Episode 75: Are Your Glutes Really ‘Not Firing’? Debunking Muscle Activation Myths in Pain & Strength Training

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• Joe Gambino
• Joe LaVacca

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Summary

In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca discuss the complexities of muscle activation, particularly in the context of pain and rehabilitation. 

They explore how pain can inhibit muscle function, the importance of understanding the underlying causes of activation issues, and the role of mobility and loading in recovery. 

The conversation emphasizes the need for compassion and realistic expectations during the rehabilitation process, highlighting that changes in muscle activation may take time and patience.

Takeaways

• Muscle activation can be inhibited by pain.
• Pain serves as a protective mechanism, altering muscle output.
• Rehabilitation should focus on re-educating muscles and restoring function.
• Mobility and loading are crucial for effective muscle activation.
• Compassion and realistic expectations are essential in recovery.
• Activation issues are common in the acute phase of injury.
• Specific warm-ups can enhance confidence and performance.
• Longer duration isometrics can help build awareness in the brain.
• Understanding the body's movement patterns is key to recovery.
• Patience is necessary for lasting changes in muscle activation.

Chapters

• 0:00 Welcome Back and Weather Talk
• 4:05 Understanding Muscle Activation and Pain
• 9:58 The Role of Rehabilitation in Muscle Activation
• 18:06 Loading and Mobility for Better Activation
• 24:48 Compassion and Expectations in Recovery

Transcript

Joe Gambino (00:00)
Welcome back into the Beyond Pain podcast. I am one of your hosts, Joe Gambino. I'm here with our other hosts, Joe Lavaca. You can find us both on Instagram at Joe Gambino DPT for myself at strength emotion underscore PT for Lavaca over there. Podcast is on Instagram Beyond Pain podcast and on YouTube. If you prefer to watch the show cups of Joe underscore PT.

As always we do love to hear from you guys so if you have a burning question in your mind please shoot us a DM on Instagram we are more than happy to chat. Welcome back Joe ⁓ and listeners.

Joe LaVacca (00:34)
Well, I should say

welcome back to you, Joe. You we missed you last week.

Joe Gambino (00:38)
yes, as you guys all can

hear, my voice is still not there. You're gonna have to carry the show. I'm gonna be on mute ⁓ a whole lot so I'm not coughing into the microphone. And then probably about three times on this episode I will not unmute myself to talk to you. That's how it's gonna go today. I foresee the future. I got my magic eight ball here. Exactly.

Joe LaVacca (00:43)
Still not great, still not great. We're gonna have to do lots of editing.

Yes, well that's, that's, that's a good one. So basically, normal episode. Sounds like just

a normal, normal episode. Well, I'm glad that you're back.

Joe Gambino (01:08)
Just poke me on your back

and remind me that I'm still muted. There we go.

Joe LaVacca (01:16)
Well,

glad you're back, glad you're feeling better, glad the kitties and the missus are feeling better as well. I'm sure all the listeners will gladly welcome you back rather than listening to me rant just for on and on and on like I did last week. But hopefully there was some good takeaways there that people were able to apply either to themselves or the clinic. And first thing I wanted to ask you was were you guys affected by this crazy Arctic vortex or polar vortex that just came literally out of nowhere?

Joe Gambino (01:46)
We actually.

Joe LaVacca (01:46)
See, I

had the-

Joe Gambino (01:49)
You can finish it up. I was going to say we were yesterday, two days ago. It was a high of 45 and we had a low of like 25. So I had to do all the winter proofing of the house at that point. So I turned off the hose bibs. had to wrap up a couple of our palms that we have in the back and our banana trees. And I got a couple of things and turn off all the water, the irrigation. So that was a lot of fun.

⁓ And then it's like 60 degrees today and yesterday so go figures like a one day blip on the radar just

Joe LaVacca (02:20)
Yeah.

totally wild.

That's a lot of work. Yeah, shut off irrigation systems, wrap trees. mean...

