Tag Archives: Medical

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Baby boomers are changing the senior living paradigm

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Having spent a lifetime demanding and indulging their independence, members of the baby boom generation are showing no signs of letting up as they prepare for their next life-stage. Now in their early 70s, leading-edge boomers are looking ahead to how they want to spend their later years.

One thing most of them don’t want is to wind up like their parents or grandparents in an isolated senior care facility. They are pressing builders and developers to give them more options to remain connected to their communities.

In the latest edition of its biennial white paper on the state of senior living, Perkins Eastman finds that of the many factors affecting senior living now and for the near future, boomers’ desire for more autonomy and self-control will have the greatest impact. It is already prompting the industry, says the report, to broaden the number of options to meet the needs of a greater variety of individuals.

Although it takes different forms and has evolved over the years, the predominant paradigm for senior living for decades has been the stand-alone, age-restricted, one-stop-shop senior living community. It is a model focused on care, congregation and convenience, but tilted more toward the needs of those who are more infirm or dependent.

Today’s healthier and more affluent boomers are looking for living arrangements that will allow them to maintain the autonomous lifestyle to which they are accustomed. They want to be close to and stay in contact with the larger community, and to live on their own.

For many, that means doing whatever is necessary to stay in their current home for as long as they can. For others, it may involve downsizing and moving to a location where they can more easily access activities and services on foot or by public transportation.

According to industry leaders on Senior Housing News’ Architecture and Design Trends for 2019 panel, development trends such as intergenerational living, senior housing as a mixed-use component, and the demand for senior housing in dense urban cores are gaining in popularity.

Instead of creating separate senior villages, the new paradigm is to weave senior living into existing communities. This places seniors in closer proximity to places of interest, such as theaters, museums and other cultural events, as well as to more varied retail options. It also encourages them to engage in more socialization and physical activity.

Anticipating that aging boomers will need more assistance in the future, some developments under construction are combing independent living residences with some assisted living and memory care facilities so that residents can age-in-place in the same community. This helps to alleviate the worry of what will happen if at some point residents find they can no longer function on their own.

In recent years, as the client for senior communities has become younger and healthier, the design trend in senior living has been to move away from a healthcare emphasis to more of a hospitality, resort-like ambience. With the trend toward more independent living, observed one of the Senior Housing News panelists, the aesthetic in the future likely will shift again, toward a more residential model. Independent baby boomers will want to feel that they are living in their own home, whatever form that takes.

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How to protect yourself from blood clots during business travel

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How much do you know about deep vein thrombosis (DVT) and pulmonary embolism (PE)? Both of these conditions can result if you develop a blood clot — a risk for business travelers who sit for long periods on a plane, train, or in a car.

The CDC reports that as many as 900,000 Americans will suffer a blood clot this year. Also according to the CDC, DVT can form in your legs during travel because you are sitting still in a confined space for long periods of time — specifically, four hours or more.

Life-threatening problems can occur when a part of the blood clot breaks off and travels to the lungs, becoming a PE, which can cause a fatal blockage.

What other essential information do you need to know about protecting yourself from clots while you travel?

Wear compression stockings.

You probably already know that both DVTs and PEs can be caused by immobility of your legs, pregnancy, or cancer. But did you know that your height can also figure in to your risk for clots?

The American Heart Association says that those around 6 feet are at the highest risk, while those under 5-foot-1 have a lower DVT/PE predisposition. This is probably because taller people have longer leg veins and therefore more surface space where clots can form. Additionally, the gravitational pressure of a longer leg is more likely to slow or stop blood flow there.

Ask your doctor if wearing compression stockings when you fly — available at medical supply stores and drug stores — is a good preventative option for you.

Be smart about medication.

Recent research found that common anti-allergy drugs (like hay fever meds) might be able to boost the cells in your body that protect you from a DVT in your leg. Although more research needs to be done before doctors will prescribe these meds as a travel precaution, you should always ask your doctor if any medication you’re on increases your chance of blood clots during travel. Also, make sure you take any blood thinners you have been prescribed prior to boarding for your journey.

Get up and walk around frequently.

Do this at least every 2-3 hours if you’re on a plane, train or bus, and stop to walk around if traveling by car. Make a habit of getting up from your chair at work during the day, too.

