... ... Strengthening your Gluteus Medius – do exercises like the Clam or a side lying leg lift actually do anything? - Mile27
Dec 092010
 

The Gluteus medius is situated on the side of your hip and controls the movement of your pelvis in the frontal plane. In English that means it control how much your opposite side hip drops when you walk or run. To feel what I mean, stand on 1 leg and let your other hip drop towards the floor. Now lift it back up again – you have just worked your gluteus medius. To see what I mean simply watch any catwalk model walk and observe how the hips move from side to side and the pelvis tilts side to side when looking from behind.Weakness in this muscle is very common and is responsible for a number of injuries including Iliotibial Band (ITB)Syndrome and knee pain.
One common exercise given by health or fitness professionals is to lie on your side and lift your top leg off your bottom leg and hold it there for up to 60 seconds. This does work the Gluteus medius but does it help stabilise the movement of your pelvis when you walk?

A study* I have just discovered confirms that strength in performing that exercise is completely independent on how much someone’s pelvis tilts from side to side. In other words performing that exercise had NO effect on Gluteus Medius strength in running.

Some people who were very weak in this exercise had very good pelvic control and some who were very strong in the exercise had very poor pelvic control.
The researchers concluded that a more dynamic test of Gluteus medius may be more appropriate.

The Clam and exercises like it – are you wasting your time?

The Clam is an exercise that is very similar, you lie on your side with your knees bent and keeping your feet together you raise the knee of the top leg , opening your legs up so that your legs make the shape of a clam, this is repeated many times. Side lying leg raises are similar except the leg is straighter and the whole of the top leg is lifted up and down.

These are recommended by many physiotherapists, doctors, personal trainers and coaches but it is my view that exercises like this are next to useless in improving gluteus medius (or gluteus maximus for that matter) strength in running or walking.
The only difference between the exercise used in the study mentioned above and clams or side lying leg lifts the angle of the knee is different and instead of holding the leg up you are moving it up and down. I don’t feel this makes the exercise any better hope to convince you to try and different approach to strengthening this muscle for running.

The rule of specificity

Remember that the strength, endurance, power and flexibility gained in an exercise is only transferable to exercises that use similar loads, ranges of movement, joint angle, body position and speed of movement. This is a universally accepted rule that no coach, trainer or physical therapist can argue with.

In simple terms it says that the strength gained in a particular exercise is only relevant to other exercises that look and feel similar to the original exercise. For example the strength gained in doing a bench press will make you better at push ups but wont improve your ability to throw a cricket ball, or the strength gained in doing small range squats will help skiing but wont help you to kick a ball further.
If the body positions, loads, speed of movement and range of movement aren’t similar then the body wont transfer the gains from one exercise to the next.

When you think about it it makes sense, someone who is good at tennis is often good at squash but may be hopeless at bowling a cricket ball. Someone who is good at surfing will pick up snow boarding easier than someone who has strong legs from doing squats in the gym.

So lets compare the two positions

Clam/ Side lying leg lifts

Body Position…………..Lying on your side
Load……………………Weight of one leg
Initial Movement……..Lifting leg up- contacting muscle
Speed of Movement…..Slow and controlled
Range of Movement…..from slightly lower then hip to approx 45 degrees or more
Stimulation………….Consciously driven by exerciser

Running or Walking

Body Position…………..Standing on one leg
Load……………………Weight of body minus the weight of the stance leg
Initial Movement……..Pelvis dropping down – stretching the muscle
Speed of Movement…….Fast – less than ½ a second
Range of Movement…….From pelvis tilted 5-15 degrees up to 5-15 degrees down
Stimulation……………Unconsciously driven by reaction to gravity

As you can see there are NO similarities at all. You may as well do bicep curls.

Proprioreceptors

One other important point to remember is that muscles react to feedback given to them by tiny cells called proprioreceptors that are found throughout the body.