Joe Gambino (02:31)
Yeah, it was

a couple hours of work to kind of get everything ready in the midst of trying to work, be sick. Jen was completely out of it. So I was taking care of both kids. it was a day. ⁓ One day, that's all I knew. mean, Jen's mom is here, so I still have help. So I can't take all the credit, but I will, you know, I will. Yeah, yeah, yeah. Put the asterisk, exactly.

Joe LaVacca (02:44)
Dad of the Year right there. You just want it. You want it on one day as a performance my friend. Very good. That's all you need. All you need is...

⁓ asterisk. is like finding out your favorite baseball player took steroids. ⁓ my God.

⁓ what a disappointment. What a disappointment.

Joe Gambino (03:01)
Exactly. Dad and husband of the year asterisk at the top. I'll

take it. I'll take it.

Joe LaVacca (03:10)
Yeah, recall, I always think about the South. I'm gonna put you in the South ⁓ whenever these vortexes happen. And I was on my rotation with Louisiana State University in the hospital system down there. And I was down there for about three months when I was in school. And I remember ⁓ a polar vortex rolling through and it dropped the temperatures to about, you

35 degrees, like they just kind of like right above freezing and people were losing their minds. No idea what to do. Emergency broadcast systems being activated. The hospitals have an emergency meetings. Like it's, crazy when it happens that quickly with little warning. I had the air conditioning on in my apartment on Sunday night. And then I had to put the heat on midway through the next afternoon. And I don't think I've ever had that dramatic of a swim. Usually.

I can tolerate these long stretches between summer and winter where it's like either the windows are open or heat or air is just not on period. It's just kind of comfortable in the house. I don't think I've ever had this dramatic 24 hour shift. So we're glad the South made it. We're glad that Jen's mom was there to help you out. We're glad that you guys are feeling better. So that brings us to today. What the heck are we talking about today, my friend?

Joe Gambino (04:32)
We can just talk about the weather for an entire episode, I don't think, maybe our listeners will enjoy it, but I doubt it. let's dive in. We're going to talk about what happens or why it doesn't happen and how can we prevent when we have these areas of our bodies that we just feel like we can't activate. The glutes are a big one, so maybe we'll just focus in and around there, but there are definitely other areas where people say that they can't feel certain things activate.

I will let you, since you're carrying the team today and my voice is here nor there, ⁓ take this whichever direction that you please and we'll go from there.

Joe LaVacca (05:11)
Yeah, I think the best way to probably take it is how I hear clients talk about it. And this is such a common idea or story. And I understand it. I do. I fought it for a while, but I understand from a client perspective why things can sort of feel, quote unquote, inhibited asleep. ⁓

some particular muscle has amnesia or is not activating. And I can also see from a clinician sense why focusing on a single muscle or single exercise would be an easy way to help people out of pain. But I think it's definitely worth discussing and that's kind of our goal for today. So let's start with just this idea of does a muscle not activate?

when people are in pain. And short of a nerve injury, Your muscles are always going to be on or activated to some degree, as long as you're up and moving and sitting and walking and blah, blah. Now I do think, and there's plenty of sort of studies to show this, that the output of muscles

is decreased in the presence of pain. So a muscle's job or your nervous system's job is to protect tissues that are sensitive. One of the ways to do that is to inhibit or kind of just turn down the volume of muscle activation or nervous system activity in an area to reduce force. Maybe it kind of makes you move a little bit stiffer, but that's the whole point of protection when we have pain and when we're trying to

heal quote unquote for lack of a better term depending on what's going on. So yes, it is normal for people I think to feel a little unstable, a bit weak when they are in pain. However, I also think that that's relatively normal, especially in the beginning. And we've talked a little bit about the differences between acute pain and persistent pain. In the acute pain scenario, I want that muscle to turn off. I want to maybe reduce force or load or movement through an area.

