Gluteus Medius (hip abductor) strengthening: Resisted side-stepping

This New Blog post from Dr. Jared Wilson, DC, MS at Gaitway Chiropractic in Spokane, Washington looks to the research to answer if the posture or position taken when performing the resisted side-stepping exercise matters when trying to maximize gluteus medius activity and minimize tensor fascia lata (TFL) activity. Dr. Jared Wilson blogs about chiropractic health and other relevant health news.  He is an expert in musculoskeletal injuries and functional rehab. He holds a Chiropractic Doctorate degree and a Masters of Exercise and Sports Science degree.

Hip abductor weakness is a common problem with people suffering from a variety of hip conditions such as femoroacetabular impingement, iliotibial band syndrome, and patellofemoral pain. It can even contribute to chronic ankle sprains. Weakness of the gluteus medius muscle will usually cause excess compensation from the TFL. Allowing the TFL to be recruited continually can lead to gluteus medius atrophy.

Corrective exercises can increase gluteus medius strength and improve muscle firing patterns. Usually exercises involving a variation of resisted hip abduction are given. However, it is important for clinicians prescribing these exercises to be aware of excessive firing from the TFL when their patient is performing them.

A recent study by Selkowitz et al (2013) looked at gluteus medius and TFL activation during 11 different exercises. The researchers used fine-wire electromyography (EMG) to determine the maximum voluntary isometric contraction (MVIC) of both the gluteus medius and TFL with each exercise. Their report showcased 5 exercises that activated the gluteus maximus and medius muscles without getting as much unwanted TFL activation. Those exercises included the clam exercise, single-leg bridge, hip extension (quadruped) with knee straight and knee bent, and the resisted side-stepping exercise. Specifically regarding the resisted side-stepping exercise, they found significantly lower TFL activation (13.1% MVIC) compared to gluteus medius activation (32.2% MVIC).

Bottom line is resisted side-stepping should be included in any corrective exercise program designed to strengthen the hip abductors. But does the position or posture you take when performing the resisted side-stepping exercise matter?

A study by Berry et al (2015) addressed this question. They had all 24 participants perform the exercise with an elastic resistance band around their ankles in both standing and squatting postures. Like the Selkowitz et al study, these researchers also used fine-wire EMG to determine the MVIC of the gluteus medius and TFL. Interestingly, they found that the EMG activity of the muscles being tested were actually higher in the stance leg rather than the moving one. They also saw that the EMG activity in the gluteus medius was significantly higher in the squat position than the upright position while activity in the TFL was lower in the squat position compared to the upright position.

So to answer the question…yes! It does matter what position or posture you take when performing the resisted side-stepping exercise. Performing the resisted side-stepping exercise should be done in a squat position rather than an upright one.

But how does this happen? Willcox and Burden (2013) gave a biomechanical explanation for the decreased TFL activity in the squat position. In the squat position the center of mass of the trunk is forward compared to the hip. This creates a hip flexion position and thus reduces the need to activate more muscles involved in hip flexion. Since the TFL acts also as a hip flexor in addition to being a hip abductor, the squat position would reduce the need to activate the TFL in order to stabilize the hip and pelvis. Increased TFL activation would be counterproductive.

I hope you found this blog to be informative. If you have any questions about how chiropractic care could help you, please call Gaitway Chiropractic in north Spokane at (509) 466-1366, request an appointment online, or come by the clinic at 8611 N Division St, Ste A, Spokane, WA 99208.

REFERENCES

Selkowitz DM, Beneck GJ, Powers CM. Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? electromyographic assessment using fine-wire electrodes. J Orthop Sports Phys Ther. 2013;43(2):54-64.

Berry, Justin W., Theresa S. Lee, Hanna D. Foley, and Cara L. Lewis. "Resisted Side-Stepping: The Effect of Posture on Hip Abductor Muscle Activation." J Orthop Sports Phys Ther Journal of Orthopaedic & Sports Physical Therapy (2015): 1-30.

Willcox EL, Burden AM. The influence of varying hip angle and pelvis position on 531 muscle recruitment patterns of the hip abductor muscles during the clam exercise. J 532 Orthop Sports Phys Ther. 2013;43(5):325-31.

Image: Photographer unknown. (2015, August 6). Participant side-stepping to the right in the squat posture [digital image]. Retrieved from http://www.jospt.org/doi/pdfplus/10.2519/jospt.2015.5888