These proprioreceptors tell the brain what is happening. For example if they feel that a muscle is getting stretched rather rapidly the brain will activate that muscle to protect itself. This is exactly what happens in the gluteus medius, the sudden impact of landing places a rapid dynamic stretch on the muscle, the proprioreceptors sense this and tell the brain which then activates the muscle to protect it. None of this happens consciously.

The idea that you can train a muscle by consciously contracting it and then hope that the brain can now apply that strength unconsciously in a completely different environment is dubious at best.

A waste of time?

So if the position of the body in side lying based exercises is so different to running and the load is different and the speed of movement is different and the range of movement is different and the mechanism that turns on the muscle is different you can begin to see why the clam or side lying leg raises are basically ineffective when it comes to strengthening the gluteus medius in relation to controlling the pelvis when we walk and run.

The justification of doing these types of exercises is that they are a starting point to gain strength and you will need to progress it from there. I disagree with this also as the exercise is so dissimilar from running I feel there is little if any carry over into running. It would be like teaching someone to ski by telling them they need to spend time on a sled first. Yes a sled involves sliding downhill on snow but, the way the muscles are used in skiing is so different to sitting on a sled you can spend all day everyday riding a sled and you’d never be a better skier.

Yes side lying exercises do work the glute muscle but in a way so different to running that you could do you side lying leg lifts every day and still have poor control of your pelvis when you run.

The next question is ok if they don’t work what exercise does?

Unfortunately this is not an easy question to answer and there is no universal exercise that will strengthen the gluteus medius of every body who does it. The reason for this lies in understanding that muscles react to stimulus provided by the proprioreceptors. If the proprioreceptors aren’t stimulated then the brain wont have any reason to activate the muscle. Alternatively the muscle may be trying to do too much due to weaknesses in other muscles. It makes no sense to train the muscle up to cope with the weaknesses in other areas, a better approach is to address the weak muscles first.

For example the glute medius can be overloaded if a persons foot pronates too much or can be understimulated if the opposite foot doesn’t pronate enough, or if the person lacks mobility in the spine or any number of other reasons.

The point is that no matter how good the glutes medius exercise you perform is if it doesn’t address the reason your gluteus medius isn’t working properly in the first place it wont help.

A better alternative to side lying glute exercises

Whilst I am reluctant to recommend any exercise as ideally you should be assessed to determine why you have the weakness in the first place I feel it would be remiss of me and frustrating for you to tell you that clams and side lying leg raises are a waste of time and not give you a better alternative.

So here’s two different exercise , one for people with tight hips ( usually men) and one for people with weak hips ( usually females). These aren’t necessarily the best exercises you can do but they are ones that are relatively easy to describe and perform by yourself. If you aren’t sure which one is best for you since not all men have tight hips and not all women have weak hips then try both andwhichever you find hardest do that one!

Tight Hips

Stand back to a wall, feet about 2-3 inches away from the wall, feet together, shoulders against wall, hands joined together, arms above head with arms ideally against the wall also but if your arms aren’t that flexible don’t worry just have them above your head as much as possible.

Now all you need to do is take your hands and reach to the side as far as possible such that your body bends sideways. Ensure BOTH butt cheeks and BOTH shoulders remain touching the wall.

Your movements should be relatively quick and your aim is to increase movement without hips or shoulder coming away from the wall. If you hips feel like they are moving side to side , great!

Progression
Try the same but without the wall behind you ensuring your body moves from side to side and there is no rotation. Imagine the wall is still behind you. Next step is to try it with one foot forward of the other.

Weak Hips
Stand on 1 leg with the same side arm as stance leg above your head and the opposite side hand on your hip. Lets say you stand on your right leg then your right arm will be above your head and left hand on your hip. Now take your right hand and reach sideways to the left as far as you can and at the same time use your left hand to push your hips to the right and then return to starting position. The speed of movement should be relatively quick but slow enough that you can control it.