I want you to take these protective strategies. Maybe you brace a little bit more, maybe you limp, maybe you lean to one side. These are all cool. These are all ways that your body is recovering. So we want to guide that process early on. We want to break those patterns when they're no longer needed. But however, that doesn't always happen. And when that doesn't happen, our nervous systems are also very good at adapting.

So I take on some of these new behaviors, I continue the limp, I continue the lean, I continue avoidance, and therefore that maybe weak muscle or weaker area stays deconditioned. So I'm gonna pause there. Is that seemingly your view of that? Does that sound like at least preliminarily what patients share with you when you're in treatment sessions with them?

Joe Gambino (08:29)
Yeah, I think the way you described it as a kind of, ⁓ you know, protective mechanism, this force output, you know, the way that our body is being able to process information, it has been altered. So you just can't physically create as much force or maybe feel the muscle in the same way that you would have in the past. And as you're talking, it brought up a couple of things for me that I think that we can kind of dive deeper on that I think will kind of, you know, maybe

weave us in a direction where I think it will give us a very like the conversation I think will be in a good place here. So I think what you said is you know, PT's is something I think it's like easy for us to describe it to somebody it comes in it's like this oversimplified your your back hurts because you can't activate your core or because you can't activate your glutes and it's this very simplified version. So there's two things that I kind of want to want to talk about here and get your your thought process on because I think when as

I think in our industry from a standpoint and from a rehab standpoint that this message has been getting out there for so long that clients fixate on it. So there's this fixation, ⁓ my back hurts because my core doesn't fire or my back hurts because my glutes don't fire. And it's very likely, know, and now we're playing like the chicken or the egg scenario. So I kind of want this conversation to go down the rabbit hole of do you see or do you view

this doesn't activate as the, need to address this for this person and their symptoms will get better or do you view it as a symptom of the more underlying root cause that has kind of led down the rabbit hole to now you can't feel something work and all these other issues that may come around it.

Joe LaVacca (10:18)
Yeah, I think again, it depends, right? If it's earlier on and we're sort of into this phase of re-educating the muscle or re-exposing the area that's sensitive to movement or load, then yeah, I want to put the muscle in positions that are most comfortable or maybe sort of like more opportunistic for it to create.

some effort, but these are going to be pretty low level things. There'll be table clam shells, there'll be bridges, maybe they're going to be doing some breath work, maybe they do some very light work ⁓ with bands, but that early on process is sort of to just maintain and help that area heal.

by guiding it in the right direction would force. The problem becomes maintaining that idea that now I have to continue to reactivate an area, start with low level like isometrics or breathwork, you know, every time I go to do an activity and or now having that continue even further as it's done some clients with, well, now I can't lift heavy because, you know, I have these

weak glutes or I have these ⁓ poor postural stabilizers that aren't coming online. again, when it is in this idea of acute phase, yeah, I want to address it early on, but I also want people to feel comfortable almost finding that area again, like, okay, I can feel something else other than pain here. I can feel fatigue. I can feel,

muscular soreness again. And I think that gives them that direction of saying, wow, okay, there's lots of things I can do, even though running might be off the table right now or deadlifting might be off the table right now, or you name it, that I can do to kind of keep myself conditioned. And these are just gateway exercises or gateway movements back into more complex things like squats and lunges and you

more compound lifts that require my full body, which is where most people want to get back to anyway. So yes, to both of your questions, I think is that it really just depends on where people are in their rehab and how much of that initial story framework of healing have they carried on with them just a little bit too long where I don't think they need these low level activities or exercises or light band work to.

quote unquote activate when a generic warmup will probably just do the trick or we just walk you right over to whatever we're gonna do first your squats your deadlifts your lunges whatever start with bodyweight add 10 % of the load you did last week add 50 % of load you did last week and then there's your specific warmup and let's get going

Joe Gambino (13:32)
Yeah, I agree with that. think, you know, the way I look at it is that most, if someone's constantly complaining with it over and over again, your muscles are not firing. It's not like the main cause of your symptoms, most likely. It's probably going to be a result of whatever is underlying and driving your symptoms or maybe just the pain in itself. Because if it was just purely an activation issue, you wouldn't have to

