Gluteus Maximus: 5 Exercises to Get Started

The gluteus maximus is the largest muscle of the hip and buttock.  It functions to maintain an erect standing posture and to extend the hip joint.  The gluteus maximus is regarded as one of the strongest muscles in the body.  Strength of the gluteus maximus is required to walk with an upright posture, stand up from a chair, climb stairs, run, jump, and throw a ball.  Weakness is associated with low back pain, knee pain, hip arthritis, and poor balance.  Gluteus maximus exercises are often prescribed for hip arthritis, hip impingement, iliotobial band syndrome, low back pain, patellofemoral pain, and many other overuse injuries.

Exercises start in non-weight bearing positions such as lying on the back or kneeling.   It is recommended that each of these basic exercises is initiated with 3 sets of 8 to 15 repetitions.  When 15 repetitions can be performed, the intensity of the exercise can be progressed by adding weight or increasing the resistance band strength.  Muscle strength and hypertrophy can be achieved with any range of repetitions.  However, to optimize strength, higher intensities with lower repetitions are needed.   Each exercise should be performed 2 to 3 times per week to optimize improvements in muscular endurance, strength, and hypertrophy.  The main objective of this strengthening program is to progressively overload the gluteus maximus so muscular control, endurance and strength are developed in a systematic manner.

2-Leg Bridge

The bridge is a great hip extension exercise to start with.  Begin by lying on your back with the hips flexed and the feet lined up with the shoulders.  Perform the bridge by lifting both hips from the floor.  A common mistake is to excessively arch the low back.  Hold the bridge position for 2 seconds then return to the starting position.  Lower the body back down in a slow and controlled manner.

Be sure to achieve the bridge position by extending through the hips.  If you lack mobility in your hip joints or hip flexor muscles this may lead to compensation through the low back.  This can be corrected with manual therapy and mobility exercises.  You can also try bringing your fleet slightly closer together and the knees slightly wider apart.  This will allow you to achieve greater hip extension range of motion.

Cook Hip Lift

Begin by lying on the back with your hips flexed and feet lined up with the shoulders.   Flex the hip by holding one knee to the chest.  It is helpful to place a small towel roll or ball in the crease of your hip.  Lift your toes off the floor and perform a bridge from one leg.  A common mistake is to excessively arch the low back.  Be sure to achieve the bridge position by extending through the hips.   Hold this position for 2 seconds then return to the starting position.  Lower the body back down before repeating another repetition on the same side.  Complete the desired number of repetitions on one side before beginning with the other leg.

The positioning of the hips during this exercise facilitates a neutral pelvis and low back position.  This is helpful for people with a history of low back pain.  However, this also increases the challenge to the gluteus muscles compared to a standard bridge.   Raising the toes makes you press your heel into the ground as you lift your hips. This facilitates the glutes and hamstrings.

Quadruped Hip Extension with Knee Flexion

Begin on the hands and knees.  The shoulders are positioned directly over the hands.  The hips are positioned directly over the knees.  The spine is maintained in a neutral position throughout the exercise.  Initiate the movement by flexing one knee to 90 degrees.  Next, lift the heel up towards the ceiling keeping the knee flexed.  It is important to avoid arching through the low back.  Hold this position for 2 seconds then return to the starting position.  Lower the leg back down before repeating another repetition on the same side.  Complete the desired number of repetitions on one side before beginning with the other leg.

Prone Plank with Hip Extension

Start facedown supported on the elbows in a plank position with the trunk, hips, and knees in neutral alignment.  Initiate the movement by lifting one leg with the knee bent.   Extend the hip slightly past neutral by bringing the heel toward the ceiling.  Hold this position for 2 seconds.  Maintain the plank position throughout all repetitions on one side.  Complete the desired number of repetitions on one side before beginning with the other leg.  A common error with this exercise is to arch or overextend the spine when lifting the leg.  Also, as the abdominal muscles tire, the hips may rise.  Be sure to maintain a neutral trunk, hip, and knee alignment throughout the exercise.