Progress the speed as you improve. Use you other non stance leg for balance if you have to.To make harder start with standing on two legs arms in the same position as before and then step forward with your right leg and at the same time perform the same arm action as before.
For a video on how to perform these have a look here

*Isometric gluteus medius muscle torque and frontal plane pelvic motion during running
Evie N. Burnet and Peter E. Pidcoe
Journal of Sports Science and Medicine (2009) 8, 284-288

  30 Responses to “Strengthening your Gluteus Medius – do exercises like the Clam or a side lying leg lift actually do anything?”

  1. >I very much agree on what you've said here. I injured a hip earlier in the year (running a marathon) and the physical therapist had me doing clams and the like for months, which did no good at all. In fact I think that they have exacerbated the problem (weak gluteus medius/minimus?). Clams and other similar exercises ended up tightening my hips further and have kept the injured muscle in a permanently contracted state; in a knot, actually. I've since realized that my problem is in my pelvic control while running and walking. That's the reason the muscles are weak in the first place, because I don't use them (even though I've been running consistently for 3 years.) I'm currently trying to figure out how to get my gluteus maximus to engage properly when I walk or run. Up until now I have simply used every other muscle to get by on, swinging my hips to get forward propulsion. Your post here is the first thing I've read that makes any sense! Thanks.

  2. Hi Andy, great stuff, now give us a quick video to demonstrate. Til then I’ll share on my page. Thanks so much for a great article. X

  3. Hi very good video. I’ve a question if you don’t mind. When you say “stiff hips” could you elaborate a bit more on that? Are you on about a certain muscle being short and tight?

    • I am referring to the movement itself being limited rather than a specific muscle. The “stiffness” could be due to any number of reasons. The aim is to restore good movement patterns back into the body from which you can use more effectively when you run. Hope that makes sense

  4. Interesting exercises. I agree interely on your points about specificity.
    I think there may still be a role at a very early level for the conventional non function muscle activation, maybe as an awareness developer, but agree totally that without specificity, it become pointless.
    Have u correlated the efficacy of your exercise with improved pelvic control,when running?
    Thanks
    Arturo

    • Thanks for your comments – regarding doing non functional exercises as an awareness developer – my argument against this is that we don’t consciously activate our glutes when we run so why would doing an exercise that involves conscious activation of the glutes be beneficial?

      Unfortunately there has been no research on the effects of the exercises on pelvic control – plenty of non scientific research from myself and numerous others that use this technique but it will be a while before the researchers look towards something non – conventional!

      • Hi Andy,

        Great article and a number of very valid observations. Can you please confirm your comment regarding not actively recruiting our glutes when we run. Are you referring specifically to glute med? In the context of glute max, I would see conscious activation as being essential (particularly with regards to effective hip extension)

        • Hi David
          Thanks for your comments. Re conscious activation of any muscle when we run – I believe if we rely on conscious activation then we will struggle. Given the foot spends approx .3 of a second on the ground the idea that in that time you can focus on getting glute max to fire doesnt really make sense.
          What many dont realise is glute max has actually switched of by the time the hip is moving behind the body, its work is done in the initial phase of landing. The hamstrings are far more active in extension. The glutes generate the force that helps drives the hip into extension and the hamstrings continue to help . If you are consciously activating your glutes after the hip is behind the body then you are encouraging abnormal running biomechanics ( assuming that your conscious thought could activate it in the first place)
          I think conscious activation of muscles during any dynamic activity is not a useful method of getting muscles to fire more effectively.
          That doesnt mean the glute max shouldnt fire – it is a very important muscle when we run , its just that I dont believe that conscious activation is possible in such a short space of time . The glutes need to be loaded effectively to fire subconsciously. To do that we need to look at why they arent firing affectively in the first place and create a biomechancial environment that facilitates them firing without any conscious thought.

          • If we agree that gluteus medius’ main functions are abduction and pelvis stabilisation during the gait cycle (as well as ext./lat. rotation and int./med. rotation of the femur depending on post. or ant. fibres) then we are limited in strength exercises that can stimulate this – namely any abduction or gait movements.

