eBook ISBN: 978-1-58394848-4 Trade Paperback ISBN: 978-1-58394-847-7 Copyright © 2014 by John Gibbons. All rights reserved. No portion of this book, except for brief review, may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without the written permission of the publisher. For information, contact Lotus Publishing or North Atlantic Books. First published in 2014 by Lotus Publishing Apple Tree Cottage, Inlands Road, Nutbourne, Chichester, PO18 8RJ and North Atlantic Books P.O. Box 12327 Berkeley, California 94712 Drawings Amanda Williams Photographs Ian Taylor Trade Paperback Text Design Wendy Craig Cover Design Paula Morrison MEDICAL DISCLAIMER: The following information is intended for general information purposes only. Individuals should always see their health care provider before administering any suggestions made in this book. Any application of the material set forth in the following pages is at the reader’s discretion and is his or her sole responsibility. The Vital Glutes: Connecting the Gait Cycle to Pain and Dysfunction is sponsored by the Society for the Study of Native Arts and Sciences, a nonprofit educational corporation whose goals are to develop an educational and crosscultural perspective linking various scientific, social, and artistic fields; to nurture a holistic view of arts, sciences, humanities, and healing; and to publish and distribute literature on the relationship of mind, body, and nature. British Library Cataloguing-in-Publication Data A CIP record for this book is available from the British Library ISBN 978 1 905367 49 8 (Lotus Publishing) ISBN 978 1 58394 847 7 (North Atlantic Books) The Library of Congress has cataloged the printed edition as follows: Gibbons, John, 1968-author. The vital glutes : connecting the gait cycle to pain and dysfunction / John Gibbons. p.; cm. Summary: “Health & Fitness; Alternative Therapies; Pain Management; Exercise”— Provided by publisher. ISBN 978-1-58394-847-7 (paperback) — ISBN 978-1-58394848-4 (ebook) I. Society for the Study of Native Arts and Sciences, sponsoring body. II. Title. [DNLM: 1. Gait—physiology. 2. Musculoskeletal Pain—etiology. 3. Buttocks— pathology. 4. Musculoskeletal Physiological Phenomena. 5. Physical Therapy Modalities. 6. Range of Motion, Articular. WE 141] QP321 612.7’4–dc23 v3.1 Contents Cover Title Page Copyright Dedication Preface Acknowledgments List of Abbreviations 1 Putting the Maximus Back into Gluteus Maximus 2 Muscle Imbalance and the Myofascial Slings 3 The Glutes and the Gait Cycle 4 Leg Length Discrepancy and Over-Pronation—the Effect on the Glutes 5 Functional Anatomy of the Gluteus Maximus 6 Functional Anatomy of the Gluteus Medius 7 Muscle Energy Techniques 8 The Antagonistic Cause—the Vital Iliopsoas, Rectus Femoris, and Adductors 9 Gmax and Gmed Causing Knee and Ankle Pain 10 Gmax and Gmed Causing Lumbar Spine Pain 11 Differential Diagnosis of Weakness Inhibition of the Glutes 12 Gmax and Gmed Stabilization Exercises Appendix: Gmax and Gmed Stabilization Exercise Sheet Bibliography Index I dedicate this book to my father, John Andrew Gibbons, who I wish was here to see what I have achieved, and to my mother, Margaret Gibbons, whom I love dearly. Preface The success of my first book, Muscle Energy Techniques: A Practical Guide for Physical Therapists, inspired me to continue with the dream of writing, and I wanted to write specifically about what I feel is one of the most neglected areas in physical therapy—the “glutes.” The last chapter of my previous book looked at the functions of the gluteus maximus (Gmax) and the gluteus medius (Gmed) and how they affected the gait pattern and subsequently caused pain and dysfunction elsewhere in the body. I also briefly discussed the firing patterns of the specific movements of hip extension and hip abduction. However, I would now like to elaborate upon this fascinating area and hopefully in this book I will do just that. I also want my readers to be able to demonstrate, and explain among their patients and colleagues in discussion groups, that if a weakness or misfiring occurs within these particular firing sequences, a dysfunctional pattern can develop through the body’s natural compensatory mechanisms. In this book I want to take the reader on a journey, just as I did in my first book. The feedback I have received in response to that book has been overwhelming; people have said that the way I have explained things has guided them on their journey through the topic. I consider my books (and also my teaching and articles) to be a bit like jigsaw puzzles: when you first open the box/cover, you have many pieces to try to fit together to form a picture. After reading one chapter you will store some information in your brain, but the “picture” will be somewhat blurred. As you continue reading successive chapters, however, I truly hope a sharper picture will begin to form. Once the book has been read from cover to cover, you should have a clear picture; it might not be crystal clear, but hopefully will be adequate for you to utilize and adapt to your own clinical setting. I will expand on the theory of muscle weakness and misfiring in order to discuss and demonstrate how and why these issues cause pain and dysfunction in so many patients and athletes. I have also added complementary treatment protocols that will help a physical therapist deal with the causes of the weakness and misfiring, rather than simply treating the symptoms. Once all this has been understood and the causes have been dealt with, I