These next two blogs will be about two of the best exercises for gluteus medius. The first exercise we will introduce is simple (with a couple of caveats we discuss below), but research has shown it to be very effective. We can abduct the leg in a variety of positions, but recent studies have shown that sidelying hip abduction produces a high amount of muscle electrical (EMG) activity in the leg being lifted. It looks like a simple exercise, but, incorrect technique can lead you to work different muscles which can then cause other issues. When you set-up for this exercise, lying on the side with the bottom leg bent, there are two potential issues:

1. When we have glut weakness and we abduct the hip, rather than lifting it purely into abduction, it is very easy to allow the leg to lift forward into flexion. This is particularly true when the hip flexor is tight as we saw in the hip extension post.When this occurs we will undoubtedly get some glut activity, but we also get activity in a muscle called the Tensor Fascia Lata (TFL). We want to correct this for two reasons. One is to get the most glut activity we can get. Secondly the TFL blends into the Illiotibial band (ITB) and with the direction of its fibers it seems to have some link in the research to people getting ITB issues. We should bear in mind that gluteus maximus also blends in to the ITB, but the direction of its fibers places a different force.
2. As we lay on the side and abduct the hip, in the presence of gluteal weakness, it is possible to substitute back muscles to help provide/stabilize movement. As we learned in the other blog, back extension as a substitution is not helpful, and once it becomes a set-in habit is difficult to correct. When this substitution occurs in hip abduction, even though it is not a major issue, if we do not attend to it it will be harder to correct in hip extension. The reason we see this substitution in hip abduction is that glut max as well as a hip extensor also plays a part in stopping the hip from internally rotating. As we abduct the hip, glut medius provides abduction and glut max stops the hip from internally rotating. If glut max is weak, there is a chance that we will arch the back and use the back extensors excessively as we try to keep the foot level and stop it from internally rotating.

So ideally when we do side hip abduction exercise we want to make sure we use our abdominals to help avoid excessive back extension and also make sure the hip is in line with the body. Although it hasn’t yet been clearly shown by research, the muscle action would suggest we would even want to abduct the hip in an extended position to get more activity.

Check out the next progression which takes this exercise to another level!

References:

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):206-23.