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Which Side-Lying Exercise Targets Gluteus Medius the Best

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Filed Under (Fitness, General, Gluteus Medius Exercises, Hip Injury, Hip Pain, Run Injuries) by Rick Kaselj on 04-05-2012

This weekend, I am teaching Exercise Rehabilitation of the Lower Body courses.  This is where I talk about exercises for knee, hip, ankle and foot injuries.

Before heading to teach, I thought it would be a good idea to see what is new in the research when it relates to the lower body.

Here is a paper that stood out on injuries and exercises:

Hip Muscle Activation in 3 Hip Exercises in Runners

 

What The Researchers Looked At

It is thought that PFPS and ITBS is caused by weak proximal muscles leading to dynamic valgus of the knee.

Dynamic Valgus is defined as:

“..a malalignment characterized by pelvic drop, which is inferior movement of the contralateral side of the pelvis during single-legged stance; femoral adduction and internal rotation; genu valgum; tibial internal rotation; and hyperpronation, and it occurs when the hip muscles cannot overcome the external torque caused by gravity acting on the body’s center of mass.”

Very cool stuff – try repeating that five times.

The research they did was straight forward.  They used 20 distance runners from a local running club.  They looked at the EMG (electromyography – electrical recording of muscle activity) of gluteus maximus (GMax), gluteus medius (GMed), tensor fascia late (TFL) and anterior hip flexors (AHF) during these three exercises:

  1. side-lying hip abduction
  2. side-lying clam exercises – it is thought that it focuses on strengthening the abductors and external rotators of the hip
  3. side-lying hip abduction with the leg externally rotated – it is thought this exercise targets GMax better than other exercises

Cool Stuff in the Introduction

As I have said before, I love reading the introduction to papers.  There are always great stats and nuggets of information in there.

  • 19% to 79% of runners will sustain a lower extremity injury
  • The knee, lower leg and foot are the most common running injury areas
  • The most frequent injuries in runners is patellofemoral pain syndrome (PFPS) and iliotibial band syndrome (ITBS), injuries to the gluteus medius muscle (GMed), and greater trochanteric bursitis.
  • TFL and GMed contribute to hip abduction but TFL also helps with hip flexion.
  • VERY IMPORTANT ==> “authors of cadaver-based anatomical studies have demonstrated that beyond 40 degrees of hip flexion, the GMed no longer functions as a primary hip abductor.  In more than 40 degrees of hip flexion, the GMEd functions as an internal rotator, and hip abduction is performed by the deep external rotators.”
  • VERY IMPORTANT ==> 40% of maximal voluntary isometric contraction (MVIC) is needed in order to obtain strength gains.

Exercise Set Up

Here are some exercise set up points that stood out:

  • Tempo – 60 beats per minute with a metronome with 1 beat concentric, 1 beat eccentric and 4 beats rest.
  • Hip Abduction – They limited people to 35 degrees of hip abduction.
  • Pelvis Neutral – They prevented any pelvis movement by using a blood pressure device in the lower back area.
  • Resistance – 5% of body weight.
  • Clam Exercises – It was done with 45 degrees of hip flexion and 90 degrees of knee flexion.  The top leg was lifted to a point of 25 degrees to the horizontal.

The Results from the Research

  1. Side-lying Hip Abduction – GMed (79.1% MVIC) was more active than TFL (54% MVIC), AHF, and GMax
  2. Side-lying Clam Exercises – AHF (54.2% MVIC) was more active than GMed (32.6% MVIC), TFL, and GMax.
  3. Side-lying Hip Abduction with the Leg Externally Rotated – TFL (70.9% MVIC) was more active than  GMax (31.7% MVIC), GMed, and AHF.

Rick’s Comment on Things

Very interesting stuff.  It highlights how side-lying hip abduction should be the focus when targeting GMed but ensure that hip abduction does not pass 35 degrees and lower back does not flatten.

Also remember that there is a difference between body weight and resistance exercises.  This research showed that with resisted side-lying hip abduction, GMed had a 79.1% MVIC while other research showed when it was just body weight it had 46.06% MVIC.

The point about 40% MVIC in order to see strength gains is a key thing to remember as side-lying clam exercises and side-lying hip abduction with the leg external rotate did not meet these requirements when targeting GMed or Max.

Where to get more information: McBeth JM, Earl-Boehm JE, Cobb SC, Huddleston WE. (2012). Hip muscle activity during 3 side-lying hip-strengthening exercises in distance runners. J Athl Train. 2012;47(1):15-23.

Where Should You Put the Tubing Around Your Knees in Order to Target Gluteus Medius the Best?

What The Researchers Looked At

The researchers wanted to look at designing a progressive rehabilitation program based on muscle activation.

They looked at the “Monster Walks” and “Sumo Walk”.  Within each exercise they looked at tubing placement at the feet, ankles and knees.

They looked at 9 healthy male subjects and their muscle activation in the hip and torso.

