The Hip External Rotation Clamshell Exercise

clamshell exercise

A few weeks ago I published an article on what I thought were two essential exercises that we should include in every program, which included the shoulder W exercise and the hip external rotation clamshell exercise.  After that post I received a lot of emails asking for a video of the shoulder W exercise, so I wrote up another technique article dedicated solely to the shoulder W exercise.  Well, in response to that post, I have received a bunch more emails asking for a similar video on the hip clamshell exercise.  So here is my video demonstration of my technique, as well as a variation of performing the clamshell exercise in neutral rotation.

 

Why I Like the Hip External Rotation Clamshell Exercise

I want to again reiterate that there are a lot of exercises for hip external rotation that I use everyday, but I highlighted the clamshell exercise for it’s simplicity and effectiveness.

I have talked in the past about the importance of strengthening the gluteus medius and some of the dysfunction that can occur with poor coronal plane strength.  We really are a sagittal plane society and this has a large impact on many of our dysfunctional movement patterns, so strengthening muscles that externally rotate the hip is important.  If this isn’t something you’ve been emphasizing, go back and read some of the above links.

 

Hip Clamshell Exercise in Hip Flexion

EMG studies have shown that the clamshell produces a good amount of gluteus medius and gluteus maximus activity, especially if technique is excellent.  Notice in the video below that I really emphasize placing your hand along your iliac crest.  This helps to cue to body to not rotate and incorporate the low back, which is likely the most common fault during this exercise, especially in those that have really weak glutes.  Also, by placing your hand on your hip like this, you can put your thumb on your glutes to feel and facilitate the contraction.  It really helps with your technique.

It should also be noted that the contralateral leg, the one of the bottom, has to isometrically stabilize into hip ER, to prevent the band from pulling the bottom leg up, so again, just another reason why I like the clamshell exercise.

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Hip Clamshells in the Neutral Position

While performing the clamshell exercise for hip external rotation has been shown to produce similar amounts of gluteus medius EMG activity in the 30 degree and 60 degree positions of hip flexion, I also like to perform the exercise with hip flexion at 0 degrees, or neutral.  The majority of us already have overactive hip flexors, so anytime I can work the hip muscles outside of the hip flexed position is good.  It is also well documented that the posterior moment arm of the gluteus medius is decreased while the hip is flexed, making the glute medius less effective in externally rotating in this position.  Hip ER in a flexed position likely increases the contribution of the gluteus maximus and deep external rotators.

In the video below, I demonstrate the hip clamshell exercise in neutral, or 0 degrees of hip flexion.  The first thing you’ll notice is that my range of motion is less.  This is normal and not indicative to poor performance in this position.  Normal range of motion for hip ER is about 30 degrees with the hip extended and 50 degrees with the hip flexed. You will notice that people with weak glutes will not like this exercise as much because it is more difficult!  Even more reason to be using it.

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What do you think?  Have you performed any variations of the clamshell exercise that you feel are essential?  I know there are many more tips and alternative exercises, but I hope these videos clarify some of my thoughts when discussing strengthening the gluteus medius by performing hip external rotation with the clamshell exercise.

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39 Responses to “The Hip External Rotation Clamshell Exercise”

  1. I really like this exercise as well. I really like the idea of doing it with hips in neutral. Will have to try that! I also sometimes have patients hold for 5 seconds at the end of the motion before slowly lowering back to starting point. This really seems to add to the fatigue factor, which leads to my question. Since you mention over fatiguing the rotator cuff resulting in superior humeral head migration, would you also see similar results here, with over fatigue leading to increased femoral IR/Add potentially leading to more valgus at the knee?

  2. Great video mike. I’ll refer patients to it. I too like the clam because it’s harder to do it wrong than some of the other glute med exercises. That’s especially important when prescribing for someone with overactive synergists.
    A lot of patients have significant resistance even without the banding, but your comment about the contralateral isometric stabalization will have me reaching for the yellow band next time.