            I agree with your idea in principle but even your exercises do not perfectly replicate the activation of glute med. during walking/running, and very little will short of…well, walking or running.

            I have often pondered on the thought that clam/lateral leg raises resemble running in no way and why we would choose to give them to clients who are weak in this area. But for me their pure focus is neuromuscular activation and would argue they are no more or less productive than leaning against a wall and bending sideways – something I rarely see runners do unless their technique is horrible (possibly mine).

            I would say that most of our movements are unconscious in the body. When I reach to catch a rugby ball down by my feet I am doing so consciously, although the contractions are performed subconsciously. I am not telling my brain “right now I need to flex my trunk and so I need to engage abdominals…”. However, if I’m weak in this area or I’m not firing these efficiently from a neurological standpoint, I might want to revisit exercises which tell my brain “okay, so this muscle is here, now work buddy!”.

            For me the clams et al merely serve as a wake up call and are a good a starting point as any for people to then progress to more dynamic movements.

          • Thanks for the comments Patrick

            I actually disagree on the main functions of the GLute med though – its my understanding that is main function is the eccentric control of hip adduction not the concentric movement of abduction .

            Muscles in gait load eccentrically first and then contract concentrically

            Hence my dislike of clams etc .

            Re the leaning sideways exercise – its a starting point that is a hell of lot closer to gait than lying on the ground and I would progress it to a faster movement , add in a landing force by adding step and then jump so the eccentric load happens over a shorter space of time .

            I dont think doing a lying down concentric action gives much of a wake up call at all when the task is a standing up dynamic eccentric action

            I agree most if not all of our muscle actions in the body are subconscious

            Re neuromuscular activation – the assumption is that the neuromuscular activation for glute med in a lying down concentric action exercise is the same as what happens when we run – I think thats a pretty big assumption

            If in running the glute med controls hip adduction through eccentric loading then an exercise that involves the client standing and giving the gliute med an eccentric load would seem to make a lot more sense than lying down isolated concentric movements

            I think a lot of physios think dynamic movements are too hard for a beginning glute exercise but I disagree totally – it all depends on the exercise and how its applied to the individual.

            Dynamic doesnt mean depth jumps or extreme plyometric exercise – it just means a faster movement – set the client up in the right position and I havent had one client that couldnt do a dynamic standing glute med exercise ( not necessarily the one shown in the video – the are literally hundreds of subtle variations that I may use).

            I also think the idea that you can isolate ( if thats even possible ) a muscle in an exercise and then simply expect it to know how to work in a chain of a lot of other muscles in a dynamic movement makes some pretty big assumptions .

            Put the body in a position that favours the muscle ( in this case glute med) you want to work but also includes the rest of the body and you have a much better rate of success in getting glute meds to fire as they should

  5. Great info. This is an older post which I had missed. Seems to apply to me pretty much. I have chronic degeneration of the lumbar region ( ex farmer! ) which means I have poor spine flexibility. On longer runs (20-30k) I get a lot of fatigue pain in the knee region, so I’m thinking this may be related? I already employ your three dynamic stretches so this looks like a good plan to keep on with.

    • Hi Andrew – it may definitely be related – its just a question of how related. With a chronic degeneration of the lumbar region the forces of running have to be absorbed somewhere and the body will be trying to not absorb them in your back if it can help – so some other part of the body will suffer an increased load. Knee problems are often due to poor hip or foot biomechanics and your hips would no doubt be affected by your lower back condition. Getting your hips to move more effectively will no doubt improve your knee problem and might resolve it but there may be other factors at play as well. The human body is a very complex organism!

  6. Just recently I found this study of different glut-med strengthening exercises: http://www.ncbi.nlm.nih.gov/pubmed/22488226 and their muscle activations. It seems the clam does not work at all in strengthening the glut med compared to the TFL which I guess is the problem with “ITB knee pain”. So maybe the reason is not specifity and motor learning only.

