Resisted side stepping with different band positions in a squat position
Resisted sidestepping is done with a resistance band at knee, ankle or feet levels. Always maintain a mini squat position and step out laterally against the band resistance. Always keep the lower back straight and engage the core abdominal muscles. Distefano et al 2009 have reported Gluteus Medius activation up to 61% MVIC with this exercise. Lewis et al 2018, studied reported that “the sidestepping in the squat position with a resistive band placed around the feet elicited more activity in the gluteal muscles without increasing activity in the tensor fascia lata muscle compared with a resistive band placed around the knees or ankles. Placement around the feet is most appropriate when the therapeutic goal is to focus on muscle activation to resist hip adduction and internal rotation”.
Clamshell (Hip clam) Progression ( 1-4)
7.1: Clamshell 1:
– Lay on your side with training leg on top with shoulder, back, hips and knees in a single neutral stack.
– Then bend your hip and knees slightly, lift the knee of the top leg away, up towards the ceiling keeping the heels or feet together all the time.
– Avoid rolling the lower back or pelvis backward.
– Philippon et. al 2011, have reported moderate activation of iliopsoas (>20% MVC) with clamshell exercise. Therefore, this exercise should be avoided when there is irritation of hip flexors or iliopsoas tendinitis is present.
7.2: Clamshell 2; reverse clamshell:
– While lying on your side with your knees bent, raise your top foot towards the ceiling while keeping the contact of your knees together. Then, lower back down to the original position.
– Do not let your pelvis roll forward during the lifting movement.
7.3: Clamshell 3; Hip abducted and externally rotated/internally rotated
– While lying on your side do traditional clamshell 1. At the end range of hip external rotation lift the top foot separating from the bottom foot. Avoid pelvis rolling backward.
– While lying on your side, stack your legs one on top of the other and bend your knees. Raise the top leg off of the bottom leg, and while keeping the knee still, raise the foot toward the ceiling (internally rotating the hip). Lower the foot back down and continue the motion. Avoid pelvis rolling inward.
7.4: Clamshell 4: Hip abducted, internal or external rotation with hip extension
– Same as Clamshell 3 but maintaining upper hip or training side hip in full extension all the time.
Hip abduction in standing
– Stand on an uninvolved side. Do not let the involved leg’s pelvis drop. Extend the free leg hip up to 45 degrees and kick sideways (laterally) keeping the knee straight.
– Stand on a training leg on the edge of a 5 cm box. Lower the heel of a free leg to touch the ground without weight bearing. Return non-weight bearing foot to the height of the box while keeping the hips and knees of both sides extended all the time.
10. Prone Heel squeeze
– Lay on your belly. Bend both knees to 70 degrees. Bring the heels together. Press the heels together while lifting the knees slightly off the table or floor.
“Weakness or reduced activation of the posterior Gluteus medius could result in increased hip adduction and internal rotation during a single-legged stance activity” Lewis et al 2018.10 In the prospective study done by Leetun et al reported that collegiate athletes who sustained lower extremity injuries over a competitive season had weaker hip abductors and external rotator than athletes who did not sustain an injury. Therefore, strengthening the Gluteus medius muscle is a key to prevent lower extremity and lower back injuries.
- Ward SR, Eng CM, Smallwood LH, Lieber RL. Are current measurements of lower extremity Muscle architecture accurate? Clin Orthop Relat Res. 2009;467(4):1074-1082.
- Earl JE. Gluteus medius activity during 3 variations of isometric single-leg stance. J Sport Rehabil 14:1–11, 2005.
- Boling MC, Bolgla LA, Mattacola CG, Uhl TL, Hosey RG. Outcomes of a weight-bearing rehabilitation program for patients diagnosed with patellofemoral pain syndrome. Arch Phys Med Rehabil. 2006;87(11):1428-1435.
- Nelson-Wong E, Gregory DE, Winter DA, Callaghan JP. Gluteus medius muscle activation patterns as a predictor of low back pain during standing. Clin Biomech (Bristol, Avon). 2008;23(5):545-553.
- Griffin LY, Albohm MJ, Arendt EA, et al. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Am J Sports Med. 2006;34:1512-1532.
- Earl J, Hertel J, and Denegar C. Patterns of dynamic malalignment, muscle activation, joint motion and patellofemoral pain syndrome. J Sport Rehabil 14:215–233, 2005.
- Distefano L, Blackburn J, Marshall S, et al. Gluteal Activation During Common Therapeutic Exercises. J Orthop Sports Phys Ther. 2009; 39: 532-540.
- Boren K., Conrey C., Coguic J., et al. Electromyographic Analysis of gluteus medius and gluteus maximus during rehabilitation exercises. The International Journal of Sports Physical Therapy. 2011; 6(3): 206-223.
- Phillipon M., Decker M., et al. Rehabilitation Exercise Progression for the Gluteus Medius Muscle with consideration for Iliopsoas Tendinitis. The American Journal of Sports Medicine. 2011; 39(8).
- Lewis C., Foley H., et al. Hip Muscle activity in Men and Women During Resisted Side Stepping With Different Band Positions. Journal of Athletic Training. 2018; 53(11): 000-000.