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Gluteus Medius - evidence based rehab. This is in part advice for runners and in part something else….…you’ve heard of a “dance off” and probably a “sing off” this my friends is a geek off!

It’s come about after I’ve heard lots of people being advised not to bother with sidelying exercises for glutes because they “aren’t functional”. Several well- meaning websites even describe them as harmful and more likely to cause “regression” than rehab. I say in my home page for this site that I appreciate everyone’s opinion and I do. I also agree that sidelying work isn’t functional, but I feel it still has a valuable place in glutes rehab and it shouldn’t be treated as ineffective quackery! My point here isn’t that sidelying work is the best, but simply that it has it’s value in rehabbing glutes and should be used as part of a comprehensive programme including weight bearing exercises. So let’s examine some glutes exercises you can do and some research behind them. Watch Journey To The End Of The Night Online Journey To The End Of The Night Full Movie Online. All pictures are reproduced from research articles freely available on the web and will be referenced and linked.

Sidelying abduction – reproduced from Distefano et al. There is also a video although it doesn’t work on the i.

Pad. This page contains links to videos for all the exercises in this article (links may take you to a “mobile page” if using i. Pad or i. Phone. Use the search box and you can locate the full article without signing in). Distefano et al. 2. EMG study to determine which exercises produced most activation of Gluteus Medius.

EMG (Electromyography) uses electrodes to examine muscle activation. They compared a number of exercises including hip clam, single limb squat, single limb deadlift, lateral band walks, multiplanar lunges and multiplanar hops. They concluded that,“The best exercise for Gluteus Medius was side- lying abduction”They found single limb squat to produce the second most EMG activity and lateral band walk the third. Now you may be wondering does this translate to changes that I can feel and see? Will it improve my symptoms? It’s fair to question this, EMG change is all good in theory but what about in practice? Fredericson, who’s written quite widely on ITB problems and their treatments did a study on runners in 2.

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They found that,“Long distance runners with ITBS have weaker hip abduction strength in the affected leg compared with their unaffected leg and unaffected long- distance runners…. So hip abduction, one of the roles of Gluteus Medius, is weaker on the side runners have ITBS.

No great surprise there. What exercises did they use to rehab it and return people to running?….…. Update 3/6/1. 2: Thanks to Stuart Palma (a nice bloke despite being a Liverpool fan!) we also have another article to add to the mix. Mc. Beth et al. 2. Unlike previous articles they used a leg weight and a “biofeedback unit” to monitor trunk position. They compared muscle activation in Gluteus Medius, Gluteus Maximus, anterior hip flexors and Tensor Fascia Latae with each exercise. They concluded that,“The sidelying hip abduction exercise was the best for activating Gluteus Medius with little activation of Tensor Fascia Latae and anterior hip flexors”A few key points here then; It gives us an indication of specificity – sidelying abduction appears to be able to activate the muscle we are targeting without working the muscles we are not targeting.

Gluteus Medius activation was similar to Distefano’s earlier work at 7. MVIC. Important to note there is no comparison with weightbearing exercise. Now I could stop there. I’ve made my point – sidelying abduction clearly has a role, but part of this is not about cherry picking a couple of articles to prove a point, it’s about looking at the bigger picture even if that includes research that goes against your theories…. Side plank abduction. This is reproduced from Boren et al. Their top 3 exercises for Glute Medius were side plank abduction with dominant leg down, side plank abduction with dominant leg up and single leg squat (in that order).

Notice again that these positions, despite being “non- functional” do create a lot of activity in Glute Medius and again more so than weight bearing positions such as single leg squat. Of note too is that they found less activity with side- lying abduction than the previous studies. This raises a good point with research and rehab. Nothing is concrete. You simply cannot say “this exercise has no role” as you will find evidence to support your claim and evidence to refute it. Also they used a slightly different technique which might account for the difference.

The Clam. Again reproduced from Boren et al. I’ve modified them with some instructions to clarify (thanks to Debra for the suggestion).

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The link above also includes detailed descriptions of this exercise and its progressions (it’s all in the appendix at the end of the article). Most people think of the clam as the exercise described in Clam 1 above.

In this study 3 progressions of the exercise were included. In many exercises they can be progressed by increasing resistance, this one is progressed by a change in position. The article demonstrated an increase in glutes activity from Clam 1 being lowest to Clam 4 being the highest. Compared to other exercises in the study Clam 4 had a high level of Gluteus Medius activity (7. MVIC – Maximal Volitional Isometric Contraction) only slightly lower than Single Limb Squat (8. MVIC). Distefano et al 2. So we’ve seen 3 exercises, all in sidelying, that produce high levels of Gluteus Medius activation, at least comparable to, and in some cases higher than weight bearing exercise.

It’s no great surprise then that the English Insitute of Sport uses a selection of sidelying exercises in its “Glutes Circuit”. We were given this by one of their team at a Strength and Conditioning lecture but sadly can’t reproduce it online. Next we look at weight bearing exercise. Single Limb Squat. Watch Mulholland Dr. Streaming on this page. Once again from Boren et al. Single Limb Squat as above showed good Gluteus Medius and Gluteus Maximus contraction with 8.

MVIC for Gluteus Medius and 7. Gluteus Maximus. Both muscles are hugely useful for runners and so this exercise clearly has its benefits. As a result it’s one I use regularly. The only issue here is the risk of aggravating pain. The deep dip position places greater stress on the ITB and patellofemoral joint. As a result I often start with a shallow knee dip or use this exercise after first rehabbing with sidelying exercises. There is also an issue of control, some patients struggle to even balance on one leg let alone perform a squat.

Distefano et al. 2. Glute Med and Max. Lateral Band Walk shown below, also showed good Gluteus Medius activation (although less than side lying abduction). This doesn’t appear to have been assessed by Boren et al. Wall Press – reproduced from O’Sullivan, Smith and Sainsbury 2. In the picture below the right Gluteus Medius is being exercised by pushing the left knee, hip and ankle against the wall and maintaining a contraction for 5 seconds. Wall press was compared to Pelvic Drop and Wall Squat and achieved the highest MVIC of 7.

Pelvic Drop – picture below reproduced from Bolgla 2. Glute Medius on pelvic drop of 5. MVIC and was similar to Boren et al 2. In Bolgla’s study it scored the highest of 6 exercises which also included sidelying abduction. For pelvic drop the standing leg (right in this case) stays straight and you lower your other leg by lowering the pelvis on that side. Krause et al. 2. 00.