Side Plank with Hip Abduction

Start side-lying supported on one elbow with the shoulders, hips, knees, and ankles in line. Rise to a side plank position with the hips off the floor to achieve neutral alignment of trunk, hips, and knees.  Maintain the side plank position and raise the top leg into abduction approximately 30 degrees.  Hold this position for 2 seconds then slowly lower the top leg. Maintain the plank position throughout all repetitions on one side.  Complete the desired number of repetitions on one side before beginning with the other leg.

A common error with this exercise is to allow the pelvis to tip forward or backward.  Also, as the top hip tires the abducting leg will move forward into flexion.  As the bottom side tires, the side plank position will be lost.  This exercise has been shown to activate the gluteus maximus and medius on both sides at very high levels.  It is also very challenging and may not be an option for everyone.

Closing Thoughts

These 5 gluteus maximus exercises do not need to all be performed during the same session.  Start with 2 to 3 of the exercises.  Exercise selection is based on your preferences and the level of difficulty.  The bridge is the least challenging and side plank with hip abduction is the most challenging.  Within 6 to 8 weeks, the exercises may feel less challenging.   This means it is time for a progression.  Progression may include adding resistance or substituting with a new exercise.  Next week we will highlight 5 more exercises which can be performed in standing.

 

Gluteus Medius Exercise: Advanced Progressions

Athletes are required to perform explosive powerful movements during sport.  The hip muscles, including the gluteus medius, help generate and transfer forces during sport-specific activities such as running, cutting, and throwing.  These types of athletic demands require high intensity training in the gym.  Gluteus medius exercise which emphasize multiple planes of movement in single-leg or asymmetrical stances are advantageous for these demands.

The advanced exercise progressions included here should first be performed in a slow and controlled manner with an emphasis on technique.  As technique becomes adequate, the speed of movement and load can be increased.  Under any conditions, control of the movement and body positions are extremely important.  Remember, the primary function of the gluteus medius is to stabilize and control the position of the pelvis.  This is mandatory for the rest of the body to generate, transfer, and dissipate forces optimally.

Skater Squat

The skater squats begins by standing on one leg and performing a squat to a comfortable depth.  The depth is determined by the ability to maintain balance and good control of the trunk and entire lower extremity.  The non-weight bearing leg extends at the hip and flexes at the knee. The torso slightly twists and the arms swing reciprocally as if skating.  The toe of the non-weight bearing leg can touch the floor between repetitions if needed.  Hold the downward position for 2 seconds then return to the starting position.   Challenge to the gluteus medius can be increased by placing a resistance band around the thighs just above the knees.

Transverse Lunge

The transverse lunge starts standing with the feet near each other and hands on the hips.  Throughout the exercise the trunk is maintained in an upright position, so the knee and hip of the lunging leg can be flexed to 90°. This prevents the knee from moving forward past the toes.  Also, the knee remains over the toes so it does not cave inwards into valgus.  During the transverse lunge, the body is rotated 135° towards the lunging side.  This involves twisting behind the body and lunging in one motion.   Challenge to the gluteus medius can be increased by holding a dumbbell or kettlebell in the hand opposite the lunging leg.

Rear Foot Elevated Split Squat

The rear foot elevated, or Bulgarian, split squat is an excellent exercise to target the gluteus maximus, gluteus medius, quadriceps, and hamstring muscles.  For this exercise, the rear foot is placed up on a 6 to 12 inch step or box.  The supporting leg should be positioned approximately one leg length in front of the box or step.  This may need to be adjusted based on comfort and balance.  However, it is important that the hip and knee of the front leg is able to flex to 90 degrees during the movement.

It is also important to maintain good upper body posture with a natural curve in the low back and the chest up.  This position should be maintained during the descent and ascent of the movement. Excessive trunk flexion or side bending are common errors.  The front knee should not move forward past the toes.  The knee should remain over the toes so it does not cave inwards into valgus.  Perform 8 to 10 slow and controlled repetitions before switching sides to the other leg.  Challenge to the gluteus medius can be increased by holding a dumbbell or kettlebell in the hand opposite the front leg.

