Day 7- The 3 Brothers

101 Things I have Learned from my Massage Therapist

I was really trying to talk about the body from head to toe as i worked through these posts. However, after teaching my patients how to stretch and strengthen gluteus medius every day this week; I realized that the universe has another plan.

When i conduct an initial interview with my patients and hear knee pain i always ask where is the pain. if it is in the hip or the knee it can often  be a referral from the 3 brothers; gluteus maximus, medius and minimus. Theses muscles do a lot of work to stabilize the pelvis during the swing phase of gait. Try it out, stand on one foot ( hold on to something if you need). If you are not feeling anything try lifting the knee a little higher. Can you feel how the weight transfers to the leg you are standing on. Place one hand on the side of your hip, Can you feel the muscle activate? Say Hello to gluteus medius and the little brother minimus.

glute med

These work horses are attached to Gluteus Maximus ( big Brother) and the illium (the top and outside edges of the hip bone) they narrows at the base and attach to the greater trochanter of the femur; both resembling open fans. Gluteus minimus is located roughly underneath medius

Greater_sciatic_notch_02_lateral_view_(Right_hip_bone)

So what does this have to do with the knee?

The trigger point referral from gluteus maximus and medius can be a real pain in the butt; however little brother gluteus minimus has a referral that travels all the way to the knee and lower leg. If the medius is weak the burden of balancing the hips when we walk falls on the little brother.

So what can we do?

  1. stretch! seated on a chair or laying on your back; bring your right ankle to your left knee. For me this is almost enough stretch… allow the right knee to get heavy and drop toward the floor. Most people will try to lean forward to really get a stretch; however i like to think of closing the hip angle and lifting up through the sternum.
  2. Strengthening gluteus medius- (I usually recommend doing this exercise when you brush you teeth; association with an activity of daily living seems to have the greatest follow through results). Stand on one foot and feel for the muscles to activate on the opposite side. keeping the hips level will help with this.
  3. The Clam-this is a common exercise done laying on your side. Bend the knees or keep the legs straight dealers choice, now begin to open them. The key here is to only open them 15%. Move slowly so you can feel the small nuances. After 15% other muscles begin to take over try doing it correctly and incorrectly to feel for the difference.
  4. Lunges- I almost never give this exercise because it is difficult for most people to do correctly. I think the big key here is to keep the knee directly over the ankle, and to move really slowly through it.  Try exhaling as you rise from one knee.
  5. little kick backs for gluteus maximus- Again a difficult exercise to feel. Stand next to a table or hold on to something. keep the foot parallel to the ground and kick back. try to imagine lifting a swinging motion like a pendulum from the hip. The key to this exercise is to only go 5 degrees.

Try them all!  Do your own research; reading, watching videos and looking at images will help …enjoy getting to know the 3 brothers gluteus.

Peace and Love. M

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