Ultramarathons. What , why and how are the questions I'm most commonly asked. Hopefully you find some answers here from my own personal perspective. My other blog at www.mile27.com.au/blog is full of information on running and health and fitness in general.

Wednesday, 8 December 2010

Strengthening your Gluteus Medius – do exercises like the Clam or a side lying leg lift actually do anything?

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.



*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

4 comments:

Anonymous said...

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.

sheila graber said...

Thanks so much for this - after having PMR 10 years ago I thought I was cured - but in fact have been walking wrongly since then without even knowing it, walking at least a mile a day. Everything flared up 3 months ago and I started to limp with great pain in right hip. My Physio says its a Hip Burser and recommends Clams and knee bends -dont seem to make any difference to my walking - started your "weak hip" exercise a week ago-feeling better already..will feed back progress in a month or so -You make such SENSE - thanks. Sheila Graber

RunJillyBean said...

I have battled ITBS for two years. I have tried PT, chiropractors, my own glute program, rest, etc. I love the concept of these exercises. As a woman, I have both tight and weak hips. I have been alternating the exercises and can feel muscles engaging I haven't felt before. Thanks for the out of the box thinking. Any other words of wisdom for this issue?

Andy said...

Thanks for the feedback re strengthening your gluteus medius. ITBS can be a real pain to get rid of unless the cause of the problem is identified and corrected. The glute med is almost always weak but there may be other causes. Foot  biomechanics can also cause problems , for example excess pronation can cause the Muscles that attaché to the ITB to work harder to try and control the pronation so unless the foot problems are corrected the ITB problem will never go away.

For more info on strengthening the glute medius have a look at another blog i have written on now to dynamically  stretch your glutes. The exercises demonstrated also fire up the glutes . In the video I give some different foot position options , to fire up glute medius more use the cross over lunge position .
http://www.mile27.com.au/how-to-dynamically-stretch-your-

Any questions feel free to ask

Andy