    I agree you need specifity for the skill of activating correct muscles, but I am not sure what your exercise will teach a runner? It does not seem very balanced ;-). You dont want to learn to lean sideways like that either and the movement could even be hazardous for your back?

    I have also read suggestions about using a single leg dead lift, possible even with eccentric overload, to help with pelvic stabilisation. It should also stabilise the trunk and you can do it even with a kettlebell and one hand to emphasize this effect. Any thoughts?

    • Thanks for your comment Antti – the problem with that study you quoted and many other studies on glute activation is the focus is on which exercise activates the glute the most. That is not something that matters at all. What matters is which exercises have the most effect on frontal plane hip control in running – just looking at activation during the exercises makes the massive mistake of assuming that strength gained in an exercise is transferable to any movement or activity involving that muscle which is obviously incorrect.
      The exercise I have suggested as a start point loads the glue med in a very similar way to what occurs when running although slightly exaggerated – I tend to make the exercise less exaggerated as the athlete gains control of hip adduction in a standing position – for example a more advanced exercise might be a sideways hop.

      If the exercise I detailed is hazardous to your back then there is a back problem that may need sorting out first. In terms of leaning sideways I’m not sure what you mean – its simply closed chain hip adduction.

      The problem with dead lift is as it is more a sagital plane exercise it will load the hamstrings more especially if the glutes are week , if the goal is to strengthen glute med to help improve glute function in running then we need to think about how to strengthen in the frontal plane. There are occasions when we may want to start in the saggital or transverse plane and progress to the frontal plane but in general I go straight for the frontal plane.

      I prefer exercise that are more dynamic and make sure of eccentric loading rather than slow concentric or heavier eccentric as its more running specific

      • I agree with your point about training specifity and transfer and about clam being a poor exercise but what I thought the article was showing was: Clams work the TFL more than glut-med, so it is very bad for your ITB pain.

        Second point is, you learn the whole movement you are practicing, so I wouldn’t train the core the way the video shows: http://www.stack.com/2014/10/06/dumbbell-side-bends/

        …because the whole body learns, not just down from hip :). With single led (romanian) deadlift correctly performed and especially if you have the weight in your opposite hand, i think you need to balance the pelvis a lot, but i am not sure how much it activates gluteus medius. Probably needs also other exercises. Maybe a lateral leg raise without external rotation (the article) standing and having a support from the upper body (hands to a wall?) or something like that?

        (Sorry, maybe a small language barrier effect :). I am more from the “strength training and team sports world” rather than endurance running but i think the same exercises should work in all running/sprinting, still i am not a qualified professional but have done some studying and had some ITB problems myself too…

        Anyway I think we agree on most parts and people should not work clams to overcome ITB pain and standing exercises probably transfer better to running then lying on the floor!

        • Agree clams no good for ITB problems and yes misundertood your article reference – another good argument against them !

          Single leg dead lift with weight in opposing hand would provide some frontal plane load and nothing wrong with that – but I have seen that loading hips more in the frontal plane dynamically brings about better pelvic control in endurance runners – and yes dumbell standing side bends not a great way to train the core at all .

          Thanks for your comments

  7. clams with a raised lower leg can improve pelvic stability when performed with control. this can absolutely transfer to improved running. the muscles inside the pelvis are important too – not just the glutes….

    • Whilst I certainly agree that its not just glute med that is important I dont understand the rational for thinking that an exercise performed slowly working the hip in abduction can be transferred to a dynamic movement where the hip is driven into Adduction .

      Its the opposite action – in clams the hip never goes into adduction in running it does. Surely training the muscles in the range of movement and position that the movement ( in this case running) requires will lead to far better carryover

      I just havent seen enough evidence that clams and sidelying hip raises have the effect on stability that people claim it is.

      If the goal is to have better pelvic control of the hips in the frontal plane when we run then surely the success of the exercises should be measured on that variable alone – but very few studies do and the ones that do show that clams have no effect . Ie clam strength/ hip abduction strength ISNT related to frontal plane pelvic control .

