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Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging

Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.


Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

Note: This article will be published in a forthcoming issue of


the Journal of Sport Rehabilitation. The article appears here in
its accepted, peer-reviewed form, as it was provided by the
submitting author. It has not been copyedited, proofed, or
formatted by the publisher.

Section: Original Research Report

Article Title: Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring
Recruitment During a Supine Bridging Exercise in Active Females? A Randomized Controlled
Trial

Authors: John H. Hollman, Tyler A. Berling, Ellen O. Crum, Kelsie M. Miller, Brent T.
Simmons, and James W. Youdas

Affiliations: Program in Physical Therapy, Mayo Clinic College of Medicine, and Department
of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN.

Running Head: Gluteus maximus EMG and bridging exercise

Journal: Journal of Sport Rehabilitation

Acceptance Date: January 16, 2017

2017 Human Kinetics, Inc.

DOI: https://doi.org/10.1123/jsr.2016-0130
Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

Do verbal and tactile cueing selectively alter gluteus maximus and hamstring recruitment during

a supine bridging exercise in active females? A randomized controlled trial

Running head: Gluteus maximus EMG and bridging exercise


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John H. Hollman, Tyler A. Berling, Ellen O. Crum, Kelsie M. Miller,

Brent T. Simmons, James W. Youdas

All authors are with the Program in Physical Therapy, Mayo Clinic College of Medicine, and

Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN.

Address correspondence to John H. Hollman at hollman.john@mayo.edu

Manuscript word count: 2,966 words

Abstract word count: 300 words


Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

Abstract

Context: Hip extension with hamstring- rather than gluteus maximus-dominant recruitment may
increase anterior femoracetabular forces and contribute to conditions that cause hip pain. Cueing
methods during hip extension exercises may facilitate greater gluteus maximus recruitment.
Objective: We examined whether specific verbal and tactile cues facilitate gluteus maximus
recruitment while inhibiting hamstring recruitment during a bridging exercise. Design:
Randomized controlled trial. Setting: Biomechanics laboratory. Participants: 30 young adult
women [age 24 (3) years, BMI 22.2 (2.4) kg/m2]. Intervention: Participants were tested over 2
sessions, 1 week apart, while performing 5 repetitions of a bridging exercise. At their second
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visit, participants in the experimental group received verbal and tactile cues intended to facilitate
gluteus maximus recruitment and inhibit hamstring recruitment. Control group participants
received no additional cues beyond original instructions. Main Outcome Measures: Gluteus
maximus and hamstring recruitment were measured with surface electromyography, normalized
to maximal voluntary isometric contractions (MVICs). Results: Gluteus maximus recruitment
was unchanged in the control group and increased from 16.8 to 33.0% MVIC in the cueing group
(F = 33.369, P < .001). Hamstring recruitment was unchanged in the control group but also
increased from 16.5 to 29.8% MVIC in the cueing group (F = 6.400, P = .018). The effect size
of the change in gluteus maximus recruitment in the cueing group (Cohens d = 1.5, 95% CI =
0.9 to 2.2) was not significantly greater than the effect size in hamstring recruitment (Cohens d
= 0.8, 95% CI = 0.1 to 1.5). Conclusions: Verbal and tactile cues hypothesized to facilitate
gluteus maximus recruitment yielded comparable increases in both gluteus maximus and
hamstring recruitment. If one intends to promote hip extension by facilitating gluteus maximus
recruitment while inhibiting hamstring recruitment during bridging exercises, the cueing
methods employed in this study may not produce desired effects.

Keywords: hip, exercise, muscle-contraction, electromyography, young-adult, randomized-

control-trial
Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

Conditions contributing to hip pain are experienced across the lifespan. In young, active

adults anterior hip pain can be particularly problematic. Differential diagnoses for anterior hip

pain in young adults range from extra-articular muscle injuries to intra-articular labral tears.1

Hip pain in general and femoroacetabular impingement in particular, which is increasingly

recognized as a cause of hip pain in young adults,2,3 may be more prevalent in women than

men.4,5 Excessive anterior femoroacetabular forces may contribute to femoroacetabular

impingement and other conditions leading to anterior hip pain.6-8 Sahrmann9 proposed that when
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gluteus maximus strength is impaired, or when hamstring muscle recruitment is dominant during

hip extension, anterior femoracetabular forces increase because the proximal femur translates

anteriorly rather than maintaining a centralized position in the acetabulum. Biomechanically, the

hamstring contributes to hip extension and with exception of the short head of the biceps

femoris, attaches distally on the tibia. Secondary to its long lever arm as a hip extensor, the

hamstring cannot precisely control proximal femoral movement during hip extension. Therefore,

hamstring-dominant rather than gluteus maximus-dominant hip extension, repeated over many

cycles during daily activities, may increase anterior femoroacetabular forces that lead to pain and

dysfunction. Lewis et al,10 for example, showed that anterior hip forces increase during hip

extension when gluteal muscle strength is impaired.

