Schenk A, Pluta N, Gasko J; Institute of Therapeutic Wisdom Inc., San Diego, CA, USA. resultsr@pacbell.net.

PURPOSE: In performing bridging as a therapeutic exercise, as it is traditionally instructed, we noted that it was not effective in strengthening hip extensor musculature for carryover to improve upright standing and gait. Visual observation of bridging did not indicate hip extension in the range that is required for these activities. Patients’ subjective reports were not consistent with the intended hip extension muscle contraction, and often included complaints of pain in surrounding structures. FOUNDATION: Utilizing anatomy, kinesiology, and biomechanics, we analyzed bridging. Based on the location of its’ origins and insertions, the iliopsoas imposes strong resistance to the gluteus maximus. The rectus femoris provides even greater opposition as it is stretched over two joints during bridging. Both inherently limit movement into hip extension. We also applied our knowledge of hip extension requirements for normal standing and gait of 0 to 10 degrees. Hip extension during bridging would have to occur within this range, in order for it to be effective in improved performance of these activities. DESCRIPTION: To validate our theory, we took goniometric measurements on 15 individuals. We measured hip extension achieved in three bridging trials each and evaluated subjective feedback in both the standard, and a modified bridging position. The modified position was with an 8 ½" diameter foam roller under the patient’s knees to eliminate the stretch on the iliopsoas and rectus femoris. OBSERVATIONS: Mean hip extension during standard bridging performance was –11.74 degrees, and 87% of participants felt primary activity in their quadriceps or lumbar musculature. Mean hip extension during modified bridging performance was –1.38 degrees degrees, and 73% of participants reported primary activity in their gluteus maximus. We also observed that individuals frequently presented with tight hip flexor and weakened abdominal musculature. Tight hip flexors create a strong tendency to pull the pelvis into an anterior tilt, which further limits the movement of hip extension. Additionally, weak abdominal muscles are overpowered by the lumbar extensors, and therefore are unable to assist in stabilizing the pelvis. These factors are minimized in the modified position. CONCLUSIONS: We feel it would be beneficial to perform bridging in the modified position for greater carryover to upright standing and gait. This allows strengthening in the range of motion that is required for these activities, and will eliminate reported pain factors. We should continue to perform biomechanical analysis to determine the efficacy of all traditional exercises. FUNDING SOURCE: None.

Copyright 2004 by the American Physical Therapy Association

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