It is always preferable to include exercises that activate the gluteus maximus and medius in training programs. Research has shown that poor hip activation/control leads to frontal plane knee collapse and this is often a concern in clients with longstanding anterior knee pain. Poor hip control also increase injury risk with planting/cutting/landing activities.

    In a prior column, I discussed the side plank with hip abduction as an excellent choice for the gluteus medius based on EMG activation. Studies have shown that quadruped hip extension is a good way to preferentially recruit the gluteal muscle complex over the tensor fascia lata (TFL).

    In research published in the Journal of Orthopedic and Sports Physical Therapy (February 2013) researchers looked at eleven various rehab exercises and activation of the flute max/medius muscles compared to TFL activation. Fine wire electrodes were used in the study.

    Note: Quadruped hip extension with the knee straight and knee flexed both produced significantly greater gluteal activation than TFL activation. Both exercises were done with the forearms on the floor and were listed in the top 5 out of all the exercises studied. I have included the original exercise along with two variations for this column.

    Execution: Begin in quadruped with the hands on the floor beneath the shoulders and knees beneath the hips. Slowly extend the left hip keeping the knee straight. Perform 10 repetitions. Next, perform 10 more hip extensions with the left knee bent. Repeat this pattern on the right side.

    Progression #1 (this is the technique published in the research referenced above)

    Position the forearms on the floor with the right knee on the floor and the left knee straight and toes on the floor. Slowly extend the left hip through the full available range of motion. Perform 10 repetitions with the knee straight, and repeat with the knee bent on each side.

    Progression #2

    Perform the same techniques starting in a full front plank position. This advanced version requires more core stability and is much more demanding.

    Application: This exercise is designed to actively recruit and strengthen the gluteus medius/maximus selectively recruiting them over the TFL. Improving hip extensor strength will improve dynamic hip stability and reduce unwanted strain on the knee. This has particular relevance for female endurance runners who tend to experience patellofemoral pain as studies indicate thy have decreased hip extension strength, while also serving as an excellent way to improve hip activation for those athletes involved in cutting, pivoting and jumping activities who may also be prone to knee injuries. Additionally, clients will improve core stability and hip dissociation performing this exercise.

    Reference

    Selkowitz DM, Bedeck 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): 54-65.

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