Muscle Activation Levels of the Gluteus Maximus and Medius During Standing Hip Joint Strengthening Exercises Using Elastic Tubing Resistance
Youdas, JW, Adams, KE, Bertucci JE, Brooks KJ, Nelson MM, Hollman JH. Journal of Sports Rehabilitation 2013, Epub ahead of print.
Take Home Message: Standing hip exercises with elastic tubing resistance do not selectively activate or provide sufficient resistance for strength training the gluteus maximus and medius muscles in healthy collegiate-aged subjects, and as such, may not provide the desired outcome when implemented clinically.
Gluteal muscle weakness has been linked to numerous lower extremity injuries and is very common after lower extremity surgery. Standing hip movements with elastic tubing resistance are among the most commonly utilized exercises for targeting gluteal strength deficits. The elastic tubing provides resistance to the swing limb, but also requires activation of the contralateral limb for postural stability. The aim of this study was to determine whether the swing or stance leg is more activated during four standing hip exercises: front-pull, back-pull, cross-over pull, and reverse cross-over pull. The authors recruited 26 (13 male, 13 female) healthy college-aged individuals for this study. While the participants performed three trials of each exercise – which they did in a random order – the authors measured muscle activation of the gluteus maximus and gluteus medius using surface electromyography (EMG). The gluteus maximus muscle had similar muscle activation between the swing and stance limbs in all of the exercises, except during the back-pull exercise. During the back-pull exercise the swing limb exhibited 3.2 times higher gluteus maximus activity than the stance limb; this difference was attributed to the increased resistance provided by the tension of the elastic tubing. The back-pull exercise generated the largest gluteus maximus activation level of the swing limb and the reverse cross-over pull generated the largest gluteus maximus activation level of the stance leg. The gluteus medius muscle had similar muscle activation between the swing and stance limb in all of the exercises, except for the front-pull exercise. The gluteus medius muscle of the stance limb demonstrated 1.7 times higher gluteus medius activation than that swing limb. The reverse cross-over pull demanded the largest gluteus medius activation in both the swing and stance limbs; attributed to the motion, resistance, and stabilization occurring in the frontal plane.
These results raise an interesting question: Do our commonly utilized techniques meet our clinical goals? It has been previously reported that a level of 50% EMG activation is required to increase strength; the reverse cross-over pull was the only exercise condition that reached this mark. So is elastic tubing resistance sufficient for gluteal muscle strengthening? It’s difficult to answer this question since the study only included healthy college-aged individuals. These results may not apply to those with injury or patients of different ages. Most of these participants also regularly engaged in physical activity and/or strength training. These results may not apply to less active patients. Despite these limitations, this study can help us in the clinical setting by demonstrating the need for more advanced resistance exercises in the treatment of younger and more active patients.
Questions for Discussion: Do you commonly use elastic tubing in your practice? Do you obtain your desired results? What other methods do you use to overcome gluteal strength deficits?
Written by: Meghan Maume Miller
Reviewed by: Jeffery Driban