A Simple and Effective Gluteus Medius Exercise

Gluteus MediusI have to admit, sometimes we all get carried away with exercise selection that we overlook some of the most basic, yet highly effective exercises.  I know I fall victim to this at times!

Strengthening the gluteus medius is often an important part of our rehabilitation and performance programs.  Like I always preach regarding both shoulder rehabilitation and core exercises, there is a difference between the role and function of a muscle.  The gluteus medius has more than just a role to abduct and rotate the leg, it has a function to dynamically stabilize the pelvis and lower extremity.

But realistically, weak muscles can’t stabilize, so we still need to focus on exercises to work on activating and strengthing the gluteus medius in addition to working on dynamic stabiliztion.

Two of the most popular posts on this website have discussed Assessing and Treating Dysfunction of the Gluteus Medius and The Best Exercises for the Gluteus Maximus and Gluteus Medius.  In these posts, I discussed a bunch of great gluteus medius exercises.  I even posted specifically about the clamshell exercise.

All of these exercises discussed are great, but there is a very simple exercise that is really effective for strengthening the gluteus medius.

A Simple and Effective Gluteus Medius Exercise

OK, get ready for this…  the simple and effective exercise for the gluteus medius is…  sidelying hip abduction!  I know what you are think, wow that is really boring.  I agree, it is boring!  But it is effective.  There are many other gluteus medius exercises that work well and have other qualities that make them important to consider, but it is hard to argue about sidelying hip abduction.

Here is a good video demonstration.  Note that the leg is straight, the hip is not flexed or rotated, that is key:

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Some of the past articles that I reference in the links above have stated that sidelying hip abduction has great EMG activity of the gluteus medius.  A new study in the Journal of Athletic Training agrees with these past studies.  The authors concluded that simple hip abduction straight leg raise was superior at eliciting gluteus medius EMG to the clamshell exercise and externally rotating the leg during the abduction straight leg raise.

The study also notes that the sidelying hip abduction exercise does a better job at enhancing the ratio of activity of gluteus medius and TFL.

Reducing the TFL component to hip exercises is often desired especially in those with anterior pelvic tilt, who tend to exhibit too much TFL activity and compensatory contraction to rotate the hip internally.  This is one of the reasons that sidelying hip abduction is probably even better than band walking for the gluteus medius because people tend to flex their hips while band walking, firing their TFL

Clinical Implications

There are two take home messages here for me:

  1. Sometimes taking a step back and performing a simple, or “boring” exercise may be indicated.
  2. The sidelying hip abduction straight leg raise should be included in many of our patients’ and clients’ programs, especially when trying to maximize the gluteus medius to TFL ratio of muscle activity.  This would be something I would add to an active warm-up or corrective exercise component to a program, much like the clamshell exercise.
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  • http://exercisebasics.blogspot.com Brandon Goulding

    I agree Mike. We often forget to break this down into it’s simplest terms. I’m usually a fan of more functional exercise, but sometimes you have to find the weakest link in a chain and fix it.

    Exercise Basics

  • http://www.jessephysio.wordpress.com JessePhysio

    Thanks for this article Mike. Although the content is great, the message behind it is even better! I find myself searching for the most functional or trendy exercises to give mt patients but often, clams, side lying abduction, bridges, wall squats, side lying ER etc are the most needed components my exercise programs. The patient doesn’t care how “cool” an exercise is…they just want it to make them feel better

    Jesse

  • http://www.chrisjohnsonpt.com/critters-corner Christopher Johnson

    Mike,

    Great post. Dr. Nicholas Sr. used to preach the importance of this exercise even in the 1960s. He used to always prescribe the “B Program,” which included this exercise. The other important item worth mentioning is that in the event that external resistance is needed, all you need to do is to strap an ankle weight around the foot (yes the foot…torque = force x perpendicular distance). I really like this as a trunk control exercise. In the event a patient is compnesating through hip hiking I will also cue them to think of gently pushing the foot away before initiating the movement as it seems to inhibit the QL. As I’ve said before, “Make things as simple as possible but not one but simpler.” (Einstein)

  • http://www.chrisjohnsonpt.com/critters-corner Christopher Johnson

    I also thought this may compliment the video in your post as well
    http://www.youtube.com/watch?v=1YFiyW05U38
    Nice post again Mike!

  • Garrett

    Hey Mike,

    Great post. You mention keeping the hip in neutral as an important component of this. I like Chris J’s thought on adding elongation, but I also think a little hip ER (emphasis on little) will help activate glut med preferential to the TFL as long as the person is able to maintain pelvic neutral and avoid rolling secondary to the added hip ER. Any thoughts?

    • http://mikereinold.com Mike Reinold

      Garett, this was actually in the original study. What the authors found was that if you externally rotated during abduction you had less gluteus medius activity and more TFL activity.

  • Don Walsh

    Wow, How bout that Mike! The original position pictured in the 1946 Daniels and Worthingham book for testing “normal” strength via manual muscle testing can actually become the exact exercise most effective to strengthen it. We have come full circle in rehab! I have seen rehab go crazy with stabilization and function emphasis so much so that we forget the basics. Sort of reminds me of the argument against isokinetics when it first came out in the 70/80’s (or isotonics even earlier) – “both are no good for strengthening because they aren’t functional movements” – give me a break! About time the rehab profession is reminded about the basics. Thank you Mike.