then want the physical therapist to be able to competently advise the athlete/patient on the best forms of gluteal control by the use of specific exercises. I have now reached a stage where, in almost each and every one of the physical therapy courses I teach (even in the case of the “Shoulder Joint Master Class”), I am constantly being asked about the glutes and how they cause pain in a specific area. I always discuss verbally how this phenomenon can happen and then go on to demonstrate practically the causes and effects; however, I have never been able to say, “Read such-and-such a book and you will find the answer.” My aim in writing now is to meet the need for a book which does give such answers. I wanted to produce a text that over time will help many thousands of physical therapists, whether they are students in this area or have been practicing physical therapists for many years. I believe that this book can serve as a core text for anyone in the field of physical therapy who wants a better understanding of how maximizing the glutes to achieve optimum functionality will help reduce a patient’s pain and dysfunction in almost every part of the body! Many years ago I wrote an article called “Putting maximus back into the gluteus.” I have written numerous articles over the years but I consider this particular one to be my most important: it has been read by lots of physical therapists throughout the world, and I have had many comments and numerous emails from therapists (and patients too) about the content. I enjoyed producing the article so much so that I decided to write a book on the subject of the glutes, and hence this practical guide for physical therapists on maximizing the glutes. A revised version of that article forms the first chapter of this book, and I would like to think that reading it will inspire you and whet your appetite to keep on reading. Hopefully you will continue on the journey with me through the remainder of the book, which will go into great depth as to why glute-related pain and dysfunction can present itself in your athletes or patients. A three-week holiday in Turkey was a good time for me to put pen to paper. Much as I like the sun, it is not a great idea for me to spend all my time in the sunshine, as I have had some skin cancer issues in the past (in fact my father died of skin cancer); so this was a great opportunity to do some writing. While I was sitting there one morning with a coffee, typing on my laptop, my son Thomas came up to me and asked me what I was doing. He knew that I had written a book the previous year, and I had mentioned to him that I was thinking of writing another one just on the glutes, but I am not sure if he understood me at the time. I said I was starting to write the book that I had mentioned to him a while back, but trying to explain to a 12-year-old about the Gmax and Gmed was going to be a bit heavy, so I told him that I was writing a book about the “bum” muscles. He said, “Dad, you are writing a whole book just about the bum muscles?” I replied “Yes,” to which my son then responded, “But the bum is just big and a bit squidgy”! As we now begin our journey, I hope to inspire you to continue reading all the chapters so that you will gain a better understanding of the role of the glutes. Once you have finished the book, you will then realize that there is more to the bum than being “just big and a bit squidgy.” Acknowledgments My thanks to Jon Hutchings of Lotus Publishing for allowing me the opportunity to continue with my passion for writing—I hope that this book will be as successful as my previous book on muscle energy techniques. I also want to thank the models and Jack Meeks from Oxford University Sport, as well as Ian Taylor, who spent so much time taking and editing the photographs for this book. I would like to personally thank someone who guided me through my osteopathy training—a musculoskeletal physiotherapist by the name of Gordon Bosworth. I consider him to be one of the best, if not the best, physical therapists I have ever met. He was and still is an inspiration to me in becoming the person I am today. I have to mention my son, Thomas Rhys Gibbons, as he means the world to me. He was 12 years old at the time of writing this book and without him I would not have had the motivation or dedication to achieve what I have accomplished in my life so far. I have many dreams and aspirations in my life and one of them is to be a success in any avenue or goal that I pursue. That is one of the reasons I do what I do in my life, as I want to show my son that when you set your heart on achieving something that you might initially consider to be potentially unachievable, then with continued perseverance you will notice that things start to change in your life, and your dream eventually becomes a reality. I would like to think that, in times to come, my son will look back at the books I have written, and which have been personally dedicated to him, and feel that since his dad has accomplished some things in his life even though it took him a while to get started, he will easily be able to do the same. You just need a goal in your life, and to add some passion to the equation, and then anything—and I mean anything—can be achieved. I am hoping that my success and determination will inspire and motivate him to do well in his own life. Thanks too to my sister, Amanda Williams, and her family. I truly hope for all the success that you, and your gorgeous children, James and Victoria (who I have