Lewis et al11 subsequently recommended that correcting abnormal movement patterns

may facilitate a reduction in anterior hip joint stresses. Cueing strategies used by rehabilitation

providers may play a critical role in assuring proper muscle recruitment during hip rehabilitation

exercises. Even though rehabilitation providers use verbal cueing often in practice, relatively

little information about the effect of cueing on muscle recruitment exists in the literature.

Investigators have demonstrated, for example, that in a prone hip extension exercise performed
Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

without specific cueing strategies, hamstring recruitment preceded gluteus maximus recruitment;

however, verbal cueing to extend the hip with gluteal muscles resulted in near simultaneous

gluteus maximus and hamstring recruitment and stronger gluteal activation.11 The supine

bridging exercise is also commonly used to strengthen the hip extensors. Those who are

hamstring-dominant tend to recruit the hamstrings initially to perform the exercise,12 which may

be undesirable when rehabilitating conditions associated with anterior hip pain. McGill13

hypothesized that specific verbal and tactile cues to promote gluteal and quadriceps muscle
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contractions during supine bridging exercises may facilitate gluteal recruitment and inhibit

hamstring recruitment. His hypothesis, however, has not been experimentally confirmed.

The purpose of this study was to examine whether performing the supine bridging

exercise with specific verbal and tactile cueing strategies described by McGill13 facilitates

gluteus maximus recruitment while inhibiting a concomitant increase in hamstring recruitment.

Since anterior hip pain may be more prevalent in women than men,4,5 we examined the question

in young adult women. We hypothesized the cueing procedures would facilitate gluteus

maximus recruitment without increasing hamstring recruitment.

Methods

Design

This was a pretest-posttest randomized controlled trial design with a 1:1 allocation ratio.

Independent variables included one between-group variable (control and experimental groups)

and one repeated-measures variable (pre- and post-randomization). Dependent variables

included the amplitude of gluteus maximus and hamstring recruitment during the bridging

exercise. As a randomized controlled trial, this study was registered at ClinicalTrials.gov as

identifier NCT02645188.
Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

Participants

Thirty female participants between the ages of 18-40 were recruited. Individuals who

presented with or self-reported any of the following conditions were excluded from the study: (1)

evidence of patellofemoral pain syndrome assessed with the pain provocation test of patella

compression into the femoral condyle; (2) reported history of previous hip or knee ligament

injury, trauma or surgery; (3) evidence of femoroacetabular impingement assessed with the hip

flexion/adduction/internal rotation test; (4) evidence of a mechanical disc syndrome/mechanical


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low back pain causing lower extremity symptoms assessed using the straight leg raise test; (5)

reports of lower extremity pain that limits functional activities; and (6) reported history of any

neurological conditions that limit functional activities. Further inclusion criteria necessary for

participation in the study included normally graded (Grade 5) manual muscle tests of the major

hip and knee muscle groups (hip flexors, hip extensors, hip abductors, hip adductors, lateral hip

rotators, medial hip rotators, knee flexors and knee extensors). The sample size (n = 30,

randomly assigned to 2 groups) was sufficient to detect an effect size f = .30 at = .05 with 80%

power. All participants voluntarily signed an informed consent document approved by the Mayo

Foundation Institutional Review Board.

Procedures

All data were collected in a biomechanics laboratory. Participants activity levels were

measured with the short form of the International Physical Activity Questionnaire.14 They self-

reported their demographic characteristics including age, height and body mass (Table 1). Raw

electromyography (EMG) signals were collected at 1000 Hz through a 16-bit NI-DAQ PCI-6220

analog-to-digital card (National Instruments Corporation, Austin, TX) with Bagnoli DE 2.1

single-differential bipolar surface EMG electrodes and a Bagnoli-16 amplifier (Delsys Inc.,
Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

Boston, MA). The sensor contacts were constructed of 99.9% pure silver bars 10mm in length,

spaced 10mm apart. The preamplifier gain was 10 v/v and the combined preamplifier and main

amplifier permitted gains from 100 to 10,000 Hz. The amplifiers minimum common mode

rejection ratio was 94dB, its input impedance exceeded 1015 ohms and its estimated noise was

less than 1.2 V. Raw EMG signals were processed with EMGworks Data Acquisition and

Analysis software (Delsys Inc., Boston, MA).