Lateral Step Down

The step down exercise begins with the hands on the hips standing with one leg on the side of a step or 8-inch high box.  Maintain balance on 1 leg and slowly squat to lower the heel of the other leg toward floor.  Gently tap the heel and return to the start position.  Throughout the exercise the trunk is maintained in an upright position.  Avoid leaning the trunk to the side or waving the arms.  The knee should not move forward past the toes.  Also, the knee should remain over the toes so it does not cave inwards into valgus.  Perform 8 to 10 slow and controlled repetitions before switching sides to the other leg.

1-Leg Squat

 If the lateral step down can be performed with proper form, the next challenge is to progress to performing a single-leg squat.  Begin by balancing on one leg with the hands on the hips.  The non-weight bearing knee and hip are flexed in front to approximately 30°. Slowly lower toward the floor being sure to maintain control of the trunk and supporting leg.  The depth of the squat is determined by the ability to maintain balance and control the movement.  Return to the starting position and keep the knees over the toes to prevent knee valgus throughout the exercise.   This exercise can be performed with or without the assist of a chair.  Many times the chair is needed initially until control and strength improve.  Challenge to the gluteus medius can be increased by holding a dumbbell or kettl bell in the hand opposite the supporting leg.

Closing Thoughts

These five exercises require practice to perfect.  Often, a trainer or physical therapist is needed to coach an individual through these types of exercises.  These are higher level exercises which are not for everyone.  However, mastering these types of dynamic movements often translate to improved coordination, strength, and power on heavier compound lifts such as the squat or deadlift.  Team sport athletes often see improvements in explosiveness and agility on the field.  Unfortunately, many become frustrated with the amount of practice and effort it takes to perform these types of exercises.  If needed, regress back to perform less challenging exercises in non-weight bearing (here) or weight bearing positions (here).  This is all part of the process.  Be patient and stick with it and you will see results down the road.

Gluteus Medius Exercise Progressions

The primary role of the gluteus medius is to stabilize and control movement of the pelvis during weight bearing functional activities.  This is required for efficient walking, climbing stairs, running, jumping, and throwing.  All of these activities require at least a brief period of single leg support.  The gluteus medius maintains a level pelvis and prevents the opposite side from dropping.  Without adequate functioning of this muscle, balance, strength, power, and performance will be compromised.  Also, abnormal movement patterns, such as dynamic valgus, occur in the presence of inadequate gluteus medius function.

It is advantageous to progress exercises for the gluteus medius from non-weight bearing to standing positions.  The exercises included in this article are 5 options but there are many others.  The most important aspect of these exercises is that they performed in a slow and controlled manner with appropriate body alignment.   The emphasis should first be on proper technique before adding repetitions or resistance.

Band Hip Abduction

Band hip abduction is performed with an elastic band tied around the ankles standing in an upright position with the feet together.   The feet are then pulled slightly apart.  Stand on one leg while keeping the pelvis level.  Abduct the other leg about 25° while maintaining the trunk in an upright position.  The most common mistake is to abduct too far and tip the body to the other side.  It is also important to keep the toes pointing straight ahead throughout the exercise.  Tension should be maintained on the band so the feet do not touch.  Both the supporting and moving side gluteus medius are very active during this exercise but the standing leg receives the greater training effect.

Band Internal & External Rotation (IR/ER)

Band IR/ER is performed with an elastic band tied around thighs (just above the knees) standing in an upright position with the feet together.  Once the band is in place, separate the feet to shoulder width or slightly wider.   During the exercise the knees and hips are flexed about 30°.  The hands are placed on the hips.  Initiate the movement by slowly moving one knee inwards over a 2 second period.  Maintain the position of the opposite knee.  Then slowly pull the knee outwards over a 2 second period.   Perform 8 repetitions in a slow and controlled manner on one side before switching to the other leg.

