Research Article| Volume 29, ISSUE 9, P971-976, November 2014

Examining the effects of altering hip orientation on gluteus medius and tensor fascae latae interplay during common non-weight-bearing hip rehabilitation exercises

  • Natalie Sidorkewicz
    Corresponding author at: Spine Biomechanics Laboratory, Faculty of Applied Health Sciences, Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada.
    Spine Biomechanics Laboratory, Faculty of Applied Health Sciences, Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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  • Edward D.J. Cambridge
    Spine Biomechanics Laboratory, Faculty of Applied Health Sciences, Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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  • Stuart M. McGill
    Spine Biomechanics Laboratory, Faculty of Applied Health Sciences, Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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      • Regardless of condition, GMed activity dominated TFL activity in CLAM and ABD.
      • GMed-to-TFL ratio was far greater for CLAM than for ABD.
      • CLAM is preferred over ABD when minimal TFL activity is desired by the clinician.



      Improving activity and strength of the gluteus medius muscle is a common goal among clinicians aiming to rehabilitate lower extremity and low back injuries. The functional anatomy of the hip is complex, particularly how position-dependent the activity and strength of many muscles surrounding the hip are, and the optimal exercise technique to isolate gluteus medius remains controversial. The objective of this study was to quantify the effect of altering hip orientation during side-lying clamshell and hip abduction exercises on the relative muscle activation profiles of gluteus medius and tensor fascae latae.


      The ratio of gluteus-medius-to-tensor-fascae-latae peak electromyography signal amplitude of 13 healthy, male participants was compared across variations of the clamshell and abduction exercises. The hip flexion angle was varied from 30°, 45°, and 60° for the clamshell, while hip rotation orientation was varied from internal, neutral, and external rotation for the abduction exercise.


      Varying hip angle – flexion in the clamshell exercise and internal/external rotation in the abduction exercise – did not significantly affect the interplay between gluteus medius and tensor fascae latae activation levels. Both exercises remained gluteus medius-dominant across all variations, but the gluteus-medius-to-tensor-fascae-latae ratio was far greater for the clamshell than for the abduction exercise; the clamshell may be the preferred rehabilitative exercise to prescribe when minimal tensor fascae latae muscle activation is desired by the clinician.


      These findings provide information for clinical decision-making pertaining to effective gluteus medius activation in lower extremity and low back exercise rehabilitation programs.