  3. Nice post Mike. I think the clamshell is a good starting point with the ultimate goal being able to maintain single leg stance without a compensated or uncompensated trendelenburg. I also wanted to personally apologize for a comment that I posted on the W exercise in terms of the red sox getting off to a good start as I incorrectly heard something on sports center eluding to the fact that they were doing well which was obviously facetious. Look forward to your upcoming posts.

  4. Hey Mike, what does it mean if I have some pain towards the end of the abduction portion of the exercise near the greater trochanter? Using my left leg.

    Is that a possible piriformis or gluteus medius strain?

  5. Michelle Hersh May 3, 2011 at 12:56 pm

    HI-
    Is this a good place to start for MCL injury problems? I looked through your site, and you didn’t have a specific link to MCL strain. Thanks much.
    Michelle

  6. i use it. Specially as a valgus knee position prevention in female athletes.

  7. Where to you get the rubber bands from?

  8. Hi Mike
    Very interesting!

    You ask for any variations we might have tried.

    Try this -Hip flexion clams -BUT after opening the top leg- Lift the bottom one -maintaining the position of both legs-

    To roughly 2-4” so your top ankle is same height as your hip-but once there you can move the 2 legs up down -forwards backwards-hold it as isometric-and or repeat etc

    You can both really feel the back of the Glute medius working, and isolate in which exact position its working most.

  9. ‘very PRI-like!’

    I have no idea what that means- perhaps you would care to discuss properly-since you asked for experiences

    -and no mate, Im not about to follow you on Facebook/Twitter as you suggested by non reply email-because Im so over all the self agrandising of Social networking-your not my guru !-and after all most of the info on this site is everywhere on the web.

    Why cant I just respond to your email-or better yet why dont you respond properly to me, rather than send a no reply email that directs me to yet another ‘social media’ So much for discussion.

    ‘This Rant is brought to you by the Beginning Backlash against the superficial, time wasting, ego stroking, non communication that is the Social Network’

    • Hi Marina, funny you say that as I actually did respond to your comment on this post. I thought your suggestion was great, thank you for that. PRI stands for Postural Restoration Institute. They use similar exercises to the one you described.

      Not exactly sure what you are referring to with your “non reply email” comments. I get 100’s of emails a week from this website, I simply can’t respond to them all. If i missed yours, I’m sorry. I do try and think many people would agree with that. I give a lot to this community and ask nothing in return. I think it is pretty cool that you get to communicate with so many people on the internet.

      I started a forum on this website so that rather than emailing me, you can ask myself and all my readers a question, and start a discussion.

      Good thing about the internet is that it is 100% optional!

      • Hi Mike

        Great stuff on your site and glad to see you always pulling from a number of good sources. I like your correlation to the PRI integration as well above.
        One thing above and beyond your thought on the top hand on hip for palpation of the GMax/GMed is to press it into the floor in front of you with your elbow out. This does a nice job of integrating abdominals and scap stabilizers to reduce inevitable thoracic rotation which goes with it. I will also most often have them press their toes into wall as well for added pelvic floor recruitment. I find I get a lot less general leg activity.
        Keep up the great work!

  10. Hi Mike,

    Just curious if you ever position someone with their hip flexed greater than 90 degrees to help reduce activation of the piriformis muscle when performing the clamshell exercise. A physio once told me that doing so helps inhibit activation of the pirifromis as it acts as an internal rotator when the hip is flexed greater than 90.

    Let me know your thoughts!

    Andrea

  11. Thanks for the comment Andrea. Absolutely muscles will work differently in terms of their activity depending on the position of the bones and joints that they influence. With respect to the piriformis, it is a little more complicated than that due to the host of factors affecting position due to tri-planar components–and that is assuming the pelvis is neutral! The modifications I mentioned above I find to be most beneficial in isolating the GMax with the least amount of substitution. I will often have them perform a hip shift as well (yes, PRI Mike) forward or back if I find they are substituting with TFL, vastus lateralis, etc.

    90% of the time the piriformis works just fine–in fact too well–which is why having patients/clients find their GMax/GMed vs just performing an exercise is so important.

    Hope this helps!