Lateral Band Walk

The lateral band walk is performed with an elastic band tied around the ankles standing in an upright position with the feet together.  During the exercise the knees and hips are flexed about 30°.   The hands are placed on the hips.   Sidestepping is initiated by leading with one leg over a distance slightly wider than shoulder width.  It is important to keep the toes pointing straight ahead and the knees over the toes throughout the exercise.  Tension should be maintained on the band so the feet do not touch.  Three slow steps are performed in one direction followed by 3 steps in the opposite direction.  Each cycle constitutes 1 repetition.  Typically, 6-8 repetitions are performed each set.   To increase the challenge of this exercise, two bands can be used.  A second band can be placed above the knees.

Dynamic Leg Swing

The dynamic leg swing begins by standing on one leg with the opposite knee flexed to 90 degrees.  Initiate the movement by swinging the non-weight bearing leg (with the knee flexed).  Move into hip flexion and extension at a rate of 1 second forward and one second backward.   Move through a smooth range of hip motion and do not allow the trunk to move out of the upright position.  Also, maintain control of the position of the weight bearing leg during the exercise.   Perform the 8-10 repetitions on one leg before switching sides.   The challenge of the exercise can be increased by holding a dumbbell or kettle bell in the hand on the side of the swinging leg.

1-Leg RDL

The single-leg Romanian dead lift begins by standing on one leg with the opposite hip and knee extended.  The weight bearing knee can be slightly bent throughout the exercise.   Initiate the movement by slowly flexing at the hip, keeping the back straight.  The non-weight bearing leg extends straight back behind the body.  Both the descending and ascending parts of the exercise should be performed in a slow and controlled manner.   Also, maintain control and the position of the weight bearing leg during the exercise.   Perform the 8-10 repetitions on one leg before switching sides.   The challenge of the exercise can be increased by holding a dumbbell or kettle bell in the hand on the side of the swinging leg.

Closing Thoughts

These 5 exercises can be used as a standalone program for improving gluteus medius activation and strength.  However, all 5 exercises do not need to be performed.  Choose 2-3 exercises to perform 3 days per week.  These exercises are also ideal for athletes and exercise enthusiasts to incorporate into their warm-up routines.  Specifically, try 2 or 3 of these exercises prior to performing compound lifts such as the squat or dead lift.   Next week we’ll highlight some more advanced progressions to load the gluteus medius.  If you any further questions, give your physical therapist a call.

 

 

Gluteus Medius Exercise: Getting Started

In a previous article, we discussed the importance of the gluteus medius muscle in controlling lower extremity alignment during the squat.  This muscle also plays a critical role in positioning and stabilizing the pelvis in many other functional activities.  This includes any activity with requires a period of single-leg support such as walking, climbing stairs, and running.  Individuals with knee pain, chronic back pain, hip arthritis, and ankle injuries have all been shown to have weakness in this  important muscle.  Glutues medius exercise can help.

Getting Started with Gluteus Medius Exercise

Basic resistance exercise for the gluteus medius can be initiated in non-weight bearing positions such as lying on the side.  Progressions can include partial weight-bearing positions such as on all fours or plank positions.  As muscular endurance and strength improve, exercises can be progressed to weight-bearing positions in standing.  Standing exercises are initiated in a double-limb stance, or with both legs fixed to the floor and then progressed to single-limb stance.  Each exercise should be performed 2 to 3 times per week to optimize improvements in muscular endurance, strength, and hypertrophy.

It is recommended that each of these basic resistance exercises be initiated with 3 sets of 8 to 15 repetitions.  When 15 repetitions can be performed, the intensity of the exercise can be progressed by adding weight or increasing the resistance band strength.  Muscle strength and hypertrophy can be achieved with any range of repetitions.  However, to optimize strength, higher intensities with lower repetitions are needed.   The main objective of this strengthening program is to progressively overload the gluteus medius so that muscular control, endurance, and strength are developed in a systematic manner.