Try this exercise recommended by the CDC while sitting:

  • Raise and lower your heels while keeping your toes on the floor.
  • Raise and lower your toes while keeping your heels on the floor.
  • Tighten and release your leg muscles.

Drink plenty of water.

Dehydration can contribute to the formation of clots, according to the Mayo Clinic.

Watch for these symptoms, the Mayo Clinic also advises:

  • Coughing up blood
  • A fast heartbeat
  • Lightheadedness
  • Difficult or painful breathing
  • Chest pain or tightness
  • Pain extending to your shoulder, arm, back or jaw
  • Sudden weakness or numbness of your face, arm or leg
  • Sudden difficulty speaking or understanding speech (aphasia)
  • Sudden changes in your vision

Get immediate medical attention if these symptoms occur. Call your doctor right away if you develop these signs or symptoms in an area on an arm or leg:

  • Swelling
  • Redness
  • Pain

Play it safe — if something doesn’t feel right, get it checked out, even if you’re on the road. A little common sense and proactive behavior can save your life.

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The baffling nature of auditory processing disorders

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Unlike many deficits that fall under the umbrella of audiology, auditory processing disorders are not diagnosed during infancy, toddlerhood or even the early school years.

In fact, most audiologists wait until age 7 to make a definitive diagnosis. This is due to the child’s neural pathways not being sufficiently mature to make a full evaluation prior to this age, explains Tracy Hagan Winn, audiologist at the Northwestern University Center for Audiology, Speech, Language, and Learning in Evanston, Illinois.

Conducting evaluations for central auditory processing disorders, which can only be diagnosed by an audiologist, is one of Winn’s areas of expertise.

The children she tests are usually between 7 and 18 years of age. Most are referred for a full evaluation through the school system — often after a school speech pathologist or psychologist sees signs of an auditory processing disorder on a child’s screening.

While most children with hearing loss will be identified through a universal hearing screening at birth or when they don’t talk around age 2, an auditory processing disorder won’t show up until much later, she explains.

Frequently the disorder doesn’t emerge or become noticed until middle school when the student’s academic workload gets more challenging. Suddenly, it becomes hard to pay attention and take notes.

“We even have kids that we think have had APD their whole lives but we don’t catch them until college. They’ve gotten by all their lives, but suddenly they’re in a lecture with 300 people and they can’t keep up,” says Winn.

What are auditory processing disorders?

Central auditory processing, per the American Speech-Language-Hearing Association (ASHA) literature, begins when the neural representation of acoustic signals are processed after they leave the cochlea and travel through the auditory nerve to the primary auditory cortices of the left and right hemispheres.

So, people with CAPD or APD generally have their hearing capabilities intact.

There are three main types of auditory processing disorders, which Winn summarizes. The first affects the ability to decode information and discriminate between words, so often information is not interpreted correctly. This can become even more difficult when there is a lot of background sound or in a noisy classroom.

The second involves extracting keywords so the meaning of a message is missed because the person is not able to pick up on the emphasis. Winn illustrates this with the example, “Look out! The window!” or “look out the window” — the same phrase with drastically different meanings based on the speaker’s emphasis.

The third central APD is an integration deficit where people have difficulty in assigning meaning because the transfer of information from right to left hemisphere doesn’t occur.

Identifying this elusive disorder

Unfortunately, there are no distinct red flags to distinguish APD because it shares common signs and symptoms with many other disorders.

“To begin with these kids appear to be hearing impaired because they’ll often have difficulty understanding what’s being said so there’s a lot of ‘what’ or ‘huh,’” says Winn. “So first and foremost hearing loss is ruled out, usually through a screening at the school.”

Along with a hearing problem, characteristics of APD, such as difficulties with writing, spelling and math, slow response in oral communication situations, or being easily distracted can also reflect a learning problem, an attention issue, or a memory issue, notes Winn.

Other behavioral characteristics of APD are listed on the ASHA site. They include difficulty understanding spoken language in competing messages, in noisy backgrounds, in reverberant environments, or when presented rapidly. Children may also find learning songs, nursery rhymes and foreign languages particularly challenging.

Misunderstanding messages or not being able to detect stress and intonation variances that aid in interpreting sarcasm or jokes may also be due to an auditory processing disorder. However, an individual with a social communication or pragmatics difficulties may also have this challenge, as discussed in a previous MultiBriefs article.

Collaborative evaluation and treatment process

Given such overlap with other deficits, detecting auditory processing disorders is a complicated process that requires an interdisciplinary approach.