Electrodes were placed on the right lower extremity. The skin over each muscle belly
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was cleansed with isopropyl alcohol before electrode placement. Electrodes were then secured

with double-sided tape, in parallel with the respective muscle lines of action, at positions over

the gluteus maximus and hamstring as described by Criswell (Figure 2).15 The gluteus maximus

electrode was placed halfway between the sacral vertebrae and the greater trochanter. The

hamstring electrode was placed on the biceps femoris, two-thirds of the distance between the

greater trochanter and the back of the knee. After the skin was prepared and electrodes were

secured, participants were assessed for maximal voluntary isometric contractions (MVICs) in

standardized muscle testing positions described by Hislop and Montgomery.16 The gluteus

maximus was tested with the participant in prone, with the knee flexed to 90 and the hip in a

neutral sagittal plane position. Resistance was applied with a strap at the distal thigh secured to

the plinth on which participants were tested. Participants extended their thigh isometrically

while maintaining their knee at 90 of flexion. The hamstring likewise was tested with the

participant in prone. Resistance was provided by a strap around the distal calf and secured to the

plinth. An additional strap was secured around the pelvis to stabilize the back and pelvis and

minimize utilization of extraneous muscles during MVIC testing. Participants flexed their knee

isometrically against resistance at approximately 20 of knee flexion. Three 7-second trials were
Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

recorded for each muscle, with a 20-second rest between trials. The MVIC tests were performed

so that tension was increased gradually over the first second, maintained isometrically at a

maximum level for 5 seconds, then gradually released over the final second of contraction. We

used the maximum value of those 3 trials to represent the MVIC trial, as recommended by

several investigators as the most reliable approach to establish MVICs.17-19 We provided verbal

motivation to encourage maximal contractions.

Participants then performed the supine bridge exercise. The position from which the
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bridge exercise was performed was standardized so that the participant began in the hook lying

position with her feet comfortably flat on the supporting surface. In that position, the knees were

flexed approximately 90 and the hips were flexed approximately 45. From that starting

position, the participant lifted her hips off the supporting surface to achieve a position of

approximately 0 of hip flexion, isometrically holding that position for 5 seconds before

returning to the start position (Figure 1A). Participants maintained their arms in a folded

position across their chests so the upper extremities could not assist or provide stabilization

during the exercise. A visual prompt of the bridge position was shown to participants in the

event they were not familiar with the exercise, but no additional cueing was given. Participants

practiced the exercise once before beginning data collection to confirm proper performance of

the test. Each participant performed 5 repetitions of the exercise, with 5-second isometric holds

during each repetition and 2-second pauses between repetitions. We used 5-second isometric

holds during the test to replicate as close as reasonably the methods used by several investigators

who examined the bridging exercise.20-23

Following the initial testing session, participants were instructed to continue their normal

activities for the subsequent week. We did not request that participants journal their activities,
Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

hence we could not control for potential confounding variables that may have influenced test

sessions one week apart. Each participant returned one week later for retesting and were tested

at the same time of day as they were at the initial testing session. Participants were randomly

assigned using a random number generator to the control group or experimental group at the

second visit. Participants in the control group performed the bridging exercise in the same

manner as at the initial testing session and were not given any additional cueing. Participants in

the experimental group were given verbal and tactile cueing as described by McGill.13 An
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investigator knelt to block the participants feet and gave the initial cue of, Squeeze your gluts.

The investigator then instructed the participant to Extend your knees while maintaining contact

with both feet on the floor in an attempt recruit the quadriceps. Last, the investigator instructed

the participant to Push into my hands, placed laterally at the knee joint line to promote external

rotation and abduction of the hip (Figure 1B). The cues given to each participant in the

experimental group were meant to enhance gluteus maximus recruitment while minimizing

hamstring recruitment. Theoretically, firing the quadriceps produces reciprocal inhibition of the

hamstring muscle. Asking participants to squeeze their gluteal muscles and push into the

researchers hands, causing isometric external rotation and abduction, theoretically should

increase gluteus maximus recruitment.13 The experimental group performed 5 repetitions of the

exercise with the verbal and tactile cues, including 5-second isometric holds of each repetition

and 2-second pauses between repetitions.

The EMG signals were band-pass filtered between 20 and 450 Hz with a 4th order

Butterworth filter and processed with a root mean square algorithm over 250-ms time constants

with sliding windows. Data from the gluteus maximus and hamstring during the tests were

normalized to their respective MVIC trials. We analyzed the mean recruitment amplitude over 2
Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

seconds during the isometric holding phase of each repetition and subsequently calculated the

mean recruitment amplitude across 5 repetitions for each subject.