Clam Shell

Begin by lying on one side with the hips flexed to approximately 45 degrees.  The knees are flexed and the feet kept together.  A resistance band can be placed around the thighs just above the knees.   Start the exercise by rotating the top hip to bring the knees apart.  Hold this position for 2 seconds and then return to the start position slowly.  Be sure to remain lying completely on the side with one hip stacked on top of the other.  Allowing the pelvis to roll backwards during the movement is the most common mistake with this exercise.   The clam shell is a great exercise to start with because it elicits high levels of gluteus medius activity with minimal activity of the tensor fascia latae (TFL).  This is beneficial because the TFL is commonly overactive in individuals with hip and knee pain.

Side-Lying Hip Abduction

Begin by lying on one side with the bottom hip and knee flexed.  The top knee remains straight.  The top hip is maintained in neutral or slight hip extension with the toes pointed forward.  The toes are pointed forward to orient the hip in slight internal rotation.  This increases gluteus medius activation and decreases TFL activation.  Initiate the movement by lifting the top leg about 30 degrees.  Hold this position for a count of two and then slowly lower the leg to the start position.  Ankle weights can be added for resistance once 15 proper repetitions can be performed.

This exercise activates the gluteus medius to a greater level than the clam shell.  However, it is also more challenging to perform correctly.  Similar to the clamshell, it is important to remain completely on the side with one hip stacked on top of the other.  Allowing the pelvis to roll backwards during the movement is the most common mistake with this exercise.   Also, as the muscle tires, the leg will drift forward into hip flexion.  It is important to maintain the leg lined up or slightly behind the trunk and upper body.

1-Leg Bridge

Begin by lying on the back with both hips and knees bent.  Perform a bridge with both legs by raising the hips to a neutral trunk, hip, and knee position.  A common mistake is to excessively arch the low back.  Be sure to achieve the bridge position by extending through the hips.  From the bridge position, straighten the knee of one leg while keeping the upper thighs parallel.  Be careful not to allow the pelvis to drop on one side.  Hold this position for 2 seconds then return the leg to the bridge position.  Lower the body back down before repeating another repetition on the same side.  Complete the desired number of repetitions on one side before beginning with the other leg.  Resistance can be added by placing a band around the thighs just above the knees.

Prone Plank with Bent Knee Hip Extension

Start facedown supported on the elbows in a plank position with the trunk, hips, and knees in neutral alignment.  Initiate the movement by lifting one leg with the knee bent.   Extend the hip slightly past neutral by bringing the heel toward the ceiling.  Hold this position for 2 seconds.  Maintain the plank position throughout all repetitions on one side.  Complete the desired number of repetitions on one side before beginning with the other leg.  A common error with this exercise is to arch or overextend the spine when lifting the leg.  Also, as the abdominal muscles tire, the hips may rise.  Be sure to maintain a neutral trunk, hip, and knee alignment throughout the exercise.

Side Plank with Hip Abduction

Start side-lying supported on one elbow with the shoulders, hips, knees, and ankles in line. Rise to a side plank position with the hips off the floor to achieve neutral alignment of trunk, hips, and knees.  Maintain the side plank position and raise the top leg into abduction approximately 30 degrees.  Hold this position for 2 seconds then slowly lower the top leg. Maintain the plank position throughout all repetitions on one side.  Complete the desired number of repetitions on one side before beginning with the other leg.

A common error with this exercise is to allow the pelvis to tip forward or backward.  Also, as the top gluteus medius tires the abducting leg will move into flexion.  As the bottom side tires, the side plank position will be lost.  This exercise has been shown to activate the gluteus medius on both sides at very high levels.  It is also very challenging and may not be an option for everyone.

Closing Thoughts

These 5 exercises do not need to all be performed at once.  Instead, choose 2 to 3 exercises to get started with.  Exercise selection is based on your preferences and the level of challenge each presents.  The clam shell is the least challenging and side plank with hip abduction is the most challenging.  Within 6 to 8 weeks, the exercises may feel less challenging indicating a need for progression.  Progression may include adding resistance or substituting with a new exercise.  Next week we will highlight 5 more exercises which can be performed in standing.

