Kenny Croxdale
Level 7 Valued Member
Strengthening and Neuromuscular Reeducation of the Gluteus Maximus in a Triathlete With Exercise-Associated Cramping of the Hamstrings Strengthening and neuromuscular reeducation of the gluteus maximus in a triathlete with exercise-associated cramping of the hamstrings - PubMed
DISCUSSION
Bergeron (2) and Schwellnus (28-30) both discuss the role of muscle fatigue in EAMC, Exercise-Associated Muscle Cramping. The gluteus maximus muscle and hamstring muscles are agonists and share common functions during running. More specifically, these muscles decelerate the thigh during terminal swing and resist hip flexion during early stance.15,23 In this case report, we suspected that EAMC was the result of hamstring overuse, resulting in premature muscular fatigue and subsequent cramping. The muscle fatigue theory is supported by the fact that our patient only experienced cramping during the run portion of his triathlons (after completing the bike and swim events).
In an attempt to resolve the issue of hamstring fatigue and overuse, impaired gluteus maximus muscle function was addressed. Consistent with our clinical hypothesis, gluteus maximus strength increased and hamstring activation decreased postintervention.
The results of the current case report are consistent with the findings of Sherry and Best,31 who demonstrated that a rehabilitation program focusing on hip and trunk strengthening/stability was far superior for return to sport following acute hamstring strains than a traditional rehabilitation program consisting of stretching and strengthening of the hamstring muscles. Both our case report and Sherry and Best’s (31) clinical trial addressed impairments of the pelvis/trunk musculature to resolve a hamstring injury. This suggests that successful interventions for hamstring injuries do not need to be focused on the muscle itself.
The literature reports that shortened muscles and muscles that cross 2 joints are more prone to cramping as a result of muscle fatigue as opposed to electrolyte imbalance. (2,14,30)
CONCLUSION
This case report suggests that a rehabilitation program with a focus on increasing gluteus maximus muscle performance eliminated running related EAMC ( Exercise-Associated Muscle Cramping) in a triathlete. Improving strength and neuromuscular control of the gluteus maximus resulted in a decrease in hamstring activation during terminal swing and the first half of the stance phase of running.
DISCUSSION:
A program of gluteus maximus strengthening and neuromuscular training eliminated EAMC of the hamstrings in this patient. Given that the hamstrings and gluteus maximus work as agonists to decelerate the thigh during terminal swing phase and control hip flexion during loading response of running, we postulate that strengthening of the gluteus maximus decreased the relative effort required by the hamstrings, thus reducing EAMC (exercise-associated muscle cramping). The results of the EMG evaluation that was performed as part of this case report provides support for this hypothesis.DISCUSSION
Bergeron (2) and Schwellnus (28-30) both discuss the role of muscle fatigue in EAMC, Exercise-Associated Muscle Cramping. The gluteus maximus muscle and hamstring muscles are agonists and share common functions during running. More specifically, these muscles decelerate the thigh during terminal swing and resist hip flexion during early stance.15,23 In this case report, we suspected that EAMC was the result of hamstring overuse, resulting in premature muscular fatigue and subsequent cramping. The muscle fatigue theory is supported by the fact that our patient only experienced cramping during the run portion of his triathlons (after completing the bike and swim events).
In an attempt to resolve the issue of hamstring fatigue and overuse, impaired gluteus maximus muscle function was addressed. Consistent with our clinical hypothesis, gluteus maximus strength increased and hamstring activation decreased postintervention.
The results of the current case report are consistent with the findings of Sherry and Best,31 who demonstrated that a rehabilitation program focusing on hip and trunk strengthening/stability was far superior for return to sport following acute hamstring strains than a traditional rehabilitation program consisting of stretching and strengthening of the hamstring muscles. Both our case report and Sherry and Best’s (31) clinical trial addressed impairments of the pelvis/trunk musculature to resolve a hamstring injury. This suggests that successful interventions for hamstring injuries do not need to be focused on the muscle itself.
The literature reports that shortened muscles and muscles that cross 2 joints are more prone to cramping as a result of muscle fatigue as opposed to electrolyte imbalance. (2,14,30)
CONCLUSION
This case report suggests that a rehabilitation program with a focus on increasing gluteus maximus muscle performance eliminated running related EAMC ( Exercise-Associated Muscle Cramping) in a triathlete. Improving strength and neuromuscular control of the gluteus maximus resulted in a decrease in hamstring activation during terminal swing and the first half of the stance phase of running.