Muscle Activation Levels of the
Gluteus Maximus and Medius During Standing Hip Joint Strengthening Exercises
Using Elastic Tubing Resistance
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.
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.
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.
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.
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?
practice? Do you obtain your desired
results? What other methods do you use
to overcome gluteal strength deficits?
Written
by: Meghan Maume Miller
by: Meghan Maume Miller
Reviewed
by: Jeffery Driban
by: Jeffery Driban
Related
Posts:
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
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.
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.
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).
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.
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.
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.
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.
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?
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.
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.
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.