      I’ll stick to adduction performed dynamically in an upright position as it just makes far more sense

  8. Andy:

    I’ve been able to transfer conscious muscle activation to unconscious motion patterns with great effect. Due to ancient history, I have a weak tibialis anterior, a tight soleus, weak gastrocnemius and hamstrings, and a tight gluteus maximus (all on my right side).

    A couple of comments above, David mentioned that conscious activation of the glute max could certainly aid the biomechanics in running. By consciously activating my gluteus maximus at the onset of the landing phase, I’ve been able to take some of the load of extending the leg away from the soleus (which wants to take over for the entire calf-thigh-hip chain), therefore allowing my tibialis anterior to get stronger, and start playing its tug-of-war with the gastrocnemius. In other words, even though activating the gluteus maximus hasn’t helped me develop gluteus maximus function, it has allowed other muscles of the body to begin moving (whereas before they had been frozen), allowing THOSE unconscious muscle firings to develop.

    Similarly, by consciously flexing the gastrocnemius and the tibialis anterior towards midstance, I’ve been able to increase triple flexion, allowing the gluteus maximus to load correctly (and then, since it’s correctly extending, it fires unconsciously all by itself).

    In other words, I’ve been able to use conscious activation of one part of the muscle chain to develop unconscious mobility in another.

    In terms of using the above exercises to develop actual skill, I think it’s totally possible, as long as we don’t rely on them exclusively. For example, let’s supposing that I did clamshells to ennervate the gluteus complex (just enough that I could feel the muscle burning). That way I make it more prominent to my nervous system, at least momentarily. And by going out for a jog (or doing an exercise such as the one in this link https://www.youtube.com/watch?v=LG-xLi2m5Rc) I can—at least according to me—take that level of ennervation/activity and put it directly into a motion pattern.

    (Theoretically, at least), the independently-trained strength gets transferred to a motion pattern by virtue of the temporal juxtaposition of the independent exercise and the muscle’s involvement in a specific motion pattern.

    Does any of this make sense to you (treating what I’m proposing as strictly hypothetical)?

    Cheers,

    Ivan

    • Hi Ivan – thanks for your comments – let me give you my thoughts

      I’m not a big believer in conscious muscle activation – I dont think we can do it quick enough or at the right point for it to make any difference. For example glute max should load eccentrically before the foot hits the ground. I’m not sure that people can actually activate glutes eccentrically with the foot in the air . If you arent activating glutes till your foot hits the ground then you are already shortening the amount of time the glutes have to work .

      I know what you mean re working glutes in clams shells and then going out for a run I’m just not convinced that the innervation is transferable – they are such different movement patterns. You may feel the glute running since its sore from doing clams but that doesnt mean its firing at the right time with sufficient strength

      Ground contact time is around .2-.3 of a second – which makes me doubt that anyone can accurately time conscious activation at the proper point of the gait cycle.

      Re independently trained strength transferring – I’m still not a believer that training a muscle in a completely different body position , different speed, different range of movement, different load can transfer across.

      I also think that we are talking about integrating the firing of whatever muscle we are trying to activate within a complex movement – isolating the movement takes the action a long way away from what we are trying to do. The closer we can make out activation exercise to the movement we are training for the more carryover

      We know this instinctively – if we want to run then no-one is suggesting you should first ride a bike – if you want to be a better runner then run . So surely it makes sense to find an exercise that resmebles running as close as possible but puts the muscle we are trying to fire up in a biomechanically advantaged position compare to muscles we dont want to work as hard.

      So many people are trying to justify clams and planks when really we should be thinking about how we can effectively train the muscles specifically for a movement – and if we agree that the closest we can train a muscle to the movement we are training for the better then why do we continue to try and say clams are good ?

      • Andy:

        I see your point. I guess the question then is one of “degrees of removal,” as in why or what makes training transferable. I completely agree with your stance that standing in defense of a particular muscle isolation—especially when prescribed by itself—is useless.

