Journal Watch: Which exercises target the gluteal muscles while minimising activation of the tensor fascia lata?

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Here’s our first installment of Journal Watch; a series summarising and commenting on the most recent scientific research.

 

Which exercises target the gluteal muscles while minimising activating of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes

Selkowitz et al J Orthop Sports Phys Ther 2013;43(2):54-64

This was a controlled laboratory study to compare hip abductor muscle activity during selected exercises using fine-wire electromyography, and to determine which exercises are best for activating the gluteus medius and the superior portion of the gluteus maximus, while minimizing activity of the tensor fascia lata (TFL).

Abnormal hip kinematics (ie, excessive hip adduction and internal rotation) has been linked to certain musculoskeletal disorders. The TFL is a hip abductor, but it also internally rotates the hip. As such, it may be important to select exercises that activate the gluteal hip abductors while minimizing activation of the TFL.

Methods:

Twenty healthy persons participated. Electromyographic signals were obtained from the gluteus medius, superior gluteus maximus, and TFL muscles using fine-wire electrodes as subjects performed 11 different exercises. A descriptive gluteal-to-TFL muscle activation index was used to identify preferred exercises for recruiting the gluteal muscles while minimizing TFL activity.

Results:

Both gluteal muscles were significantly (P<.05) more active than the TFL in unilateral and bilateral bridging, quadruped hip extension (knee flexed and extending), the clam, sidestepping, and squatting. The gluteal-to-TFL muscle activation index (see Table 1 below) ranged from 18 to 115 and was highest for the clam (115), sidestep (64), unilateral bridge (59), and both quadruped exercises (50).

Conclusion:

If the goal of rehabilitation is to preferentially activate the gluteal muscles while minimizing TFL activation, then the clam, sidestep, unilateral bridge, and both quadruped hip extension exercises would appear to be the most appropriate.

 

ExerciseGluteal-to-TFL Activation Index
Clam115
Sidestep64
Unilateral bridge59
Quadruped hip extension, knee extending50
Quadruped hip extension, knee flexed50
Sidelying hip abduction38
Step-up32
Bilateral bridge32
Squat28
Hip hike28
Lunge18

Our comments

Ok – if you’re someone who has had back pain or any lower limb pain and been to see a physio, there’s no doubt you’ve been told your glutes are weak and need strengthening. One of the most common exercises prescribed is the clam. Which this study seems to suggest is a no brainer as it generates the most glute activation whilst minimising TFL recruitment. This is important as generally we’re trying to encourage external rotation (glute med) and reduce internal rotation (TFL) to rectify the typical muscles imbalances we see.

However, there is no information here about how the clam was performed, what coaching cues were/weren’t given. We are also able to look to similar studies which find alternative hip exercises better at glut med activation (1). This study shows not only differing results on gluteal activation but also includes two variants of the clam (differing hip flexion – 30/60 degrees) each demonstrating a different gluteal activation profile.

Clam is also an open chain exercise (non weight-bearing so it works on just one joint) which isn’t that functional for us when trying to rehab patients post-injury (2). So which exercises should we be doing to recover from injury or prevent injury? Is the clam better suited to early rehabilitation to initiate glut med control rather than be the standard exercise rolled out to all patients?And how important is TFL activity if we are able to prescribe exercises that result in greater overall gluteal activation?

For the therapist?

From a practical perspective all this study shows is variation in muscle recruitment between different hip exercises. Without more specifics on how exercises were executed or variation between patients we cannot draw much into a clinical setting. Coaching cues are especially important as, anecdotally, we see patients performing the clam with extensive TFL recruitment in clinic, and require significant assistance to adjust their movement patterns. In these cases we may find that moving to a closed chain exercise much more useful, or accept that although other exercises may be more effective in accelerating patient rehab into a functional setting even though they cause greater TFL recruitment.

Abnormal hip kinematics (ie, excessive hip adduction and internal rotation) has been linked to certain musculoskeletal disorders. The TFL is a hip abductor, but it also internally rotates the hip. As such, it may be important to select exercises that activate the gluteal hip abductors while minimizing activation of the TFL.

But as we said above, we’re generally trying to encourage external rotation – and to do so we look to strengthen the gluteals. But does this mean that we’re also trying to inhibit/not recruit the internal rotators? Not really, as it’s about establishing appropriate musculoskeletal balance. When you go into a deep squat are we looking to only recruit the gluteals and externally rotate the thigh? No….we also need recruitment of the internal rotators, including the TFL, to appropriately stabilise the hip.

This study does raise the issue of muscle recruitment patterns and variation between exercises. Exercise variation in a patient’s rehab protocol could be a useful tool for ensuring effective targeting of the gluteals and encouraging comprehensive joint rehabilitation.

For the patient?

  • Make sure you are clear on how to perform the exercise correctly. If in doubt, ask
  • As you progress with an exercise your therapist should encourage you to include new exercises targeting that joint, as well as increasing sets/reps.
  • Remember, it’s about encouraging muscle balance. As you begin to restore balance to a joint the nature of your exercises will change – don’t be surprised by this, it’s a sign of things working!!

To access the full article click here

J Orthop Sports Phys Ther 2013;43(2):54-64

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