“We don’t do our testing for auditory processing in isolation,” emphasizes Winn.

After normal hearing has been checked at the school, Winn requires candidates to get both speech-language and psychological evaluations. Often they have other issues with learning disabilities, such as ADHD or language processing.

“It’s a ruling out process. We just look at each component and then see how that component might influence another,” says Winn. “Many times the kids we’re seeing are also seeing a speech language pathologist, possibly an educational specialist who is working with auditory memory or working memory.”

The clinic at Northwestern is multidisciplinary, so children who’ve exhausted their options within the school system come in for a comprehensive evaluation lasting over two days, shares Winn. It includes learning, speech and language and auditory processing.

The process begins with a test to rule out any peripheral hearing loss.

“We would then look at all the components of the central auditory system so it’s between four to seven sub tests to put the full picture together. We look for very specific patterns in the test results to indicate what type of disorder, if any, they have,” explains Winn.

Once the type of auditory processing disorder present is determined, she’ll make recommendations for treatment to be carried out by a speech and language therapist — usually within the child’s school.

Treatment, which depends on the type of APD present, often includes a combination of direct skills remediation such as auditory discrimination, compensatory strategies and environmental modifications.

Examples of compensatory strategies Winn shares are keyboarding instead of writing, having a note taker, and using Cliffs Notes to support reading. Environmental modifications could include using an FM set for direct communication between teacher and student, preferential seating in the classroom, or being placed in a quiet classroom.

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ADA partners with National Institutes of Health for opioids webinar

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Prescription opioid abuse remains a dangerous and growing problem in America. Every day, more than 115 Americans die after overdosing on opioids, according to the U.S. Department of Health and Human Services.

When taken as prescribed for short periods under a doctor’s care, opioids can be an effective pain management tool. However, prescription opioids carry the risk of abuse and addiction, particularly if they are used for nonmedical purposes.

The ADA is hosting an opioids webinar on Wednesday, April 3, featuring the National Institutes of Health. Called NIH Response to the Opioid Crisis from a Research Perspective, the webinar will take place from 3-4 p.m. EST.

The free webinar, which includes an hour of continuing education credit for member dentists, will touch on the following topics:

  • An overview of the opioid crisis.
  • How addiction is a chronic brain disease.
  • What NIH is doing to address the issue through research as related to pain management and dentistry.
  • The Helping to End Addiction Long-term, or HEAL Initiative, including ongoing and completed studies related to dental pain management and opioid prescribing from the National Dental Practice-Based Network.

Featured speakers of the one-hour webinar include Wilson M. Compton, MD, deputy director, National Institute on Drug Abuse; Dr. Martha J. Somerman, director, National Institute of Dental and Craniofacial Research and Dr. Brad Rindal, senior research investigator and associate dental director for research, HealthPartners Dental Group.

Dentists or dental practice administrators interested in this important and informative webinar can register here.

ADA Health and Well-Being Conference Coming Soon

Calling all dentists! The 2019 Health and Well-Being Conference will take place on Aug. 16. The council’s ADA Dental Wellness Advisory Committee will host the conference at ADA Headquarters in Chicago and focus on continuing education on career burnout and stress management.

For more information, contact Alison Bramhall at bramhalla@ada.org or 1-202-898-2410.

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How to keep your immune system strong for running

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Whether you’re a new runner who wants to know how to run properly, an experienced runner who wants to work on breathing techniques for running, or even just someone looking for tips for a 5K, it’s tough to train when you’re sick.

Health and a strong immune system are prerequisites for running training. So how do we keep our immune system strong and ensure that we can achieve our specific training goals no matter the season?

In this article we’ve got tips on everything from what’s in your blood when you’re sick to which foods you can eat to get better. Let’s dive in!

Why do we get sick in the winter?

It’s just that time of year. Sickness is going around like it does every year around this time. Why does that happen? There are a few contributing factors.

First, we’re just inside more in the winter. We don’t get as much fresh air, and we get a lot more stuffy, indoor air that is usually carrying germs.

The more we’re all inside, the longer those germs live. And not only are we missing out on fresh air, we’re not getting enough vitamin D either.

And the germs in that indoor air are often ones we picked up after traveling a lot for the holidays. Traveling exposes us to germs our bodies are not used to, and those new germs can linger into the new year as well.

