Hi guys! So, in this video, I'm going to talk about the bridge and what to do if you find
you've been prescribed the bridge because you've got glute pain or you've got piriformis pain
or you've got high hamstring tendinopathy, but you find that it just aggravates your pain.
Now, often patients feel that if they can't do the bridge, they're not going to get better,
because all of the research you read – especially for high hamstring tendinopathy – usually has
bridge exercises in there. And it's just not true; there are other options as well. So,
what I'm going to discuss in this video is, if you do get pain with a bridge,
how you can adapt it to try and make it pain-free, and then secondly, what other options have you got
for strength training if you can't do bridges. So, for those of you who don't know me, my name
is Maryke. I'm one of the physiotherapists from sports-injury-physio.com, where you can get online
physiotherapy assessment as well as treatment for your injuries. So, have a look at the description
of this video if you want a link to our website. So, what if the bridge causes you trouble? Now,
the first thing that I find people do is that they do the bridge, and they really want to
feel everything working; so, they'll go into that position, and they'll squeeze as hard as they can.
Problem with that is, if things are sensitive and the tissue around that is sensitive, it may not
like you squeezing that hard, and it may irritate it. It's like kind of pushing on a bruise,
and it really kicks the pain signals off. So, that's the first thing I want you to try is,
don't squeeze. It's extremely common for people to say, “I can't feel things working! My glutes
aren't working when I go up!” Now, you cannot physically lift up into the bridge and lock
your hips out without your glutes working. It may be that you don't feel them, but that's
just because your brain is not connected to them properly, that it understands what it feels like;
it doesn't mean that they're not working. So, instead of thinking how you feel it, think about,
“Can I feel that I'm doing the movement right? So, can I feel that I'm going up,
and I feel my hips get to a point where they're not gonna go higher, and that's where I stay;
I'm not bothering with squeezing anything, I'm just looking to sustain the position.”
A second thing is that maybe you're doing too many repetitions, maybe you're trying to hold
it for too long, or you take it that step too far. Because with all of these things, you have
to choose the exercise that it's done to the level that the tissue can sustain at this point,
and it may be that it's just too sensitive to do quite so many repetitions. So, you've got to
start with the right dose. And then also, you do not have to do the perfect bridge at the start;
ease into it, get things used to it slowly. So, let me demonstrate what I mean with that. If we
think of the bridge … get this one out of the way … this is what your typical bridge would
look like, okay. So, we want to go up, get the hips straight, and stay in that position. Now,
in yoga you may have been taught to go there, but can you see that that's just my back doing it,
that's not my hips. We're just interested in the hips, so we're going to take it just to level.
So, when you lift up, think about tightening up your tummy gently and then just leading with
your hips and coming up, lifting the hips up, until you feel they're straight. Now,
you'll notice I'm not super, super straight. You can argue there's a little bit of a bend in there,
but that is where I feel my hips are saying, “Hmm, we're a bit tight around here; this is
where we want to stay at this point.” And I'm not squeezing as hard as I can to stay there;
I'm just sustaining the position. I'm feeling my bum is getting a little bit
tired from talking in this position. If I had to really squeeze, I could get it to there,
but that's okay; you don't have to do it like that at the beginning. Just take it
up and get into that position, and you will be working the things that you need to be working.
As it gets used to that, the tissue then desensitises, and you'll be able to do more of
it and harder versions of that over time. But then there is a significant portion of patients where
I've had it that they just cannot do a bridge; it always kicks their pain off. And for those guys,
we've used other types of exercise. So, if we think of high hamstring tendinopathy: A really
brilliant way of strengthening the hamstring is just hamstring curls. Now, you can do them
with a band, you can do them … I had a patient the other day who's been brilliant; he actually
duct-taped a weight to his boot because he found the band was actually annoying things. But then,
the machines in the gyms, they are actually my first choice. Two reasons: You can really set
the range of motion on that, that you stay within the range that works best for it, and you can also
really control the weight that you use, because remember, we want to slowly increase the weight on
that tendon over time, and with that machine it's really easy, because when you hit a certain level,
you can increase the weight, bring the reps down, and just build it up again. So, if you don't know
what a hamstring curl looks like; it's anything where you're either lying on your front, and
you've got the weight of the band attached to your foot, and you'll be doing that motion,
or you get the machine in the gym also, that you sit on, and you do that motion. Now,
depending on how sensitive your tendon is, it may not handle that at the beginning,
but later on it may be good. You can use things like deadlifts and stuff as well,
but during the initial phases, they usually aggravate it a bit,
so I tend to leave them for later in the rehab process. If we think of glutes and
piriformis, one of the best ways to start is just regular old side-leg lifts, where you're
on your side, and you just take the leg out, and you hold it there, and you slowly bring it back.
Sometimes, instead of moving it, you've just got to do isometrics for that first. Then later on,
other exercises you can do is like standing on the step and dropping your hip up and down. So,
there's plenty of options. Doesn't have to be a bridge just because the research is using it;
it's just what they decided in that study; there's no research to show that one is better
than the other; it depends on the patient in front of you. So, I would really advise,
if you're stuck on an exercise and it doesn't work for you, ask your physio for a different
one and discuss it with them; they should in any case be reviewing you on a regular basis
and adapting your program if it doesn't work for you. I find that rehab programs should be a fluid
thing; it's never, or very in very few cases, the first exercise you prescribe to that level
is the one that people need to be doing. Quite often there's little niggles that come out,
and you've got to adapt it down or you've got to adapt it up, and that's why it's important to
keep an open conversation with your physio, that that adaptations happen through the rehab process,
that you don't do things for too long that they just irritate it. So, let me know if you've got
any questions. And remember, if you need help with an injury, you're welcome to consult one
of us via video call; the link to the website is in the description of this video. Take care!