A Month Later, and the Plot Thickens
If you’ve been following along, you’ll know that I’m still rehabbing my troublesome left knee – the one I injured in 2022 and had surgery on in 2023. Recently, I decided to embrace Tom Bradley’s approach at the Come Back Club: blood flow restriction training combined with electrical muscle stimulation. It’s an evidence-based way to build strength without overloading dodgy joints, and after my initial assessment showed I was apparently in the 88th percentile for quad strength (ego duly stroked), I was optimistic about what a month of consistent training might achieve.
I’m apple-shaped but I’m also a mesomorph – one of those annoying people who gains muscle relatively easily. Give me a decent programme and some consistency, and my body generally responds. So I committed to going twice a week, dutifully strapping on my blood flow restriction cuffs and doing my Come Back Club swagger around the gym like an overly enthusiastic John Wayne impersonator.
The Physician Who Couldn’t Heal Herself
Almost immediately though, disaster struck. My left hip flexor decided to stage a dramatic protest, going into full spasm mode. I spent the next ten days limping around like someone who’d attempted the splits for the first time at forty, snarfing naproxen like Smarties, and religiously releasing my hip flexors with a foam roller.
And here’s where I have to confess something deeply embarrassing.
For ten days, I treated my hip flexors. TEN DAYS. I’m a physiotherapist. I’ve literally created a self-assessment course on how to work out what’s actually causing your pain, and one of my core principles is that the bit that hurts isn’t always the bit to treat. And yet there I was, happily ignoring my own training like a complete numpty.
Eventually, my professional brain kicked back in. I actually tested myself properly (revolutionary concept, I know). And guess what? The problem wasn’t my hip flexors at all. It was my glutes.
I released my glutes using this technique, and within 24 hours, the problem had vanished. Poof. Gone. Like it had never happened.
Embarrassing doesn’t even begin to cover it.
The Reassessment: A Tale of Two Glutes
After this little episode, everything felt easier. I was progressing nicely through my initial programme – sit-to-stands, bridges, step-ups, and calf raises – and felt genuinely confident heading into my reassessment with Tom.
Tom wheeled out his Vald dynamometry kit, and we ran through the testing battery again. The results started rolling in, and they were brilliant:
- Quads: improved by about 20%
- Hamstrings: improved by about 20%
- Good symmetry on squats
- Improved jump height
- Right glute: improved by about 20%
I was feeling rather pleased with myself. And then we tested my left glute.
0.4% improvement.
Not 4%. Not 14%. Zero point four percent.
Which meant I now had a 24% discrepancy between my left and right glutes. For those playing along at home, that’s really not ideal. In fact, it’s spectacularly not ideal.
When Your Nervous System Says “Absolutely Not”
Now here’s the puzzle: I know I use my left glutes in everyday life. I can demonstrate left glute exercises to my patients perfectly well. So what on earth was going on?
The answer, I think, lies in the difference between everyday functional tasks and high-resistance training. When I’m showing exercises to my patients, we’re generally working on lower-load functional movements – getting up from chairs, walking, climbing stairs. My glutes are perfectly happy to engage for these activities.
But here’s what I suspect happened during my month of high-load training: my nervous system, faced with a left hip that has a labral tear and doesn’t particularly enjoy maximum force hip extension exercises, essentially decided that using my left glute was too risky. So it quietly reassigned the job. My quads could work a bit harder. My hamstrings could pick up some slack. My hip flexors could chip in. My lower back could help out.
The result? A month of training where my left glute barely got any extra recruitment at all. No extra recruitment means no training stimulus. No training stimulus means no strength gains. Hence: 0.4%.
Meanwhile, every other muscle in the vicinity got stronger, creating an increasingly unbalanced system. And when the load got too much for this cobbled-together compensation strategy? Hip flexor spasm. Because of course it did.
The Solution: Keeping the Nervous System Calm
But here’s the thing: I actually need my left glutes to be strong. They’re not just there for decoration. When I play tennis or do any high-load sporting activity, my glutes need to be able to support me properly. Otherwise, I’m just setting myself up for more problems down the line.
The question became: how do I train my glutes properly without triggering my nervous system’s protective alarm bells?
My hypothesis was this: what if I could keep my nervous system calm during the training process? When I talk about “releasing” muscles, I’m not creating any structural changes – I’m releasing tension, essentially sending a “calm down, everything’s fine” message to the nervous system. What if I did this between training sets?
So I tested it. And it works. Hurrah!
Tom has now given me a programme that’s laser-focused on building my left glutes: split squats, single-leg bridges, single-leg deadlifts – all the unilateral hits. And as long as I use a tennis ball to release my glutes between sets, my hip stays calm. No spasm. No drama. Just steady, progressive loading of exactly the muscle that needs strengthening.
It’s been two weeks since I started this new approach, and so far, so good. No hip flexor tantrums whatsoever.
The Takeaway
This whole experience has been a masterclass in the complexity of the nervous system’s role in rehabilitation. It’s not enough to just prescribe exercises and hope for the best. You need to understand why certain muscles aren’t recruiting, what the nervous system is trying to protect, and how to work with it rather than against it.
It’s also been a humbling reminder that even as a physiotherapist with years of experience, I’m not immune to the classic patient mistake of treating symptoms rather than causes. Sometimes you need to step back, do a proper assessment, and remember your own training.
I’m looking forward to my next check-in with Tom to see what happens when you actually train the right muscle. Watch this space – I’m cautiously optimistic that my left glute might finally decide to join the party.
And if nothing else, I’ve become rather good at the Come Back Club swagger.
The Come Back Club is based at 26 Phipp Street, Shoreditch. If you’re interested in learning more about self-assessment techniques for musculoskeletal problems, check out my self-assessment course. And if you need to release your glutes, here’s the technique I use.
