It’s Literally a Pain in the ………

“It’s all in the hips. It’s all in the hips.” Chubbs Peterson tells this to Happy Gilmore to calm him before he starts a golf tournament in the movie Happy Gilmore. This also applies to human movement where it is very important to have good range of motion as well as strength in your hips. Weakness in your hips has been shown in many low back and lower body musculoskeletal issues such as hip bursitis, ITB syndrome, patellofemoral pain syndrome, and ankle sprains. Whether you have had a low back or leg injury in the past or are looking to prevent an injury or a fall in the future, performing hip strengthening exercises specifically for your gluteal muscles would be beneficial. If you have an injury that was never treated or have pain or difficulty with any of these exercises, do not continue the exercise and contact Progressive Rehabilitation Associates for an evaluation from one of our skilled Physical Therapists (PT).

There have been many studies looking at how different exercises contribute to strengthening of certain muscles. In this blog we will discuss an article titled “Which Exercises Target the Gluteal Muscles While Minimizing Activation of the Tensor Fascia Lata? Electromyographic Assessment Using Fine-Wire Electrodes.” This is a study that looked at 11 exercises to strengthen the gluteal muscles without targeting a muscle on the front side the hip called your Tensor Fascia Lata (TFL). This muscle will compensate if you have glute weakness and a muscle imbalance may occur around your hip.  Of the 11 exercises, the researchers found five exercises that focused on the gluteal muscles significantly more than the TFL.

Clamshell

The clamshell exercise is performed by lying on your side with your legs on top of one another with hips flexed to about 45 deg and knees bent to 90 deg. Keeping your feet together and your belly button and pelvis facing forward, raise your top knee toward the ceiling about 30 degrees. For this exercise and the rest of the exercises discussed, technique is very important as pelvic position will make a difference on how your muscles work. In another article that looked at pelvis positions during a clamshell exercise, it was found that your glute muscles are more active when the pelvis is in a neutral position versus when the pelvis rolls backward and your belly button rotates up toward the ceiling. This is a very common compensation that I see with patients in the clinic. A PT can ensure you are doing the exercise correctly or give cues to modify the exercise so it is done correctly.

Unilateral Bridge

The unilateral (or singe leg) bridge is performed by lying on your back with one leg lying straight on the table and one knee is bent with foot flat on the table. Push through the foot on the table lifting the hips off the table maintaining your pelvis in neutral (without any rotation). As you do this exercise, you should feel your bottom muscles working. If you notice your hamstrings really working or starting to cramp or increased tightness in your lower back, you may not be using your gluteal muscles efficiently. Also, pay attention to keeping good trunk alignment in order to avoid compensation and creating tension or stress somewhere else particularly the low back. This exercise requires a lot of core strength as well as hip strength to perform. You may need to progress to this exercise on a single leg by starting with a double leg bridge.  

Resisted Side Stepping

Set up for resisted side stepping is standing with a slight bend in the knees and a resistance band around knees or ankles. It is performed by stepping to the side 3-4 steps then stepping in the other direction for 3-4 steps. You should feel the muscles on the back and sides of your hips working. Continue that until your gluteal muscles get tired. Try to keep some tension in the band the whole time by not bringing your feet as close together. This will help to keep your muscles working through the exercise. A compensation I see with this exercise is leaning too much to the side with the upper body. Let your legs do the work!

Quadruped Hip Extension with Knee Extension (Straight) Quadruped Hip Extension with Knee Flexion (Bent)

The last 2 are both performed in the quadruped position (on your hands and knees).  Though not pictured, it may also be done on your forearms and knees. From this position, keeping your spine and torso as still as possible, lift one leg straightening out your knee so it is in line with your body. The next exercise is performed the same way but by lifting the leg with the knee bent to about 90 deg throughout the range of motion. The big thing with these exercises, like the previous ones, is maintaining the pelvis in neutral and not arching the back. Sometimes with tightness in muscles on the front of the hip, the back may arch with these exercises, so the range of motion may need to be modified to prevent arching of the back. 

This study did have a few limitations. It was performed on healthy individuals. Someone with an injury or pain with these exercises may need to be assessed and treated for any soft tissue or joint tightness and to make sure he or she is utilizing the glutes correctly. This will allow him or her to perform these exercises correctly and efficiently. Another limitation is this article only looked at 11 exercises and there are many exercises to help strengthen the hip.

Overall, a balanced exercise program including double leg and single leg hip strengthening exercises as well as non-weight bearing and weight bearing exercises would be best. As far as repetitions, it depends on your goals. 6-12 repetitions are good to improve your strength and above 12 repetitions are good to improve your muscular endurance. You can also work on endurance with prolonged holds of the exercises. Like I mentioned, if you have any questions on these exercises or want to learn what regimen of exercises would be best for you to perform, call in to Progressive Rehabilitation Associates for an evaluation.  We will ensure you are moving well in order to perform your activities of daily living, to participate in your hobbies, or to drive the golf ball like Happy without pain!

Lucas Schippers, DPT

Resources

Willcox, Emma L., and Adrian M. Burden. “The Influence of Varying Hip Angle and Pelvis Position on Muscle Recruitment Patterns of the Hip Abductor Muscles During the Clam Exercise.” Journal of Orthopaedic & Sports Physical Therapy, vol. 43, no. 5, May 2013, pp. 325–331., doi:10.2519/jospt.2013.4004.

Selkowitz, David M., et al. “Which Exercises Target the Gluteal Muscles While Minimizing Activation of the Tensor Fascia Lata? Electromyographic Assessment Using Fine-Wire Electrodes.” Journal of Orthopaedic & Sports Physical Therapy, vol. 43, no. 2, Feb. 2013, pp. 54–64., doi:10.2519/jospt.2013.4116.