    Michael

  12. Mike, would strengthening the glute medius via clamshells be useful in a case where the knee feels strained when doing glute bridges and forward lunges? My wife has a problem with this, and with some investigation I’ve found out that if I press her knees towards each other while she’s glute bridging, the pain is significantly diminished – indicative of glute medius not firing? Also step ups and reverse lunges cause less pain than forward lunges though they’re all knee dominant movements.

  13. Hi Mike,
    I’ve been reading a lot of your articles and find them really useful- I’m not a professional but am an athlete recovering from knee problems and was told I needed to strengthen my gluteus medius. The problem is- there’s so many glute medius exercises out there it’s hard to know which ones to go for! I was originally prescribed clams and a version where you lift your feet up whilst doing them which seems to work the muscles much harder. I found my glutes got a good workout from these but have seen a couple of physios who said that the clam was just for beginners and it’s better to strengthen in a more functional, weight bearing position. I’m just wondering what you’re thoughts on this are- other exercises I’ve been suggested to try are hip hikes, single leg squats, single-leg glute bridging and monster walks and not to bother with the clams anymore but I did feel they were working. Just wondering what your views are on this- are the clams only a beginner exercise or can they be used to maintain glute med strength at a higher level? I’d really appreciate any feedback on this and on whether you think any of the other exercises I mentioned (or any suggestions you have) which might be beneficial. Thanks and keep up the good postings!

  14. My left leg externally rotates and my right leg internally rotates.
    Would I do the clams shell for my leg left leg and what would I do for my right leg?
    Thanks
    Ange

  15. I lost my butt because of a month bed rest. It’s really difficult to sit for long and very inconvenient. I been trying all kinds of exercises( Leg press, squats, glute-bridge) for almost 3 months and did not get any result. Clam shell gave me immediate results and I am very happy. Thank you.

  16. Hi Mike,

    I’ve been working abduction with lateral rotation and extension to combat internal rotation of the hips. However, I think I have overdone it. I notice a burning nerve like sensation in the sciatic notch through the hams. What do you think about doing abduction work with slight lateral rotation in the FLEXED position? Do these need to be balanced out? Seems like I get nerve pain nowadays with almost any gluteal involvement (stairs, walking, squatting, etc). Any help would be much appreciated. Thank you.

    • Raul, without knowing specifics for you, that will change the exercise. You will compensate with something else, perhaps the TFL. Perhaps you need to work on your soft tissue? Hard to say over the internet. Good luck

      • Thanks Mike. Any recommendations of anyone in the San Francisco/Oakland Bay area? Thanks again.

  17. Hi mike,

    I have very weak glutes and found that clams in the neutral hip position activates my QL muscle. I have an overactive QL already so as soon as I start this particular position my glutes and back both kick in.

    As for the 30 degree position, I do ok but reps are range are low. The QL doesn’t seem to kick in. Can you explain why this happens?

    Thanks!

  18. I have performed this exercise, without a band, incorporating the PRI breathing techniques and neutral/posterior pelvic tilt. I highly recommend giving that a shot as an advanced glute recruitment exercise/interior core activator and corrective exercise.

  19. Hey Mike. Thanks for this article and your many others. I’ve gotten alot from them.
    I try and do clams at least once a week and straight-leg frontal raises for my TFL at lease once a week. I have found the weak glutes (especially medius) and over-loaded TFL to be the main culprits to running injuries for myself over the years.

  20. I’ve been struggling with pain in my lower semimembranosus/semitendonosus hamstring area upon hiking over uneven terrain. It seems to be irritated by lifting my leg and swinging it over things. I can walk normally on flat ground without pain. The clamshell exercise re-creates this pain though, and I am wondering why this might be. I can definitely feel the glutes working when I do this exercise, so I am definitely doing it right. Why then, might it be irritating my lower hamstrings when it shouldn’t really be working them at all?

  21. Hi, Mike
    Thanks for the post. Do you have any particular articles or resources documenting the posterior gluteus med activation decreased while the hip is flexed.
    Thanks!

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