Winter also tends to be a time of high stress for most people. After a busy holiday season, the first few months of the year are often used to play catch up.

Maybe we feel behind at work, or we’re struggling to keep up with our training in the new year. January and February are always extremely busy months. Seasonal depression can also play a role in increasing our stress levels.

No matter the reason for high stress levels, when stress is high, your immune system does not work as well.

Something else that comes with high stress — an irregular sleep schedule. Sleep is vital in maintaining the immune system, yet it’s often the first thing to go when we get stressed.

On a similar note, our diet tends to be worse in the winter. We love to indulge during the holidays but it can be tough to get back on track, especially when we are stressed with work and other commitments during these months.

What’s going on internally when we’re sick?

Now that we know why we might be getting sick, let’s take a look what is going on internally.

A great way to do this is to test your blood for biomarkers. These biomarkers will show you if you’re already sick, and they will also tell you if you’re going to get sick in the future.

The main thing to look for are white blood cells. Your white blood cells are your attack cells. They help fight infection, and they strengthen your immune system. If your white blood cell count is high, that’s a direct indication that your body is healthy.

On a similar note, iron is responsible for building, strengthening, and maintaining your white blood cells. This makes iron an essential component of your diet, and something to note if your blood shows you are lacking it.

Next, check your cortisol levels. Cortisol is an indicator of your stress level. As cortisol goes up, your immune system weakens. High cortisol is a warning sign that your body is weaker and might not be able to fight off infection as well.

Electrolytes, potassium, and sodium are all essential to immune function because they reflect your hydration level. If your biomarkers are showing that potassium and sodium levels are off, your body may already be fighting an infection.

The last biomarker to look for is magnesium. Magnesium helps create antibodies which fight infection, it helps prevent infections in the first place, and it helps improve your sleep. All of these are essential in keeping your immune system strong.

What foods can I eat to stay healthy for running?

Excellent nutrition for runners is very vital to give great performance. The million-dollar question: what foods can I eat so that I do not get sick? It should come as no surprise that No. 1 is fruits and vegetables. They are chock-full of vitamins and minerals.

The second category to be sure you’re getting is Omega-3s. Nuts, seeds, and fatty fish are all great sources. These anti-inflammatory foods are great to keep your immune system strong, because your inflammation is often one of the results of sickness.

To keep that white blood cell count high, iron-rich foods are also crucial. Red meat, dark chocolate, and spirulina are a couple of options.

To get your magnesium the following foods are all great options: nuts, pumpkin seeds, whole grains, spinach, black beans, and avocados. Try to work some ginger and garlic into your diet as well.

Supplements will also help during this time of year. Vitamin D is crucial, because you’re likely not getting enough given the winter weather.

Gut health is immune health, so probiotics are going to be your best friend here.

Some others that have been found to help the immune system: echinacea, ginseng, vitamin C, and zinc.

Also: oregano oil. It’s absolute magic when it comes to your immune system. More palatable in pill form, oregano oil should be the first thing you grab when you start to feel sick.

And lastly, sick season is not the time to cut carbs! Carbohydrates are necessary for fueling and recovery. Be sure to keep good carbohydrates in your diet during this time of year.

What habits keep me healthy for running?

Lastly, let’s go over a few practical tips for staying healthy for running.

Tip 1: SLEEP.

If you’re sick or getting sick, sleep is going to do more for you than any food or medicine can. It is arguably the most necessary component of keeping your immune system strong, and if you do get sick, it’s the fastest way to recover.

Tip 2: Avoid touching your eyes and mouth.

This is a simple tip that will definitely help you stay healthy. On a similarly simple note, wash your hands. A little soap and water go a long way. We all know this, but it’s good to be reminded every once in a while.

Tip 3: Lower your stress.

Do what you can to lower your stress when you’re worried about getting sick. Be sure you’re not over-training, take tasks off your to-do list where you can. Be smart about your priorities — it’s hard to accomplish things when you’re sick, so don’t let it get there.

And when you’re training, be sure you are implementing good recovery processes. Eat well, and avoid big caloric deficits and crazy detoxes.

Tip 4: Avoid the sick.

If you can, stay away from sick people. Another simple tip with big results.

Tip 5: Disinfect surfaces.

Disinfect things like door handles, your phone, and anything else that carries a lot of germs.

Tip 6: Stay hydrated.