        I’ve personally been able to do a lot with conscious muscle ennervation (although, like you, I do it in a position that’s analogous to the one I train for). I usually work on particular muscles while jumping rope (making sure, of course, that I’m not in constant knee extension), and then I transfer them to running. I generally do NOT do isolations, but I’m interested in their clinical applications—or more importantly, why they’ve been so prescribed.

        I read your post—which again, I largely agree with—and I ask myself: what gives? What are the workarounds? How can we bridge this gap? Conceivably, isolations could have an important application, albeit when used in a much wiser fashion than they usually are. Personally, I’d like to find the answer to that. In the meantime, though, I’ll be training like you recommend.

  9. Distefano et al pushes the effect of hip abduction in side lying +/- hip/knee flexion although there is not the 60 second hold described above. This is just one of many scientific papers that do, however, feature a number of exercises that are significantly supported (ie lying) rather than upright against gravity (though not exclusively). Looking at variables supplemental to dynamometry alone, they do give some base premise as to why health professionals in particular will go to the floor. The relationship to upright stance & gait is not always clear.

    Regarding proprioception, the greatest of these appear to lie in the superficial or deep fascia of the tissue, and this may be critical as to the importance of fascia in human movement: as far as force production there is a greater demand on this tissue in gravity resistant situations with a contribution of up to 30% of the myofascial unit (the work of Huijing, Rijkelijkhuizen, Maas, Sandercock & Yucesoy for the past decade demonstrate this aspect of human function clearly and vividly. Boris Hinz has also been also well respected for his recent study of pathogenisis in injury, particularly the skin and wound healing for restoration of normal function).

    How we can manipulate environments to promote a myofascial rehabilitation/regeneration/conditioning remains something tricky to quantify (outcomes can be measured, but proprioception cannot-it is all by implication rather than explicit calculation or recording) with any certainty.

    • Hi Stephen thankyou for your comments – I have read the paper by DIstefano and many other like it and NONE of them give any evidence that those type of exercises effect pelvic control in a dynmaic activity like running . I dont care what activates the glute med the most in a lying down non functional position – what I care about is what exercises can I give my client that helps improve their pelvic stability when they run.
      Regarding your comment on fascia and proprioreception increased against gravity – in an upright position gravity is alos the main load – its just in a more function position – ie driving into adduction rather than moving against gravity in abduction.
      Surely giving propriorecptive feedback that is similar to what we want to happen in function is the preferred option?
      Why do we cling to old ideas and try and justify them?
      Ask yourself this – if we can find a more functional exercise that gives greater control of a joint in the movement the client wants to perform why dont we purseu that? We do we cling to no functional positions that are nothing like the movement just because an EMG says it activates a muscle more ?
      It makes no sense at all.
      Taking glute med as the example – we have a muscle that is allowing more movement in the hip joint than the body can handle during stance phase of running – that movement is moving into adduction dynamically in an upright position so why do we think that the best way to improve the situation is lying down, moving slowly into abduction and why do people keep try to justify it ?

  10. Thanks for a rapid response, and some more comment on your main themes.
    To take your last point first, my initial paragraph offers up reasons as to why ‘people continue to try to justify’ using side lying or supported positions.
    The details offered up about the continuum of myofascia regarding proprioceptive input demonstrate that the effects of gravity occurs whether lying or standing (or indeed running), and should also serve as backup evidence and useful academic research implying explanations as to why we ought to be considering ‘actions’ for rehab or conditioning rather than unhelpful labelling of exercises as ‘muscle specific’ exercises. This also is salient for your point about the relevance of concious activation in any protocol, and therefore any transference or crossover from non weight bearing to upright functional tasks.
    My final point also stands: there is a dearth of evidence (partly due to the logistics of such data retrieval) for many weight-bearing exercises of the hip and pelvis where running is compromised.