Statistical Analyses

Anthropometric and demographic data were compared between groups with t-tests and 2

analyses for data measured on continuous and categorical scales of measurement, respectively.

Mixed model 2 2 ANOVAs having one between-groups factor (cueing vs. control group) and

one within-groups factor (pre- vs. post-intervention) were conducted to analyze differences in
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gluteus maximus and hamstring recruitment during the bridging exercise. Simple effects tests

with Bonferroni corrections were used to analyze and interpret statistically significant group

test interactions. Effect sizes to estimate the pre- to post-intervention change in EMG

recruitment were estimated with Cohens d statistics. Shapiro-Wilk tests were used to assess

whether distributions were normally distributed; if the assumption of normality was violated,

data were transformed with natural logarithmic transformations prior to conducting the

ANOVAs. All analyses were conducted with IBM SPSS Statistics 21.0 software (IBM

Corporation, Armonk, New York, USA) and thresholds for statistical significance were set at =

.05.

Results

The flow of subjects through the study is shown in Figure 3. None of the comparisons in

age, height, mass, BMI or activity levels were statistically significant (Table 1); hence the groups

were comparable to one another with regard to their demographic characteristics following

randomization.
Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

Data presented in Figure 4 partially support our hypothesis. The intervention consisting

of verbal and tactile cueing increased gluteus maximus recruitment during the supine bridging

exercise. Gluteus maximus recruitment was equivalent between groups at baseline (t = 0.211, P

= .835) but greater in the cueing group at the second visit (t = 3.762, P =.001), increasing from

16.8% MVIC to 33.0% MVIC (F = 33.369, P < .001). The cueing technique did not, however,

minimize a concomitant increase in hamstring recruitment. Hamstring recruitment was also

equivalent between groups at baseline (t = 0.568, P = .575) and greater in the cueing group at the
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second visit (t = 3.166, P = .004), increasing from 16.5% MVIC to 29.8% MVIC (F = 6.400, P =

.018). The effect size of the change in gluteus maximus recruitment in the cueing group

(Cohens d = 1.5, 95% CI = 0.9 to 2.2) was not statistically greater than the effect size in

hamstring recruitment in the cueing group (Cohens d = 0.8, 95% CI = 0.1 to 1.5).

Discussion

The principal finding in this study was that verbal and tactile cueing intended to

maximize gluteus maximus recruitment during the supine bridging exercise yielded comparable

increases in both gluteus maximus and hamstring recruitment. Significant increases in muscle

recruitment were exhibited among participants who received verbal and tactile cueing, but those

increases were not selective to the gluteus maximus.

To our knowledge, this is the first study to examine efficacy of cues hypothesized by

McGill13 to increase gluteus maximus recruitment and minimize hamstring recruitment during

the supine bridging exercise. The way in which rehabilitation providers cue patients to recruit

muscles may optimize a desired performance, as Lewis & Sahrmann11 demonstrated during a

prone hip extension exercise. Our findings imply that the cues we employed may not have

optimized gluteus maximus recruitment while minimizing hamstring recruitment during the
Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

bridging exercise. Other exercises may better accomplish that goal. Jeon et al,24 for example,

reported that prone-on-table hip extension with knee flexion better optimized the gluteus

maximus-to-hamstring recruitment ratio than a similar exercise with the knee extended. Kang et

al25,26 provided evidence that incorporating hip abduction with hip extension likewise may

maximize gluteus maximus recruitment. Perhaps greater emphasis on cueing abduction during

the supine bridging exercise may have altered our findings.

While a few studies have examined EMG during the bridging exercise, they primarily
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monitored abdominal (rectus abdominus and obliques), paraspinal, iliocostalis and gluteus

medius recruitment.27-29 Two studies reported data on gluteus maximus and hamstring

recruitment during the bridging exercise.21,22 Ekstrom et al21 reported gluteus maximus and

hamstring recruitment at 25% and 24% MVIC, respectively. In a later study in which a similar

exercise was examined, Ekstrom et al22 reported gluteus maximus recruitment to be 27% MVIC

and hamstring recruitment to be 35% MVIC. In neither study were any particular cues used to

enhance muscle recruitment. Both studies report higher magnitudes of muscle recruitment

during the bridging exercise than we report in the un-cued condition (e.g., approximately 15-16%