Hydration needs to be a non-negotiable at this time of year. Don’t expect your immune system to function properly if you are not giving it the hydration it needs. Go above and beyond when sickness is a concern. Along with the above tips, you can also check out my blog that covers detailed insights on how to run in cold weather.

Conclusion

Go above and beyond! There is no such thing as being too cautious when it comes to avoiding sickness.

Incorporate the listed foods, supplements, and habits as much as you can. And check in with yourself constantly! Even if you cannot test your blood, be honest with how you feel, how hydrated you are, how your diet is going, etc.

Take care of yourself, and spring will be here before you know it!

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A blood test to measure pain

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Whether acute or chronic, most of us have dealt with pain. In 2016, 20 percent of adults in the United States had chronic pain, and 8 percent had pain that limited at least one major life activity. These are the findings of a recent study that analyzed National Health Interview Survey data to establish the burden of pain in the U.S. and aid in the development and implementation of population-wide pain interventions.

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Professor claims cure for CWD, but others aren’t sure

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The United Sportsmen of Pennsylvania (USP) turned a lot of heads in the hunting community during a press conference at the state capitol in Harrisburg in February when they announced that a cure to Chronic Wasting Disease (CWD) may be close at hand.

During that conference, the group declared that Dr. Frank Bastian of the Louisiana State University Agricultural Center has made a breakthrough in his research of the disease. USP is partnering with Bastian to help support his continued research.

CWD is a transmissible spongiform encephalopathy (TSE) similar to mad cow disease, scrapie, and Creutzfeldt-Jakob disease. CWD is always fatal and has a very long incubation period. This means infected creatures will not show symptoms for several months or years, but can still infect other animals. There have been no documented cases of humans contracting CWD to date, but many people fear that the disease will eventually make the jump from cervids to humans.

Abnormal proteins called prions are the generally accepted cause of TSEs in the scientific community. Contrary to prevailing theories on the subject, Dr. Bastian claims that CWD and other TSEs are actually caused by a type of bacteria known as Spiroplasma and that that prions are merely a byproduct of the bacterial infection.

The USP representatives stated that Dr. Bastian hopes to develop a portable CWD test kit within the next 12-18 months so that hunters can determine whether or not the deer they have killed is infected with CWD at the site of the kill. They also announced plans for a CWD vaccine for captive deer and elk within 2-3 years and eventually even a vaccine for wild deer and elk.

During the press conference (which you can watch in its entirety at the top of the article), USP also announced it will receive the portable hunter test kits and vaccines as soon as they become available for field testing.

Needless to say, the group has made some very bold assertions during that press conference and many people are understandably skeptical of Dr. Bastian’s conclusions. For instance, the Pennsylvania Game Commission issued the following statement in response to the USP press conference:

“Following today’s press conference on Chronic Wasting Disease (CWD), the Pennsylvania Game Commission and Pennsylvania Department of Agriculture would like to make clear that decades of research have provided abundant evidence that prions, or misfolded proteins, are the infectious agent of CWD, and this hypothesis is accepted by state agriculture and wildlife agencies across the U.S.

While alternative theories exist, they have not been thoroughly researched.”

Dr. Krysten Schuler of Cornell University also released a detailed statement refuting Dr. Bastian’s claims, which you can read here.

On the other hand, other wildlife officials are expressing a desire to know more about his research. The Wildlife Bureau executive director for the Mississippi Department of Wildlife, Fisheries, and Parks, Russ Walsh, had this to say:

“There’s a lot of questions if it is indeed credible science. We’re not discounting it, but we want to know more.

Certainly it could be plausible. There’s still a lot of questions about prions and the prion theory. The scientific community will know more through research. This could be a large paradigm shift in the scientific community.”

The fact that Dr. Bastian is offering a different theory regarding the origin of CWD from the mainstream scientific community doesn’t necessarily mean he is wrong. Indeed, it’s certainly possible that he is correct in his assertions. If true, this development is great news.

Let’s not get carried away, though. At this time, there is still no known cure to CWD and the best we can hope for is to slow the spread of the disease until someone, whether that’s Dr. Bastian or somebody else, develops a proven cure or vaccine.

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Top exercises for glute activation

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What are the Glutes?

The glutes are the butt muscles. There are lots of them, some superficial, and many more, deeper into the buttock. When we talk about the glutes, and specifically glute activation, we tend to be referring to the three biggest glute muscles — gluteus maximus, gluteus medius and gluteus minimus.

