The Glute Medius: The Solution for Optimal Ankle Health

Well, winter is here.  I can't say I'm excited because I hate the cold but I am looking forward to seeing my basketball athletes excel this season.  As a collegiate player, ankle injuries plagued my teammates season after season.  Why was this?  Prior to the start of every season, our team would perform a program using resistance bands, ankle weights and marbles to improve the overall strength of our ankles.  After completing this program why were my teammates still spraining their ankles in non contact situations?  Were we missing the boat in regards to prevention and overall ankle health?

Typically, with prevention you find yourself looking beyond the affected area to solve the problem.  In regards to ankle trauma, the missing link is the glute medius not the ankle.  During various movement patterns, the primary function of the glute medius is to initiate external rotation and to provide an adequate amount of stabilization toward the lumbo-pelvic region along with the femur.  How does glute medius strength and ankle sprains relate?  To start, ankle sprains and shin angles go hand in hand.  When changing directions, a positive shin angle must exist in order to avoid any ankle  trauma.  In high-speed/high-force environments, glute medius strength is needed to provide optimal control over the femur which will translate into correct shin angles and osteo-alignment.

An assessment I have been implementing with my basketball athletes for a number of years is the Trendelenburg Test.  Since introducing this test, the number of ankle injuries in my basketball players has decreased significantly.  The Trendelenburg Test is simple yet very effective method for diagnosing glute medius strength/activation in any of your athletes not just basketball players. To perform the test, have your athlete stand facing away from you (preferably a wall or body grid) so you have an unobstructed view of the individuals lumbo-pelvic region.  At your cue, have them slightly flex their knee and pick up their foot about 4-5 inches off the floor.  Hold this position for 2 seconds and then alternate.  The focal points you should be looking for is pelvic alignment and body stabilization.  A weak glute medius can be confirmed if your athletes pelvic alignment drops below neutral to the uninvolved side or if they seem to be having a difficult time balancing on the involved leg while performing the test (placing the foot down abruptly or moderate/intense instability).  For advanced or elite athletes a modified test can be administered which requires the individual to lift their leg higher (femur parallel/high knee position).

One method I love to use is to create what i like to term "Prevention Equations".  Similar to mathematical equations, it is impossible to obtain a solution without taking the proper steps and methods.

Poor Glute Medius Strength + Poor Femur Control+ Poor Shin Angle = Increased Ankle Trauma

Excellent Glute Medius Strength + Good Femur Control + Optimal Shin Angle = Decreased Ankle Trauma

The first two videos demonstrate both variations of the Trendelenburg's Test.  The third video demonstrates the pelvic drooping which accompanies a weak glute medius.

Exercises you can introduce to strengthen the glute medius are hip hikes, bucks, bridges, peg legs, monster walks and lateral wall slides.

Take a few seconds to administer the Trendelenburg Test.  Not only will it improve your program design but it will improve upon the overall health of your athletes.

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