 

Gluteus Medius: Controlling Knee Position during the Squat

The gluteus medius is a broad thick muscle on the outer part of the pelvis.  The muscle spans from the buttock to the upper aspect of the thigh bone (femur) on the bony part of the outer hip (greater trochanter).  The primary function of the gluteus medius is to stabilize the pelvis and femur during dynamic activities such as walking or performing a deep squat.  It is responsible for preventing the opposite side of the pelvis from dropping during walking.  The gluteus medius packs many short muscle fibers together.  This allows it to generate high forces.  However, a trade-off to its structure is its inability to produce large forces when in lengthened positions.

Poor squat due to gluteus medius weakness

The gluteus medius is lengthened when the hips flex and internally rotate.  This causes the knee to cave inward during the squat.  This may be more obvious during a 1-leg squat or landing from a jump on one leg.  This movement strategy is sometimes called, dynamic valgus, and is believed to be disadvantageous.   The gluteus medius is unable to accomplish its primary role of stabilizing the pelvis when in extreme joint positions.  This is the case when the hip is in flexion and internal rotation.  Hip internal rotation during the squat also impairs the ability of the gluteus maximus to extend the hip.  However, the hamstrings and adductors can often overcome this deficit to compensate.  Squatting with the hip internally rotated increases the demands of the gluteus medius and may be a compensation for the weakness of this muscle.

Gluteus Medius & Injuries of the Lower Extremity

It is commonly believed that squatting with hip internal rotation or dynamic valgus is indicative of hip weakness.  This is particularly thought to occur in those with knee pain and those at risk for anterior cruciate ligament (ACL) injury.  Other injuries which are characteristic of this pattern include runner’s knee, iliotibial band (ITB) syndrome, labral injuries of hip and femeroacetabular impingement of the hip.  In many cases, this pattern is likely a compensation for the weakness of the hip musculature.  Hip internal rotation may increase the force capacity of the weakened gluteus medius.   This allows for performance of the squat but subjects the knee and hip joints to excessive stress.

Lifestyle Factors Contributing to Gluteus Medius Weakness

Side sleeping with the leg crossed can place additional stress on the gluteus medius tenddons

Gluteus medius weakness can be the result of previous injury or lifestyle factors.  Standing with the body weight predominantly on one leg with the pelvis swayed sideways can lead to an underdeveloped muscle on one side.  Sleeping on one’s side with the top leg flexed and crossed over the other leg results in an elongated muscle.  Both of these scenarios can potentially weaken the muscle over time.  Repeated running on crowned roads or surfaces can also potentially lead to weakness of the gluteus medius on one side.

Closing Thoughts

Hip internal rotation and dynamic knee valgus negatively impact the gluteus maximus and increase the force generating demands of the gluteus medius.  This movement strategy may be a compensation to increase gluteus medius force production and a cause of gluteus maximus weakness.   In any case, this movement strategy should be addressed with resistance exercise targeting improvements in strength and hypertrophy of both muscles.  Next week, I will post an article about initiating and progressing exercises for the gluteus medius.

Youth Ice Hockey Injuries

There are few sports with the same unique physical demands as youth ice hockey.   Brendan Shanahan explained it this way when asked by a reporter “Is hockey hard?”

“Is hockey hard? I don’t know, you tell me. We need to have the strength and power of a football player, the stamina of a marathon runner, and the concentration of a brain surgeon. But we need to put all this together while moving at high speeds on a cold and slippery surface while 5 other guys use clubs to try and kill us. Oh yeah, did I mention that this whole time we’re standing on blades 1/8 of an inch thick? Is ice hockey hard? I don’t know, you tell me. Next question.”

