Which Side-Lying Exercise Targets Gluteus Medius the Best

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:

 

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2 Comments

  1. What I would question about these findings is does it correct the movement dysfunction. Are these exercises just adding strength to a stabilizer which we know is not the best way to train them. Yes these exercises hit the GMed a lot, but that is in a side lying position. When you defined dynamic valgus it was in single leg stance. There is a huge difference between the two positions. If the exercise doesnt clean up the movement dysfunction in single leg stance then all the MVIC doesnt mean anything.

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    Rick Kaselj Reply:

    I look at it from the perspective that the exercise is part of my continuum of exercises that I use to target gluteus medius.

    Rick Kaselj

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  2. Hi, Rick! They say that in more than 40 degrees of hip flexion, the GMEd functions as an internal rotator. Does it mean that Clam 60 exercise isn’t appropriate exrcise to activate GMed?

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    Rick Kaselj Reply:

    I am no sure what the clam 60 is.

    Rick

    [Reply]

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