Find yourself constantly needing that stimulus to feel like you're you can feel your glutes or your whatever feels a little bit better It wouldn't have to be this constant like once it's strengthened, right? It should be strong again. The output should be there shouldn't like reset constantly That's kind of one of the things that that I've found and I think you know, obviously pain is one of those things that can always will

change the way that our bodies produce force and things like that, right? And how it moves in general. So bringing down the pain response is one of those first things that we need to do in order to give somebody the opportunity to actually strengthen those things and create a better input there. I do think that particularly ⁓ rotational deficits and mobility, especially active, can play into that. When we have

some sort of capsular something or even if there's like impingement stuff going on when there's some sort of capsular issues going on, we know that that's where a lot of our, how our body figures out where we are in space and how much force is and how, and then,

Things within that nature, like this is where we're gathering all of our information. So, you know, working on some of that stuff and even just like, how can, you know, I've done a lot of like, how do we load rotation inflection? I think that's the more common one, but I've also done it in extension and then all the ranges in between. think even personally for myself has made a huge difference in like how stiffness and things feel when I'm lifting and activating has made a huge difference for me.

So think Capsule or Stuff is a big one in there. And then I had one more other one in my brain and it's gone now. we'll just, it will come to me, come to me later. But.

Joe LaVacca (15:38)
Well,

question for you. What do you mean by loading into that rotation? Right? Again, like for people maybe not familiar with that. What does that mean? Was that more?

Joe Gambino (15:48)
So I

will literally do other like actual almost like strength training. So I'll use a band or a pulley or an ankle weight or whatever it is to physically like load myself starting from like an actual end range like maybe internal rotation I'm starting with and then work it all the way through like full range to my end range, external rotation and back. So you're getting eccentric and concentric in both directions. Sometimes it's just I do

⁓ isometrics as well at an end range or you know whether lengthened or shortened for long durations and drive like significant fatigue I think and that's one thing that ⁓ his name is escaping me we did ⁓ a course in New York with him your buddy from Chicago that he did rock tape with I don't know why I can't remember his name right now yeah

Joe LaVacca (16:41)
⁓ Adam. Adam.

Joe Gambino (16:45)
You know, we did, when we did that, that was probably one of the bigger things that I took from that course is like these longer duration isometrics to just help build awareness in your brain again. Cause that whole process is actually just talking about it with a patient today about cortical smudging and like how, we have pain and this use the areas of our brain where we have ⁓ a representation for that body part can be.

kind of distort in a sense. again, like why our bodies aren't able to produce as much force or we don't have as much awareness to those areas. So doing stuff like that where we can create these longer duration isometrics, create some fatigue, put some strength inputs. I think when we're also bringing down pain and working on any sort of ⁓ deficits from a mobility perspective, once all those things start to come together, then all of a sudden now you feel like things activate better. You can feel that muscle more. You can fatigue that muscle better.

And then all that stuff carries over to your lifting and the things that you want to do and the other one that I was trying to think of that I forgot was I think there's a lot of people who are just limited in hip extension and Obviously if you're missing that kind of range of motion You're gonna have a harder time feeling those, you know things on the backside if we're talking about Glutes not firing that's gonna be a big one as well So I think because it being able to get into positions is just as important as anything else when we're trying to feel something work or activate when we're trying to

Extend in a squat or in a deadlift or if we're trying to run right like sprinting say where we really need triple extension If you're if you're limited in these ranges of motion, right? It's gonna their body is gonna have to figure out another way to kind of get around that. So There's all my thoughts Joe. Yeah, I'll take your thoughts now

