Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction
The gluteal muscles, particularly the gluteus medius and gluteus maximus, play a critical role in stabilizing the pelvis and controlling hip movement during functional activities. Weakness in these muscles is often linked to lower extremity pathologies such as tibial stress fractures, low back pain, iliotibial band friction syndrome, and patellofemoral pain. The study examines muscle activation during various rehabilitation exercises to determine which exercises most effectively recruit these muscles. By quantifying activation as a percentage of maximal voluntary isometric contraction (%MVIC), the study provides guidance on selecting exercises for progressive rehabilitation of the gluteal musculature. Exercises producing greater than 70%MVIC are deemed sufficient to promote strength adaptation, based on prior research.
Methods
The study involved 26 healthy subjects who participated in a single testing session. Electromyographic (EMG) electrodes were placed on the dominant gluteus medius and maximus muscles. Maximal voluntary isometric contraction (MVIC) was established through standardized manual muscle testing positions. Participants performed 18 exercises, with surface EMG data collected to assess muscle activity. Exercises were selected to include both weight-bearing and non-weight-bearing tasks, some using unstable surfaces for additional challenge. These exercises included sidelying abduction, single-limb squat, front plank with hip extension, clamshell variations, and side planks with abduction. Exercises were randomized to mitigate fatigue effects, with rest periods provided between trials. EMG data were analyzed using a root-mean-square algorithm and normalized to %MVIC.
Results
Key findings indicate that several exercises effectively activate the gluteal muscles. For the gluteus medius, the top exercises included side plank abduction with the dominant leg on the bottom (103%MVIC), side plank abduction with the dominant leg on top (89%MVIC), single-limb squat (82%MVIC), clamshell progression 4 (77%MVIC), and front plank with hip extension (75%MVIC). For the gluteus maximus, the highest activation was observed during front plank with hip extension (106%MVIC), gluteal squeeze (81%MVIC), side plank abduction with the dominant leg on top (73%MVIC), side plank abduction with the dominant leg on the bottom (71%MVIC), and single-limb squat (71%MVIC). Exercises exceeding 70%MVIC for both muscles included front plank with hip extension, side plank abduction variations, and single-limb squat. These results provide rank-ordered recommendations for gluteal strengthening, emphasizing exercises that require high levels of stability and muscle coordination.
Discussion
The findings align with prior research but offer a unique cross-comparison of gluteal muscle activation across multiple exercises. Exercises requiring stabilization, such as planks and single-limb squats, generally elicited higher activation levels. Differences in muscle recruitment between studies were attributed to variations in technique and external support. Notably, exercises like side planks with abduction and front planks with hip extension demonstrated co-contraction of core musculature, which likely enhanced gluteal recruitment. Practical applications of these findings include tailoring exercise selection to a patient’s functional capacity, with simpler tasks like clamshells used initially and more complex exercises introduced progressively.
Conclusion
This study identifies effective exercises for strengthening the gluteus medius and maximus, providing valuable insights for rehabilitation protocols. High %MVIC values observed during certain exercises support their use in targeted strengthening programs. Clinicians can use these findings to design progressive exercise programs, ensuring optimal muscle recruitment and functional outcomes.
Contributions to Physical Therapy
Gluteal muscle strengthening is essential in managing various lower extremity and low back pathologies. Exercises like front planks with hip extension and side planks with abduction not only target the gluteal muscles but also engage the core, enhancing overall stability and functional movement patterns. These exercises can be used to address muscle weakness, improve pelvic control, and reduce compensatory movement patterns. By incorporating these high-activation exercises into rehabilitation protocols, therapists can promote efficient recovery and prevent injury recurrence, ultimately enhancing patient outcomes.
1. Boren K, Conrey C, Le Coguic J, Paprocki L, Voight M, Robinson TK. ELECTROMYOGRAPHIC ANALYSIS OF GLUTEUS MEDIUS AND GLUTEUS MAXIMUS DURING REHABILITATION EXERCISES. Int J Sports Phys Ther. 2011;6(3):206-223. Accessed December 22, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201064/