Sports Medicine Research: In the Lab & In the Field: Muscle Activation During Standing Hip Strengthening Exercises (Sports Med Res)


Monday, September 9, 2013

Muscle Activation During Standing Hip Strengthening Exercises

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

Related Posts:

Youdas JW, Adams KE, Bertucci JE, Brooks KJ, Nelson MM, & Hollman JH (2013). Muscle Activation Levels of the Gluteus Maximus and Medius During Standing Hip Joint Strengthening Exercises Using Elastic Tubing Resistance. Journal of Sport Rehabilitation PMID: 23921445


Unknown said...

This topic was of particular interest because I have found, by observation, that many clinicians go to 4 way hip exercises as a primary exercise for hip and glut strengthening. Although, I see some logic to this I have personally found it to be a supplementary exercise at the most. I prefer using more closed chain multi-planar glut and hip strengthening exercises with the use of elastic resistance when appropriate.

Meghan M. Miller said...

It's true that depending on your patient population, the 4-way hip exercise may not be challenging enough to cause strength changes. The study recruited healthy, trained, college aged individuals. However, for patients of other ages, who do not train, or may have existing pathology, this exercise may be warranted. Also, 4-way tubing exercises may be indicated for patients who need muscle activation training, using the tubing as an external cue, rather than strength training. If you are working with generally healthy, younger athletes, you may want to utilize the more complex, multi-planar exercises. Further research of these exercises are warranted for extrapolation beyond this study population.

Jacob Crow said...

Personally, I work with T&F athletes who typically have poor gluteus strength, especially poor in terms of stabilization of the pelvis. Rarely do I use standing 4-way hip w/ tubing as a mode of strength training for the glute muscles. Commonly, this exercise is done incorrectly by recruiting other muscles such as quad or hamstring to assist in motion. Exercises that I do frequently use in the clinic is variations of glute bridge, Side Lying abduction, clamshell with theraband, Lateral walk w/ theraband, variations of modified squats, etc. Probably the most important cue that I use is to train the patient to activate their glute muscles while performing exercise and during sport activity.

Other interesting research topics could include: Prevalence of hip injury after glute strength training. Muscle activation of other exercises such as leg abduction, clamshells, glute bridge, etc (This could provide guidance to what exercises are actually effective within our goal).

Meghan M. Miller said...

Jacob, thank you for your comment. You pose some interesting thoughts regarding alternative exercises for a more advanced population. Compensation is one downfall to any targeted strengthening program and is certainly something needing attention during training.

Amanda Brown said...

I have found that the 4-way hip with a theraband is an appropriate exercise for post-op, older, less active patients. However, I am currently working with cross country athletes and I agree with Jacob. These athletes do not have very good pelvic and core muscular activation it stability. This instability and poor muscle activation affects these athletes throughout the rest of the kinetic chain. I have been using the Myokinematic Restoration realignment home program for these athletes. They have responded very well and are learning how to properly activate their pelvic muscles while also controlling their breathing. I think it would interesting to do a future study with injured collegiate athletes so we could determine if the 4-way hip with a theraband is an effective exercise for this population.

Meghan M. Miller said...

Thanks for your comment, Amanda. You raise an interesting point of discussion with the less active, post-op population. The fact that the 4-way hip exercise is so strongly utilized must mean that it is effective for at least some patients. I too think further research in this area would be greatly beneficial, with both injured athletes and the less active.

Kaitlyn Johnson said...

For what I have seen and experienced thus far as a student Athletic Trainer, the 4 way hip exercises have been a go to exercise. I think this is because it is a simple and easy exercise to do with athletes. Seeing the information that has been done it definitely encourages me to look for other ways that can be more beneficially in strengthen the hip, especially some of the things that previous people use.

Kaitlyn Kelly said...

As a student Athletic Trainer I know during rehabilitation I usually use the 4 way hip exercises with resisted tubing to start off a rehabilitation. I then usually follow up by using other strength exercises including closed chain exercises. Seeing this information has made me rethink that approach. Do you think that these exercises are sufficient in warming up the hip before adding in more complex exercises?

Meghan M. Miller said...

Thanks for your question, Kaitlyn. You make an excellent point about movement preparation prior to exercise. This article did not set out to discredit the 4-way hip exercise, but more to determine it's efficacy as a strengthening exercise. The 4-way hip should likely be paired with more difficult tasks if gluteal muscle strengthening is the primary goal. However, it has been repeatedly shown that movement preparation is important prior to exercise. The 4-way hip exercise is a great tool to use for movement preparation as it activates stabilizing muscles (to remain in a balanced stance position) as well as introduces the planes of movement to be used. It is my opinion that this article doesn't provide enough information for you to remove this exercise from a program, but stresses the importance of the more challenging, closed chain exercises for increasing strength.

Jenna Robinson said...

Agreeing with what Kaitlyn had to say, the 4 way hip exercises have really been what most athletes go to for glute strength and hips as well. They are easy exercises and can be easily demonstrated and performed. But after reading the results of this study, I also want to look for better ways to go about strengthening the hip and am very curious to see what I might find.

Thomas Gooding said...

In my experience as an athletic trainer and personal trainer, I've seen 4-way hip used as the "go to" rehabilitation exercise for deficit involving the hips, and I agree that it may be sufficient for the start of the rehabilitation program, but should be moved past in a short order. Some exercises I prefer to use include body weight/light resistance squatting (deep squats can improve gluteus maximus activation), side lunges, and resisted band donkey kicks for the gluteals. I do think gravity dependent resisted movements would further improve the continued use of 4-way hip over gravity independent.

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