MVIC in the gluteus maximus and 13-16% MVIC in the hamstring), even though the methods

for performing the bridging exercise were comparable (e.g., 5-second isometric holds,

performing the exercise from a standardized position in which the feet were flat on the

supporting surface). Two methodological differences may account for our varying results. We

used make tests with external strapping to establish MVICs whereas Ekstrom et al used manual

break tests to establish MVICs. Make tests involve muscle fiber shortening contractions and

may induce greater amplitudes of muscle recruitment than do break tests, which involve muscle

fiber lengthening contractions;30 hence our denominators in the normalizing equations were
Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

likely greater, yielding lower normalized recruitment amplitudes. Second, while participants in

Ekstroms studies were similar in age and activity levels to those in our study, they included

male participants while we examined the question in women only. Men may elicit higher

recruitment levels during exercise than women,31 which could potentially account for the higher

mean recruitment amplitudes reported by Ekstrom et al.21,22

Generalizing our findings is limited in part by the sample. Only healthy, female

participants were recruited. The cueing procedures used in this study may produce different
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effects in individuals with impaired hip extension strength or in those with hip pathology.

Similarly, the findings cannot be generalized to a male population. Additionally, the cueing

procedures may not have been optimal. While McGill13 proposed the verbal cue to extend your

knees would reciprocally inhibit hamstring recruitment, several participants reported that

particular verbal cue was confusing. Providing more cues for hip abduction or rotation may have

further maximized gluteus maximus recruitment or minimized hamstring recruitment in the

supine bridge exercise, as was reported to occur in the prone position.25 Finally, our study may

have been underpowered to detect smaller, yet potentially clinically relevant, effect sizes and our

power analysis leaves open a 20% probability that Type II error may have been made. While the

difference between the gluteus maximus and hamstring effect sizes of the change in recruitment

under the cueing condition was not statistically significant, the gluteus maximus effect size

(Cohens d = 1.5, 95% CI = 0.9 to 2.2) was nearly twice that of the hamstring effect size

(Cohens d = 0.8, 95% CI = 0.1 to 1.5). Variability in the data was sufficiently large that the

confidence intervals around the effect size estimates overlapped, yet comparable data with a

greater sample size may have yielded a different result.


Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

Conclusion

Verbal and tactile cueing techniques as described by McGill13 during a supine bridging

exercise did not selectively increase gluteus maximus recruitment while minimizing an increase

in hamstring recruitment. Gluteus maximus and hamstring recruitment increased concomitantly

using the cueing procedures. If ones intent during a bridging exercise is to promote hip

extension by optimizing gluteus maximus recruitment and minimizing hamstring recruitment, the

verbal and tactile cueing methods employed in this study may not produce the desired effects.
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Different cueing techniques or different exercises may be needed to selectively target gluteus

maximus recruitment.
Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

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Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

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Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

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Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

Figure 1 Performance of the supine bridging exercise, (a) without and (b) with verbal and
tactile cueing. In the cued exercise condition, participants were instructed to Squeeze your
gluts, Extend your knees and Push into my hands while an examiner resisted lateral hip
rotation and abduction manually, as described by McGill.13
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Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.
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Figure 2 Illustration of electrode placement locations over the gluteus maximus and biceps
femoris muscles. As recommended by Criswell,15 the electrode over the gluteus maximus was
placed halfway between the sacral vertebrae and greater trochanter, while the hamstring
electrode was placed over the biceps femoris muscle belly, approximately two-thirds of the
distance between the greater trochanter and the posterior popliteal fossa.
Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.
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Figure 3 Consolidated standards of reporting trials (CONSORT) flow diagram for the
randomized controlled trial study design.
Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.
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Figure 4 Mean amplitudes of electromyography (EMG) recruitment in the (a) gluteus


maximus and (b) hamstring before (Pre) and after (Post) randomization to the control and cueing
intervention groups. Error bars represent 1 standard deviation. *Statistically significant increase
in recruitment amplitude in the cueing group (P < .05).
Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging
Exercise in Active Females? A Randomized Controlled Trial by Hollman JH et al.
Journal of Sport Rehabilitation
2017 Human Kinetics, Inc.

Table 1. Demographic data for participants, mean (SD) for continuous data and n (%) for
categorical data.

Control Group (n=15) Cueing Group (n=15) P

Age (years) 24.7 (4.2) 23.3 (1.7) .239

Height (cm) 168.0 (6.5) 169.4 (8.3) .611

Mass (kg) 63.7 (8.2) 62.6 (6.7) .678

Body Mass Index (kg/m2) 22.5 (2.4) 21.9 (2.5) .461


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IPAQ category

<600 metmin/wk 0 (0) 1 (7) .519

600-3000 metmin/wk 10 (67) 8 (53)

>3000 metmin/wk 5 (33) 6 (40)

IPAQ = International Physical Activity Questionnaire