From this quote alone you could have guessed that many of the injuries sustained playing ice hockey are contact injuries.  Not surprisingly, the majority of injuries occur due to contact with another player, the boards, or attempting to block a shot.  Many of these factors are not modifiable and certain risk factors have been associated with increased risk of contact injury.  Thankfully, hockey initiatives have led to decreased contact injuries in youth leagues.  Other things that can be done to reduce the chances of sustaining an injury due to contact in youth ice hockey include

  • Avoiding early sport specialization.
  • Ensure adequate nutrition and rest. Athletes who rated themselves as having low energy levels or higher levels of fatigue had higher rates of injury in high school ice hockey.
  • Practice matters! Athletes who had much higher time spent in games compared to practice had higher levels of injury.
  • Strength and conditioning. Athletes with lower body weight tend to have higher injury rates.  Youth athletes may be physically immature and compete against individuals who are significantly more physically developed than them.

Overuse Injuries of the Hip in Youth Ice Hockey

Another unique demand of hockey is the amount of range of motion required throughout the hip joint and the muscular control needed in what would typically be considered awkward positions.  The hockey stride is a repetitive motion alternating between repetitive hip flexion and internal rotation followed by hip extension, abduction and external rotation. Running only requires small amounts of hip flexion and hip extension without any movement in the other planes of motion.  These unique requirements lead to hip injuries that are more prevalent in hockey players.

Many of the non contact injuries acquired in youth hockey are at the hip joint.  They typically include groin strains or sports hernias and bony injuries around the hip joint. Luckily there are some things that can be done to help reduce non contact hip injuries for kids playing ice hockey.

Early Sports Specialization & Youth Hockey Injuries

As described above, avoiding early sport specialization is important to minimize injury risk.  There is a great deal of stress placed on the hip through repetitive skating.   Therefore, avoiding year round skating while the athlete is still growing may help reduce the incidence of growth plate injuries and other bony abnormalities.  Taking time off from one sport to learn new motor skills and athletic abilities will ultimately translate to improved performance and reduce the chance of an overuse injury at the hip.  A strength and conditioning or prehabilitation program designed at improving hip and core muscular strength and endurance as well as hip mobility specific to the demands of hockey can help reduce injury.

Conclusion

Hip and groin pain can be very challenging and limiting for athletes and often becomes a recurrent injury.  It can be difficult to distinguish between sports hernias, adductor strains, or bony injuries within the hip joint itself. If you are experiencing hip pain, see a rehabilitation expert who can help you treat this pain and improve your performance.

References

  1. Smith AM, Stuart MJ, Wiese-Bjornstal DM et al. Predictors of injury in ice hockey players. A multivariate, multidisciplinary approach. Am J Sports Med 1997;25:500–7.
  2. Popkin CA, Schulz BM, Park CN, Bottiglieri TS, Lynch TS. Evaluation, management and prevention of lower extremity youth ice hockey injuries. Open Access J Sports Med. 2016;7:167–176.

 

 

Understanding the Hip Hinge: The Basics

The hip hinge is an important movement pattern for everyday life and athletics.  This movement is similar to “bowing” or bending at the hips while maintaining a flat spine.  The movement occurs at the hips which loads the gluteus maximus and hamstring muscles.  The hip hinge is characteristic of picking up a bag of groceries from floor or performing a maximal dead lift with a barbell.  Mastering the hip hinge takes advantage of the large gluteal and hamstring muscles while minimizing compressive loads through the low back.

Muscle Activity during the Hip Hinge

The hip hinge movement is controlled by eccentric actions of the hamstrings and gluteus maximus muscles.  These muscles are actively lengthening to control the “bowing” movement of the hip hinge.   Research has shown slightly greater activation of the medial, or inner, hamstring muscles during the hinge in comparison to the lateral hamstrings.  Also, in comparison to the squat, the hip hinge requires greater hamstring than quadriceps muscle activation.

The hip hinge also requires activation of the core musculature to maintain a neutral spine position.  The rectus abdominis and oblique abdominal muscles are activated at relatively low levels compared to the low back musculature.  The erectors spinae is the primary muscle required to maintain a neutral lumbar spine during the hip hinge.  The demands placed on the hamstrings, gluteus maximus, and erector spinae makes the hip hinge a great movement pattern to train the posterior chain.  The posterior chain is important for athletic success and to counteract the postural changes which occur as a result or aging or a sedentary lifestyle.