The Results from the Research

  • Tensor fascia latae (TFL) – demonstrated an increase in activation when you moved the band from the knees to the feet but there was no difference between the ankle and the foot.
  • Gluteus medius – demonstrated an increase in activation as you move from the knees to the toes.
  • Gluteus maximus – was only active when the tubing was wrapped around the feet.
  • External Rotation of the Hip – when the tubing was wrapped around the ankles or feet, this lead to greater external rotation of the hip which lead to greater gluteus medius and maximus activation.

Rick’s Comment on Things

I was talking about this last weekend during the Exercise Rehabilitation of the Lower Body courses.  I am glad I dug this up and finally read this.

I think this info will help bootcamp instructors, personal trainers, senior fitness leaders and rehabilitation professionals.

Darn, I love research.

Where to get more information – Cambridge ED, Sidorkewicz N, Ikeda DM, McGill SM. (2012). Progressive hip rehabilitation: The effects of resistance band placement on gluteal activation during two common exercises. Clin Biomech (Bristol, Avon). 2012 Mar 29. [Epub ahead of print]

Here is a resource for gluteus medius exercises. It is the video presentation that I did on Gluteus Medius Exercises:

Gluteus-Medius-Exercise-Program

That is it, have a great day.

Rick Kaselj, MS

If you enjoyed the above article, here are some of my other research reviews:

 

Best of 2011

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Filed Under (Corrective Exercise, Fitness, Foam Rolling, Gluteus Medius Exercises) by Rick Kaselj on 30-12-2011

Another year has passed, wow.

They just keep truck’n on by.

It is always nice to stop and take a look at the year that is just about to pass.  Before I look at the year, I wanted to see how far this little blog has come.

Looking Back at ExercisesForInjuries.com

I started this Exercises For Injuries thing on February 26, 2009.  My first post was Keeping Up with the Bones .  It was a bad post.  I had no idea of what I was doing, but I just started writing.  Nearly 3 years later, I am well past my 400th post.  Things have improved drastically but there is still a lot more that I can do.

Rick and YouTube

One other way that I have been helping getting the word out when it comes to injuries and exercise has been my YouTube channel.  I started it on December 25, 2008.  Looking at the channel, I am getting very close to 250 videos.  Not sure what I was doing starting a YouTube channel on Christmas Day but I am happy how it has progressed over the last 3 years.

Facebook and Rick

I might as well finish off with the last place that I spend my time when it comes to getting the word out on exercises and injuries.  It is Facebook.  I started my fan page this year and I am still figuring it out.  Just like my blog and YouTube, I will:

  1. Keep delivering the best content that I can
  2. Help people in any way that I can
  3. Stay consistent with what I do
  4. Try to improve with every day

If you plan on doing this blog/YouTube/Facebook  thing, remember those four things as I think they are very important and have helped me out a lot.

Okay, lets get to the list.

Top 7 Posts for 2011

Read the rest of this entry »

Using Corrective Exercise to Overcome an Injury

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Filed Under (Ankle Injury, Corrective Exercise, Fitness, Gluteus Medius Exercises, muscle imbalances, muscle imbalances revealed) by Rick Kaselj on 17-12-2011

A great article for you today.

It is a guest blog post from Nick Rosencutter.

Enjoy.

Take it away, Nick.

Injuries are no fun.

They are a pain, literally.

They can stop you from doing something you love.

They can cause nagging aches and pains.

They can affect you mentally.

They can ruin your day.

They are something that most people try to avoid.

On the other hand, they can also be a blessing in disguise. This is something that I have realized first hand.

The Rush of Training

I absolutely love training, especially powerlifting. I love the thrill and rush of stepping on the platform to compete. I love pushing my body past limits and growing stronger both physically and mentally when I push past barriers with my training. I love being in great shape and moving weights that most people can only wish to move. I’ve loved training (notice I said training and not “working out”) for over 12 years without a break (which really isn’t that much and I still have a long way to go).

When I’m not training, I’m helping others train, reading about training or dreaming about training. The deadlift happens to be my ace and pretty much my favorite thing to do in the world. In my opinion, there is absolutely no better feeling than locking out a heavy deadlift as you feel every muscle in your body tighten up to make it happen.

The hip drive, grip strain, the glutes coming through, the back locking out, the traps stabilizing, the intrinsic foot muscles gripping the floor, the blood rushing through the veins and the rush that flows through the body and mind; just an amazing feeling that only certain people will understand. Not being able to do this for a period of time was devastating.

Great little video from Nick on Gluteus Medius Exercises:

Training Stupidity

Flash back to November of 2008. I had just done my fifth meet in about seven months, which was probably a little too frequently. I was on pace to pull my first 600lb deadlift at a bodyweight around 178-180. Training had gone well as I had pulled 610 with band tension, tripled 540 and had made good progress on most of my assistance work. Well, I ended up missing 570ish at the meet when I had nearly locked out 585 a few months earlier. Part of the problem was just training stupidity. I had gone too intense for too many weeks before the meet and had competed too many times. But I knew that couldn’t be the only issue at hand because when I made that attempt, the weight was coming up smoothly; I thought for sure that I had it locked. Then as I approached lockout, I just couldn’t finish it. I was upset to say the least.