  • Mike Reiman

    Mike, thanks for the article.
    Myself and a couple colleagues tried to demonstrate the point of clinical relevance of the “basic” exercises. Hope the link works (not as tech savvy as yourself):
    https://owa.dm.duke.edu/owa/redir.aspx?C=NBnSAikgSkiQcGbmPubCmlrHwwBt_M4I04HGhSDYolecdHiyDJarvSXcPvMecmegsYaDXs2NSNs.&URL=http%3a%2f%2finformahealthcare.com.dml.regis.edu%2fdoi%2fpdfplus%2f10.3109%2f09593985.2011.604981
    I think we sometimes get too caught up in making exercises fun we forget about the clinical relevance of “basic” (note emg of bridge off stable surface vs bridge off stability ball and emg of the basic hip hike).
    In fact, I sometimes think these basic exercises may be too high level for some patients when prescribed with proper volume. Remember, these studies were done on normals.
    We should be cognizant of the large standard deviations, as well as the variability in emg values in different studies investigating the same exercise though.

    Thanks again,

    MR

    • Marcus

      @MikeReiman would you mind emailing me this link? I can’t get it to open correctly on my PC due to security reasons.Thanks! mholliday@etbu.edu

      • Mike Reiman

        Marcus,

        Thanks for the interest in the article. It should be in your mailbox.

        MR

  • http://www.kcnorthsjc.com Justni

    Mike,
    What would you do for individuals that feel pain in the TFL and/or IT band while performing this exercise? They can not distinguish TFL and Glute Med.

    Justin

  • Marcus

    I love how the guy in the video says ‘external auditory meatus’ for the ear, but then says ‘ankle bone’ for the lateral malleolus. :)

  • http://www.fitnesspainfree.com Dan Pope

    I guess we don’t always have to get fancy! The last clinic I was at had a sliding board mounted on the wall below a therapy table. Patients could perform the sidelying abduction with the wall as a guide. Pretty cool, thanks for the info.

  • Betsy Estacio

    Yes, this is a great exercise and has always been albeit boring. Thank you for the TFL/glut medius ratio explanation, explains why this is a better exercise than the sidestep with band to start with even with higher level people.

    This like every simple exercise needs diligence in making sure it is done correctly without compensation. I cringe when I see people swinging their leg up in the air pelvis torquing and spine a curling.

    There was a JOSPT article on the Active Hip Abduction test in December 2011 that use sidelying hip abduction to assess lumbopelvic movement during dynamic lower limb activity. It is a good measure of lumbopelvic compensation out of the frontal plane which could have multiple causes ie. hip hiking by QL, tight adductors. In working with patients I have them put their hand on their ASIS to monitor that it stays still while doing hip abduction. Many patients find this exercise extremely difficult and tiring when preventing the compensatory movement. If they cannot control this compensation in this simple exercise I know they are substituting el grande with dynamics and functional movement. Getting them to feel what their bodies are doing or not doing is always great for their somatosensory system as well

  • http://www.smartmovesfitness.com Lauren Saglimbene

    Great Article – I have a question! Has improved gluteus medius activation during isotonic exercises (i.e. sidelying hip abduction) been linked to an improvement in the stabilizing/isometric function of the gluteus medius during standing? I’m not familiar with the research.

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  • Matt Stuckey

    I use this frequently. It can be useful to demonstrate the weakness in the glute med to athletes who think they already strong from working only in one plane. Like Dan Pope, I use the wall. Shoulders, hips, and heels against the wall, then cue the pt to press slightly into the wall. I get much better isolation and avoid ER with TFL and compensation with the quads.

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  • BJ Stockton

    Thanks for all the great suggestions. Has anyone tried a TRX supine bridge with bilateral abduction? Basically putting your heels in the TRX straps, lie on your back and do a supine plank. From this position, then abduct your legs (keeping your core quiet). I like it because it is hard to cheat in this position (just don’t hyperextend the lumbar spine). Here we take the hip flexors and TFL out of the equation, loading the glute max and med. Also, you get less HS recruitment since your legs are straight. I’d love to hear your feedback if anyone has thoughts on this.

  • Tim

    On the sidelying hip abduction exercise, I have my patients in the same position you have described, but additionally have them roll their top hip forward a little bit to prevent the hip flexors from assisting with the movement. Even in a neutral sidelying alignment a patient can compensate with their hip flexors by externally rotating the hip during the hip abd movement.

    • http://mikereinold.com Mike Reinold

      Good call Tim, nice modification.

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  • http://Website(optional) JonC

    I’m trying to fix my patellar-femoral pain – I have the medial movement while bending knees, etc.. I can do the side-lying hip abduction all day but I cannot do even ONE when on my right side in the side plank; I can do about five with left side down. Does that ring a bell for anyone – is that some other kind of hip weakness maybe?

    Thanks

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