Adding Load to the Hip Hinge

Once the hip hinge pattern has been mastered, a kettlebell or dumbbell can be used to add load and build strength.  Begin by placing a light kettlebell or dumbbell on its end on the floor.  Stand over top or slightly in front of the kettlebell.  Place your feet slightly wider than hip-width with your knees slightly bent.  Keep your chest up, shoulders back, and abdominals tight.  Without bending your knees any further, push your hips back and lower your chest toward the floor.  Reach for the kettlebell, keeping your back straight and bending your knees only slightly.   The movement occurs at the hips, not the knees.   Once you can grab the kettlebell, pick it up and reverse directions by pushing your hips forward and squeezing your glutes.  Return the kettlebbell to the floor by hinging at the hips.

Closing Thoughts

The hip hinge can be a challenging movement pattern to master.  Many are prone to flexing or rounding the low back instead of moving through the hips.  This commonly occurs in everyday life when bending to the floor to pick up light or heavy objects.  A low back-driven pattern will increase demands on the lumbar spine structures instead of the much larger and stronger lower body muscles of the posterior chain.  This article highlights some of the basics to performing the hinge.  In future articles, we will outline exercises to improve the hip hinge movement pattern.

References 

  1. Andersen V, Fimland M, Gunnarskog A, et al. Core muscle activation in one-armed and two-armed kettlebell swing. J Strength Cond Res. 2015;30(5):1196-1204.
  2. Del Monte M, Opar DA, Timmins RG, Ross J, Keough JW, Lorenzen C. Hamstring myoelectrical activity during three different kettlebell swing exercises. J Strength Cond Res. 2018;Ahead Prin:1-17. doi:10.1519/JSC.0000000000002254.

Total Hip Arthroplasty (Replacement)

Total hip replacement is a surgical procedure that is most likely performed on people who have severe osteoarthritis of the hip. Other possible reasons for a hip replacement include, rheumatoid arthritis, osteonecrosis, fracture, and bone tumor. Since 2003, the number of hip replacement surgeries performed has increased by 33% in the United States. The most common age groups receiving hip replacements are people over 70 years of age.

Hip Replacement: Anterior vs. Posterior Approach?

There are 2 main surgical options for a total hip replacement; a posterior approach and an anterior approach. The type of surgical approach is typically determined based on physician preference. The anterior approach is a fairly new procedure which requires the surgeon to cut less muscle which some believe results in a faster recovery time. The posterolateral approach has been done for a longer period of time. One of the biggest risks following total hip replacement is dislocation. This complication has been noted to occur with 1% of surgeries with anterior approach and 1.3% with posterolateral approach.

The Role of Physical Therapy

The typical course of treatment after total hip replacement could involve a short stay in the hospital and in some cases a short stay at an inpatient rehab facility. Upon returning home, a large percentage of patients undergo a period of outpatient physical therapy, which usually lasts 1-2 months. Outpatient Physical Therapy consists of a combination of manual physical therapy, supervised exercise to improve range of motion, strength training of the muscles around the hip, and functional exercises that are geared towards returning the individual to prior functional activities.  At least one study shows that physical therapy had a positive effect on patients after a total hip replacement with faster recovery times and an increase in walking ability. Another study also found that physical therapy allows for an overall increase in functional status for patients who have received a total hip replacement.

Closing Thoughts

Physical therapy following hip replacement surgery requires a team approach between the patient, surgeon, and physical therapist.  If you are considering undergoing a hip replacement, or have recently undergone this procedure, please call one of our physical therapists to learn more about your recovery and return to function.

-Dr. Tom Michaels, PT, DPT, OCS, CSCS

References

  1. Freburger J. An analysis of the relationship between the utilization of physical therapy services and outcomes of care for patients after total hip arthroplasty. Journal of Physical Therapy. 2000;80(5):448-458.
  2. Kishida Y et al. Full weight-bearing after cementless total hip arthroplasty. International Orthopaedics. 2001;25:25-28.
  3. Jolles B, Bogoch E. Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis. Cochrane Database Systematic Review. 2006:3.