The Injury was in the Details

So at this time, I was in my last semester in the exercise science and strength & conditioning program at UW-La Crosse. Luckily, I was surrounded by some very knowledgeable people who knew their stuff. I spoke with one of my mentors, an amazing strength coach who knows a thing or two about the iron game. I showed him a video from my missed deadlift. He immediately pointed something out that I hadn’t noticed or really even thought of. My left leg began to shake as I approached lockout. He looked at another video of a 560 pull I had made easily a few months earlier. I had some rotation occurring through my hips and trunk as I pulled the deadlift. It was subtle, but you could sure see it.

So what the heck was going on?

He evaluated me and found out that:

  1. my left glute was not firing as well as my right with hip extension
  2. my right shoulder had some issues as well
  3. my subscapularis was very fibrotic and was stopping my scapula from moving as efficiently as it could

If you have ever read any of Thomas Myers’ stuff on fascia and exercise, this should make you think of the spiral line: opposite hip and shoulder.

I’m assuming that many who read this page know about the book, Anatomy Trains, so I won’t get into tons of detail, but the spiral line is a line of fascia that wraps around the body and at a certain portion of its path, connects opposite hip and shoulder together; basically meaning that an issue with one can affect the other with various movements.

This had implications with the rotation that was occurring with my movement. So he did some ART on my hip and shoulder (left TFL and right subscap among other things) and gave me a few corrective exercises to fix this imbalance that I had. This was probably my first real personal experience/encounter with the world of muscle imbalances and corrective exercise.

I had been decently well versed in every strength and conditioning modality imaginable but had apparently slacked on this whole other department. I was determined to fix my imbalance and get better. I decided to take some time off of competing and hammer these things out for a little while. The January following this encounter, I would embark on my full time internship in order to finish up my degree, which would turn out to be one of the best experiences of my entire life.

Muscle Imbalances that Affected My Lifting

Enter Indianapolis Fitness and Sports Training with a couple of guys named Mike Robertson and Bill Hartman. I learned a tremendous amount about training during my amazing time there and was totally immersed into the world of analyzing and addressing postural faults and muscular imbalances. I had no choice but to get better.

They discovered some of the same that my mentor at La Crosse had plus more:

  • left glute medius was weak
  • left glute max had gotten a little better but still wasn’t great
  • external obliques weren’t where they needed to be, which meant that I didn’t have optimal control over my pelvis and trunk and was leaving pounds on my lifts
  • lower traps were weak, especially the left side, which meant that my scapulae were not as stable as they could have been (implications for all of the big lifts)
  • I had a slight shift and rotation with squats and pulls, which was definitely part of the issues listed above.

Those were some of the main problems for me. So I hammered out lots of special exercises to help balance things out and get my lifts up. I did however, make one mistake. I still trained too intensely, too often. I picked a meet that I wanted to do that May and trained for it.

Little clip from Bill Hartman’s Presentation in Muscle Imbalances Revealed – Lower Body Edition:

Now, these issues that I had were things that were probably going on for a long time. In my early days of training back in high school, I really had no true idea what I was doing (though I sure thought I did) as I pretty much just taught myself and learned from random gym rats and magazines back then.

The shifts and rotation that I had with my squat and pull were subtle enough that an average eye would never notice them, so who knows how long that had been going on. While I had gotten along fine and had built up to a respectable strength level and build, fixing some of these things earlier could have saved me lots of trouble and probably helped me to hit bigger weights easier. I mean, locking out a max deadlift with one glute firing versus two glutes firing is kind of a big deal. So anyhow, I was training hard and lifts were going up, etc. until…..

===========================

That is the end of part 1.  I got part 2 coming up very soon.  Big thanks to Nick.  We all have an in jury story.

About the Author

Nick Rosencutter, CSCS, NSCA-CPT, LMT – Nick is a Certified Strength and Conditioning Specialist and Certified Personal Trainer through the National Strength and Conditioning Association and is also a Nationally Certified and Licensed Massage Therapist. He received his Bachelor’s degree in Exercise and Sports Science with a Fitness emphasis and Strength and Conditioning Concentration from the University of Wisconsin La Crosse, and received his diploma in Massage Therapy from Lakeside School of Massage Therapy in Milwaukee. He has worked with all varieties of clients ranging from fat loss to various levels of athletes and is also a competitive powerlifter. He currently trains clients at Southridge Athletic Club in Milwaukee and offers corrective exercise and movement training at Miller Sports and Wellness Chiropractic in West Allis. You can learn more at his website www.rosencutterultrafitness.com

Rick Kaselj, MS

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