Hip pain and glute strength
Health Disclaimer:
These articles are for educative and entertainment purposes only. They are not intended to be a substitute for professional medical advice, diagnosis or treatment. If you have a current injury or are in pain, please seek the advice of your regular health care provider. You are responsible for your own safety and health at all times. Especially, given physical activity is not without risk and can cause harm. By engaging with any content on this website you acknowledge and agree that The Musculoskeletal Clinic is not liable for any direct, indirect, special, consequential, exemplary, or other damages arising therefrom.
Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this web site.
Introduction
Hip musculature changes are seen in those with hip pain pathologies (1,2). Atrophy of the gluteus medius has even been correlated with severity of hip osteoarthritis (OA) (2). How does hip abduction strength (sideways movements) relate here?
Strength loss is seen in hip OA, femoroacetabular impingement and chronic hip pain populations (2–4). Strength reductions in the hip abductors also increase lower limb injury risk in various sports (5). Fortunately, increasing strength in these populations does improve symptoms and function (6–8).
What exercise is best?
What exercise do we choose? There are many! How do we choose?
The tricky thing is that most of these studies base the exercise choice off of experiments looking at the electrical activity of a muscle (9,10). Unfortunately, predicting that strength will increase from movements with increased electrical activity is not validated with longitudinal studies (11). Essentially, we cannot be sure that using an exercise that has ‘high’ electrical activity of a specific muscle will actually result in better strength improvements than an exercise with ‘lower’ electrical activity (11). Although, others may disagree (9). As always, more long-term research is needed!
So, what else could we use to base our choice of strengthening exercise?
Using dynamometry can be helpful here, as we get actual measurable force outputs (7). We’ll leave the nuances of how to do this kind of testing for another post. In the meantime, testing this way will actually tell you if a muscle is weak. You can then do an intervention (that looks similar) and re-test every 6-8 weeks to measure changes. Standing and side-lying tests are good options for assessing hip abduction strength (12). Knowing that this means we can be more certain that using the same movement as a strengthening exercise will relate to the changes in testing seen. That being said, various exercise combinations have been shown to increase glute strength (13).
Various options:
Conclusion
In summary, this video covers an option for strengthening your abduction in standing. Interestingly it also demonstrates high levels of electrical activity in the gluteus medius (9)! Go figure.
References:
1. Lawrenson PR, Crossley KM, Vicenzino BT, Hodges PW, James G, Croft KJ, et al. Muscle size and composition in people with articular hip pathology: a systematic review with meta-analysis. Osteoarthritis and Cartilage. 2019 Feb 1;27(2):181–95.
2. Zacharias A, Green RA, Semciw A, English DJ, Kapakoulakis T, Pizzari T. Atrophy of hip abductor muscles is related to clinical severity in a hip osteoarthritis population. Clin Anat. 2018 May;31(4):507–13.
3. Mastenbrook MJ, Commean PK, Hillen TJ, Salsich GB, Meyer GA, Mueller MJ, et al. Hip Abductor Muscle Volume and Strength Differences Between Women With Chronic Hip Joint Pain and Asymptomatic Controls. Journal of Orthopaedic & Sports Physical Therapy. 2017 Dec;47(12):923–30.
4. Freke M, Kemp JL, Svege I, Risberg MA, Semciw AI, Crossley KM. Physical impairments in symptomatic femoroacetabular impingement: a systematic review of the evidence. Br J Sports Med. 2016 Oct 1;50(19):1180–1180.
5. Stastny P, Tufano JJ, Golas A, Petr M. Strengthening the Gluteus Medius Using Various Bodyweight and Resistance Exercises. Strength Cond J. 2016 Jun;38(3):91–101.
6. Rostron ZPJ, Green RA, Kingsley M, Zacharias A. Efficacy of Exercise-Based Rehabilitation Programs for Improving Muscle Function and Size in People with Hip Osteoarthritis: A Systematic Review with Meta-Analysis. Biology (Basel). 2021 Nov 30;10(12):1251.
7. Kemp J, Grimaldi A, Heerey J, Jones D, Scholes M, Lawrenson P, et al. Current trends in sport and exercise hip conditions: Intra-articular and extra-articular hip pain, with detailed focus on femoroacetabular impingement (FAI) syndrome. Best Practice & Research Clinical Rheumatology. 2019 Feb 1;33(1):66–87.
8. Kemp JL, Risberg MA, Mosler A, Harris-Hayes M, Serner A, Moksnes H, et al. Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med. 2020 May 1;54(9):504–11.
9. Macadam P, Cronin J, Contreras B. AN EXAMINATION OF THE GLUTEAL MUSCLE ACTIVITY ASSOCIATED WITH DYNAMIC HIP ABDUCTION AND HIP EXTERNAL ROTATION EXERCISE: A SYSTEMATIC REVIEW. Int J Sports Phys Ther. 2015 Oct;10(5):573–91.
10. Moore D, Semciw AI, Pizzari T. A SYSTEMATIC REVIEW AND META-ANALYSIS OF COMMON THERAPEUTIC EXERCISES THAT GENERATE HIGHEST MUSCLE ACTIVITY IN THE GLUTEUS MEDIUS AND GLUTEUS MINIMUS SEGMENTS. Int J Sports Phys Ther. 2020 Dec;15(6):856–81.
11. Vigotsky AD, Halperin I, Lehman GJ, Trajano GS, Vieira TM. Interpreting Signal Amplitudes in Surface Electromyography Studies in Sport and Rehabilitation Sciences. Frontiers in Physiology [Internet]. 2018 [cited 2022 Jun 20];8. Available from: https://www.frontiersin.org/article/10.3389/fphys.2017.00985
12. de Castro MP, Sanchotene CG, Costa GV, Lopes CMS, Hubert M, de Brito Fontana H, et al. Comparison between side-lying and standing positions for hip abductor strength assessment. Journal of Bodywork and Movement Therapies. 2022 Apr 1;30:181–6.
13. Penna G, Russo L, Bartolucci P. EFFECTS OF TWO TRAINING PROTOCOLS ON THE STRENGTH OF THE MEDIUS AND MAXIMUS GLUTEUS IN ADULT WOMEN. 2017;(2).
Copyright Disclaimer - This article is protected by the Copyright Act 1994. The author controls the copyright of this article. Recognition of the author’s right to be identified as the author will be acknowledged and when relevant the author will be acknowledged as the author. You will obtain the author’s permission before publishing any material from this article. For further information you can reference the Act here: https://www.legislation.govt.nz/act/public/1994/0143/latest/whole.html