Joe LaVacca (18:23)
No, I think you did a good job explaining the idea of workspace. I like every joint has a space That it can work in quote-unquote to make a shape. So for people who are stuck and This idea of hey, I can't get X Y or Z to activate or turn on Yeah, I totally agree with you then when we just go bring it back to some rudimentary assessments basic stuff we can find a lot of these opportunities with

rotation in a hip, extension in a hip, flexion in the shoulder. And when you sort of come at it from that angle of, well, hey, if you can't make a shape or if you can't get into position, how do we expect the muscle to activate in that position when now it's already maybe in a really, really shortened state and a shortened state would make it insufficient to produce force or it's just not able to exert

the same amount of pull optimally, or it might just be blocked by pain at that point. I mean, when you're starting to force a joint into position to get it to turn on without the proper mobility or maybe like progressive overload strategies to put you in that position, it's going to just hurt. People are just going to probably cramp and they're going to be super sore. And again, without that proper education or understanding that, you know, this could be an expectation, you know, it's going to feel pretty frustrating pretty quickly. So yeah, I think

taking the brakes off or clearing the runway. These are phrases I use with clients a lot. Let's open up the area for movement and then see what's left over. You might find that a better moving joint just feels better and you don't have to go through all these activation drills because to your point, now your brain, nervous system, tissues are all sort of on the same page again and they can figure it out.

So now all we have to do is really just put you in these positions, re-teach you some basic concepts with hinging or squatting or pushing or pulling, whatever we're working on, and then just let your body take the reins and start to get exposed again. I think my question to you, and this kind of came up with a client this week, is that sometimes these narratives stick, but patients just feel better doing them.

I had an opportunity to work with a client who's had some really persistent back pain. We were talking about some of the things she does with her trainer and some of the things that she's done in the past. And she very specifically was doing some specific core bracing, core activation, hip isometrics, just makes me feel better for my lift. And in that case, I'm totally cool with it.

That makes you feel better if you like specific warmups versus general warmups, then do your specific warmup. So will you take that same approach again, like giving the patient the reins there to, hey, if isometrics makes you feel good, if this core brace, it makes you feel good prior to a lift, if turning something on makes you think that you're more engaged and ready to go, do you let them go or will you try to kind of redirect the narrative to something maybe more beneficial?

Joe Gambino (21:40)
No, I would just let them go because I'm a big proponent of if it makes you feel better You should probably be doing a lot a lot more of it right because the whole process the whole part of it right is as the more we can bring down the pain response the more likely the frequency of the intensity of the discomfort is going to start to change So I let them roll with it plus it's a confidence right like you want someone to go into their workouts feeling as confident as possible Anytime there's fear and apprehension. Those are always symptoms

that I'm weary about, right? If someone's like, I'm nervous to squat, like if you start to squat them under load, like the chances of them not moving well or feeling pain afterwards, I think is just gonna be higher. So if you can do, if they say, I like these two exercises, I feel really great, like when I'm at the bottom of my squat, I feel super open. Well, sure, that's a great warmup for you on those days where you're doing lower body. And then you feel confident and you can go out and you can push the needle a little bit more and you're probably also not gonna hold back.

Those people will actually probably like do our piece of maybe eights and nines because they feel more confident as opposed to like, I'm only going to do a six today. And then you're not really going to get the stimulus that you want from a strength perspective anyway. So then you're probably going to either want to modify the squad or not. So I would let them roll with it, let them do it again from a confidence perspective and just feeling the perspective that's, that's money.

Joe LaVacca (22:56)
Yeah, I think the only time I ever interject is when people start to talk about time and if their workouts are running long and I have all these things to do and I can't get to this and I can't get to that. And then that's when I'll typically offer, well, hey, instead of spending all this time setting your hip and mobilizing this and rolling around on the floor and doing all these things that were helpful in the past, why don't we just

hop on the bike and get your heart rate going rather for three or four or five minutes. Work at a nice progressive scale. First minute can be easy, second minute a little bit harder, third minute a little bit harder than that. So by the time you get off the bike, you're maybe huffing and puffing a little bit, you're already sweating, and then you're feeling good and you're ready to go, and then just gradually start with your lifts. Or just start with your lifts. Start with the body weight motion. Gradually add a little bit of weight.

