The Monday Memo
February 11th, 2019 PITT DPT STUDENTS
The Role of Stabilizing Muscles
When most people go to the gym, they usually work out the “beach body” muscles: chest, arms, shoulders, and legs (only sometimes). Rarely do they focus on smaller muscles that are important for everyday functions such as walking, stairs or running. A lot of musculoskeletal hip pathologies stem from muscle imbalances due to years of compensation patterns.
I have worked out my entire life, but it wasn’t until my first orthopedic clinical rotation this semester that I realized how important the less commonly known muscles are. One that comes to my mind almost instantly is the gluteus medius. Ask an everyday patient, and they most likely will not know what this muscle is, let alone what it does. The gluteus medius is necessary to counter the hip adduction moment during gait/running. Weakness in this muscle is evident almost instantly by valgus collapse, which in turn leads to various types of injuries and pain further down the kinetic chain at the knee and ankle. No one goes to the gym and has a “glute day” solely focused on working out their gluteals. But almost all the patients I have seen at my clinical have weakness in this muscle.
Another muscle that comes to mind is the transversus abdominis, which is necessary to stabilize the pelvis during hip movements. Limiting anterior or posterior pelvic rotation is essential during rehab to make sure you are targeting the muscles you want to target. For example, if your goal is to strengthen lower abdominals and you have a large anterior pelvic tilt, you will emphasize more hip flexors during exercises rather than core. During our initial session, we instruct our patients on a proper activation of their TA, and couple every subsequent exercise with TA activation in order to stabilize the pelvis.
In conclusion, rehab is similar to building a scaffold. You must start by laying a foundation with activating primary stabilization muscles before building up with more targeted strengthening. Emphasize form over reps at the gym because you will also target stabilizing muscles that don’t immediately come to mind. Every muscle serves a function and we should design our treatment plan based on that idea. After all, evolution would not leave a muscle that has no purpose.
-Sam Yip, SPT