As a physical therapist, I see and treat people whose glutes are not working as they should on a daily basis. In many cases they don’t fire (contract) when they should to produce the movement they are designed to produce.

The role of the glutes is to extend and abduct the hip joint. That is to say, they move the leg backwards and out to the side. They also assist in rotating the hip, some medially and some laterally, depending on their location and attachment points.

They are such a vital muscle group for good form and function. Inactive or weak glutes can result in faulty biomechanics, leading to pain and injury. For example, if your gluteus medius is not strong, your thigh adducts (falls inwards towards the other) and the knee is placed under excessive stress.

If the gluteus maximus is misfiring, the lower back fascia is not tightened sufficiently to support the lumbar spine. This can cause sacroiliac joint dysfunction amongst other problems, even as high as the shoulder and neck.

Why are the Glutes Inactive?

In many cases the glutes are inactive due to postural issues. A large number of people now have an anterior pelvic tilt, whereby instead of sitting level, the pelvis tips forwards at the front, resulting in an exaggerated curve in the lower back and lengthened glutes. A muscle held in a lengthened position for extended periods becomes less effective.

Sedentary individuals, and even those who exercise regularly but sit for long periods also face the problem of inactive glutes. This is simply a case of “use it or lose it.”

Previous injury is of course another factor which may contribute to glute issues, especially if not rehabilitated thoroughly at the time.

What is Glute Activation?

The aim of glute activation exercises is to get the glutes working again. They are simple exercises designed to “switch on” the glutes. The individual has to learn how to contract the muscles rather than compensating by using other muscle groups such as the hamstrings.

These exercises are best performed prior to activity, i.e., first thing in the morning, after long periods of sitting and also at the start of a workout. This ensures the glutes are awake and firing, ready to take on the task at hand.

They are low-load exercises with high reps and should focus on form on both sides, maintaining a good pelvic posture and a tight core throughout. The idea is not to fatigue the muscles at this point.

Example Exercises

Every therapist has a different approach to getting the glutes up and firing again. The approach will also depend on the severity of the issue. A starting point for one person may be to simply lie on their front and practice squeezing the glutes, first both sides together and then trying to isolate left and right.

If you can achieve this, then there is a whole catalog of exercises you can try. In all cases, you should be able to feel the glutes contracting, and not feel the hamstrings, lower back or hip flexors instead.

Standing hip extension/abduction

  • Stand facing a wall, finger tips lightly touching for support
  • Tighten your core muscles and perform a slight posterior pelvic tilt, tucking your tailbone underneath you
  • Take the weight onto one leg, without shifting the pelvis over
  • Move the free leg backwards and out to the side, in a diagonal line, keeping the knee straight. Try to squeeze your butt muscles as you move
  • Ensure the lower back is not arched on the movement — the upper body should stay still
  • Return to the start position and repeat
  • Resistance in the form of an ankle weight or resistance band can be added later

Lateral band walk

  • Use a mini resistance band around both feet
  • Contract the core and lightly tuck the pelvis under
  • Walk sideways taking small steps
  • Ensure the upper body is as still as possible

Hip thrust

  • Lie on the floor on your back, knees bent and feet hip width apart
  • Contract the glutes and core muscles
  • Lift the buttocks, lower and mid back off the floor to form a straight line from shoulders to knees
  • Avoid over-arching the lower back
  • Return to the start position and repeat
  • For all-round glute activation, add a mini resistance band around the knees and push gently outwards as you lift up

Modified clam

  • Lie on your side with your head supported and bottom leg straight
  • Have your top hip bent up to 90degrees, knee on the floor and your top foot resting on your other knee.
  • Contract your core muscles before you move to stabilize your pelvis
  • Keep your top foot rested on your bottom knee as you lift your top knee off the ground
  • Make sure your hips don’t roll back as you lift your knee
  • Lift as high as is comfortable without rolling backwards
  • Slowly return to the start position and repeat

Frog pump

  • Lie on the floor on your back
  • Place the soles of the feet together and allow the knees to fall apart as far as is comfortable
  • Maintaining this position, squeeze the buttocks and lift them and the lower back off the floor, as if performing a hip thrust
  • The laterally rotated, abducted position of the hip in this hip thrust variation adds for additional glute max activation at end range

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