foot; it may hurt to sit, walk or lie down. Exercise to lengthen the Piriformis

Supine Stretch

Lie on your back with knees bent Cross the right leg over the left leg as in Figure 10 Pull the left leg toward your chest The right will also move closer toward your chest, stretching the piriformis Hold the stretch for 30 seconds Repeat 3 times Repeat with the other leg

Figure 10

What is the impact of a short/tight Psoas? The rectus femoris acts as a hip flexor and knee extensor. The synergists are the psoas and the tensor fascia latae (TFL). Once the femur reaches about 90 degrees of hip flexion (Figure 11), the psoas takes over because the rectus femoris has shortened and is incapable of applying the necessary force to move the knee above the 90 degree of flexion (Figure 12). Psoas Test Stand up tall and while maintaining posture attempt to lift one knee past hip height (Figure 12). If your psoas is short/tight you may find that you experience cramp in the TFL, as your TFL attempts to carry the load, or your hips tilt back as the quadratus lumborum's attempts to carry the load.

Figure 11 Exercise to lengthen the Psoas

Figure 12

Psoas and Quadricep stretch

Kneel on the ground with the left knee well behind you With the left hand grab the left leg just above the ankle Engage the core and glutes Assume the position in Figure 13 Keep your back straight and vertical Keep your hips square Hold the stretch for 30 seconds Before the next stretch move the left knee further back Repeat 3 times Repeat with the other leg Figure 13

and finally This exercise strengthens your weak hip muscles, glutes and core while challenging your hip flexors

Form a bridge as in Figure 1 Engage the core and glutes Extend the left leg as in Figure 2 Lift your left foot off the ground and pull your left knee toward your left shoulder as in Figure 14 Lower left your foot to the ground and do the same with your right leg Maintain the bridge position the entire time you do the exercise Complete 15 lifts with each leg

Figure 14

How Often? Suggest the above exercises are performed 3 times a week with at least 24 hours recovery between sessions to allow the muscles to adapt