thing is I'll have people do body weight, then 50 % of the weight that they used the week before, and then 75 % of the weight they used the week before, right? And these are sort of like, maybe they do 12 body weight, 10 at 50%, ⁓ then maybe five at 75%, and then we make a decision. How are you feeling? Do you think you need one more groove set just to sort of get going before we launch you into your working sets, or are you feeling pretty good? And even then that could be a way to cut off five, 10,

whatever minutes into your workout. So the only time I'll interject with that client is when they start to report time as a factor, when they're not getting everything, when they're feeling like a little bit rushed at the gym, or maybe they're just going at a time that it's so busy. It's hard to find space, equipment to do different things. So then that's when I'll kind of ⁓ coach them to just give them this other option.

Joe Gambino (24:48)
Yeah, no, I like that. I think in the case if someone was doing that much foam rolling, a bunch of activation work, I need to set this and set that and it's taking them 20, 30 minutes, that's probably too long. So there would have to be some sort of education. Like, okay, how do we get that down to 10 minutes? What's like your one or two areas of your body that make you feel ready to squat if that was the case for that particular person? And then what is one or two movement that...

like activation drills that make you feel really good. And now you can do that in five minutes, then you can get on the bike or do something else more specific, maybe some plows or whatever it is that you feel like you need. Then you can do that as the finish for your warmup and then you can get right into your warmup sets or working sets or whatever the session looks like from that perspective. So I think that's well said. you know, I think if anyone listening, if you're doing 20, 30, 40, 50 minutes of warming up, it's likely going to be way too much and you can definitely condense that.

And I think that starts to lend towards probably a more underlying bigger issue that needs to be addressed at that point.

Joe LaVacca (25:49)
Yeah. And I think the context there is like in a strength session, right? So if your primary goal is strength, right, then you don't need all that. If you're at home and you're doing a low level recovery day, then hey, all your isometrics are great. ⁓ your repeated movements are great. ⁓ that's going to be your recovery from your heavy lift the day before or your lung run the day before. So unless that's your target, probably don't need that much. So I would say for me in summary, a lot of these muscle.

Joe Gambino (25:53)
Correct.

Joe LaVacca (26:18)
inhibition turned off ideas are pretty normal in the acute phase. Give your body some compassion, give your body some space. We don't necessarily need to overload those areas and turn them back on instantly. Let healing occur. If we're still seeing those deficits outside of normal healing times or healing parameters we would expect, yeah, then let's, to your point, reintegrate your nervous system.

reintegrate some of these maps in your brain, reintroduce and condition the tissues that maybe haven't been exposed in a long time. And then that is our gateway into the higher level things, not necessarily that they need to be there forever and ever because your hip had turned off once before is now turned off. And that is your only way that you can squat and deadlift and run and return to sport. So I think that's where my takeaways would go.

You have anything else to add there, Joe?

Joe Gambino (27:19)
It's a well-lasted thought and if you don't have any others you can take us home but I think the last thing just on your point of compassion and just expectations I know we talked a lot about expectations here on this podcast ⁓ You know if Activation is an issue don't expect it to change in one session or two sessions, right? This is something that's going to say take some time as your pain comes down as you're working on mobility as you're working on whatever it is that that is going to be needed to kind of get you there and just imagine right it's going to take you a few weeks to

actually start to see some of those changes that you wanna see. So I think people also get a little too impatient. like, my glute's not activating, then I do this drill, and then I feel really good. And then the next time I go lift, it's like, well, I felt the same as I did before, and then it gets disheartening for somebody, especially if someone's is in chronic pain or someone's been dealing with this for a while. So just remember that sometimes you just need a little bit more.

Joe LaVacca (28:12)
Yeah, absolutely. All right, Joe. Well, we're happy to have you back, my friend. We love you listeners. We love you. And don't forget to come back next week for another exciting episode of the Beyond Pain podcast. I still don't think I get this right.

Joe Gambino (28:29)
Not too shabby, Joe. Not too shabby.