    • I do agree with some of your points – eg unhelpful labelling of muscle specific exercises

      I know many people continue to justify side lying positions but I have never heard the argument ” I prefer to do side lying exercises because it leads to quicker and better results for the client in terms of developing greater frontal plane control of the pelvis when they run and this is supported by research”

      Many choose to do sidelying exercises because they feel they can control things better and make sure other muscles ( eg TFL) aren’t taking over) but if there are exercises that you can do standing up , in a more functional position that can be given at a level that is suitable for the client surely thats a better option?

      The main reason that most physios/ trainers coaches give side lying exercises is they dont know any exercises suitable for the client since to many standing up means squats lunges etc which are more demanding and therefore weaker muscles will tend to be compensated for by stronger muscles.

      If there were exercises out there that could train the body to have better control of frontal plane hip movement during running that could be tailored for each individuals strengths surely that is a better option?

      So I guess my argument can be boil down to the following 2 points

      1. Is it better to perform an exercise in a more functional position relative to what the client is training for?
      2. Should we be thinking less about what activates glutes more and more about what gets our client back running again as quickly as possible?

      Thats it- to which the answer has to be yes – assuming the exercises are specific to that clients strengths and weaknesses but I havent met a client yet that wasnt able to do a standing up exercise in over 10 years of using this approach

      Yes there is a dearth of evidence for this but thats because everyone is so focussed on finding out which exercise activates the glutes the most forgetting activating the glutess ISNT the goal – running pain free the most effective way possible is the goal.

      Remember back to my original blog and the research I did find – side lying hip abduction strength does NOT correlate to pelvic stablity in the frontal plane when running

  11. Really good piece. We sometimes need reductionism in order to measure things (i.e. emg of glute med activation), but rarely is reductionism useful in a practical sense: how can I run more efficiently and pain free?
    What you say here about glute med/e,mg also transfers ot Vo2 max, force platforms and other paraphenalia where it is easy to get lost in improving those numbers, rather than the performanc eof the athlete.
    For me, I use a series of hip exercises in prone and standing, plus resisted walks and stances using mini bands. I use the wall to get a feel for the exercise, then move off the wall to walking drills. Balance/ strength/ posture and mobility all work together rather than in isolation. They do seem to work on the improved running action.

    • Thanks James – I think what we need to work on is developing tests that have more relevance to running. A side lying hip raise doesnt relate to pelvic stability in running. If it did then anyone with pelvic instability in running would have a poor side lying glute test and anyone who tested poorly in a side lying glute test would suffer frontal plane problems when running but this isnt the case at all.

      Totally agree re getting lost on improving numbers . For athletes nothing else matters except the finishing time – pointless having a higher VO2max only to get beaten by someone whos is much lower. We make some pretty big assumptions in sports science and whilst they may translate well to road races once you hit the trails and increase the distance there is so much more to it than thresholds, heart rate zones , VO2max etc

      Balance strength posture do all work together and I dont believe you can isolate one – you can highlight one but as soon as you isolate ( if thats even possible) you lose the sense of intergration with the rest of the body that is so necessary.

      The more isolated the exercise is the more steps and progressions you have to do before it becomes useable in running , hence my focus on finding running specific exercises that can be tailored for anyone from people with hip bursitis to elite athlets with no injury at all

  12. I have found this very interesting, I hurt my when doing a very long hike, and I am worried about its healing process, physio told me to do clams. I am 54 and never had knee pain before.

    • As yo know I’m not a big fan of clams and I know a few physics who share my point of view however the best exercise does depend on the individual as with any injury we need to make sure the exercise is not more than the person can handle – I;d still argue clams are a waste of time and find a different exercise to get the glutes working again

  13. Thanks for the post and for sharing your thoughts. As a physio I use clams for some patients but not for others. Its a basic exercise that should be scaled and progressed to something more “functional” and specific to whatever your sport is. But for extreme weakness, poor control/body awareness, post-op cases they can be an excellent starting point. There is also the case of how the clams are done, there is huge variation on technique which can change the outcome drastically. Thanks for sharing!

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