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        • Arab A.M.
        • Nourbakhsh M.R.
        The relationship between hip abductor muscle strength and iliotibial band tightness in individuals with low back pain.
        Chiropr. Osteopat. 2010; 18: 1
        • Beckman S.M.
        • Buchanan T.S.
        Ankle inversion injury and hypermobility: effect on hip and ankle muscle electromyography onset latency.
        Arch. Phys. Med. Rehabil. 1995; 76: 1138-1143
        • Bolgla L.A.
        • Uhl T.L.
        Electromyographic analysis of hip rehabilitation exercises in a group of healthy subjects.
        J. Orthop. Sports Phys. Ther. 2005; 35: 487-494
        • Bolgla L.A.
        • Malone T.R.
        • Umberger B.R.
        • Uhl T.L.
        Comparison of hip and knee strength and neuromuscular activity in subjects with and without patellofemoral pain syndrome.
        Int. J. Sports Phys. Ther. 2011; 6: 285-296
        • Boren K.
        • Conrey C.
        • Le Coguic J.
        • Paprocki L.
        • Voight M.
        • Robinson T.K.
        Electromyographic analysis of gluteus medius and gluteus maximus during rehabilitation exercises.
        Int. J. Sports Phys. Ther. 2011; 6: 206-223
        • Cambridge E.D.J.
        • Sidorkewicz N.
        • Ikeda D.
        • McGill S.M.
        Progressive hip rehabilitation: the effects of resistance band placement on gluteal activation during two common exercises.
        Clin. Biomech. 2012; 27: 719-724
        • Cobb S.C.
        • Earl-Boehm J.E.
        • Huddleston W.E.
        • McBeth J.M.
        Hip muscle activity during 3 side-lying hip-strengthening exercises in distance runners.
        J. Athl. Train. 2012; 47: 15-23
        • Crow J.F.
        • Buttifant D.
        • Kearny S.G.
        • Hrysomallis C.
        Low load exercises targeting the gluteal muscle group acutely enhance explosive power output in elite athletes.
        J. Strength Cond. Res. 2012; 26: 438-442
        • Cynn H.S.
        • Oh J.S.
        • Kwon O.Y.
        • Yi C.H.
        Effects of lumbar stabilization using a pressure biofeedback unit on muscle activity and lateral pelvic tilt during hip abduction in sidelying.
        Arch. Phys. Med. Rehabil. 2006; 87: 1454-1458
        • Delp S.L.
        • Hess W.E.
        • Hungerford D.S.
        • Jones L.C.
        Variation of rotation moment arms with hip flexion.
        J. Biomech. 1999; 32: 493-501
        • Distefano L.J.
        • Blackburn J.T.
        • Marshall S.W.
        • Padua D.A.
        Gluteal muscle activation during common therapeutic exercises.
        J. Orthop. Sports Phys. Ther. 2009; 39: 532-540
        • Dostal W.F.
        • Soderberg G.L.
        • Andrews J.G.
        Actions of hip muscles.
        Phys. Ther. 1986; 66: 351-359
        • Fredericson M.
        • Cookingham C.L.
        • Chaudhari A.M.
        • Dowdell B.C.
        • Oestreicher N.
        • Sahrmann S.A.
        Hip abductor weakness in distance runners with iliotibial band syndrome.
        Clin. J. Sport Med. 2000; 10: 169-175
        • Freeman S.
        • Mascia A.
        • McGill S.M.
        Arthrogenic neuromusculature inhibition: a foundational investigation of existence in the hip joint.
        Clin. Biomech. 2013; 28: 171-177
        • Friel K.
        • McLean N.
        • Myers C.
        • Caceres M.
        Ipsilateral hip abductor weakness after inversion ankle sprain.
        J. Athl. Train. 2006; 41: 74-78
        • Gottschalk F.
        • Kourosh S.
        • Leveau B.
        The functional anatomy of tensor fasciae latae and gluteus medius and minimus.
        J. Anat. 1989; 166: 179-189
        • Janda V.
        Differential diagnosis of muscle tone in respect to inhibitory techniques.
        J. Man. Med. 1989; 4: 96-99
        • Janda V.
        • Frank C.
        • Liebenson C.
        Evaluation of Muscle Imbalances.
        in: Liebenson C. Rehabilitation of the spine. Williams and Wilkins, Philadelphia, Lippincott2007: 203-205
        • Johnson S.
        • Hoffman M.
        Isometric hip-rotator torque production.
        J. Sport Rehabil. 2010; 19: 12-20
        • Khayambashi K.
        • Mohammadkhani Z.
        • Ghaznavi K.
        • Lyle M.A.
        • Powers C.M.
        The effects of isolated hip abductor and external rotator muscle strengthening on pain, health status, and hip strength in females with patellofemoral pain: a randomized controlled trial.
        J. Orthop. Sports Phys. Ther. 2012; 42: 22-29
        • Lee J.
        • Cynn H.
        • Choi S.
        • Yoon T.
        • Jeong H.
        Effects of different hip rotations on gluteus medius and tensor fasciae latae muscle activity during isometric side-lying abduction.
        J. Sport Rehabil. 2013; 22: 301-307
        • McGill S.M.
        Low Back Disorders.
        2nd ed. Human Kinetics, Champaign (IL)2007
        • Nelson-Wong E.
        • Callaghan J.P.
        Changes in muscle activation patterns and subjective low back pain ratings during prolonged standing in response to an exercise intervention.
        J. Electromyogr. Kinesiol. 2010; 20: 1125-1133
        • Presswood L.
        • Cronin J.
        • Keogh J.W.L.
        • Whatman C.
        Gluteus medius: applied anatomy, dysfunction, assessment, and progressive strengthening.
        Strength Cond. J. 2008; 30: 41-53
        • Rasch A.
        • Byström A.H.
        • Dalen N.
        • Berg H.E.
        Reduced muscle radiological density, cross-sectional area, and strength of major hip and knee muscles in 22 patients with hip osteoarthritis.
        Acta Orthop. 2007; 78: 505-510
        • Reiman M.P.
        • Bolgla L.A.
        • Loudon J.K.
        A literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises.
        Physiother. Theory Pract. 2012; 28: 257-268
        • Selkowitz D.M.
        • Beneck G.J.
        • Powers C.M.
        Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes.
        J. Orthop. Sports Phys. Ther. 2013; 43: 54-64
        • Surface Electromyography for the Non-Invasive Assessment of Muscles (SENIAM) [Internet]
        Recommendations for sensor locations in hip or upper leg muscles; [cited 2012 Dec 15].
        (Available form)
        Date: updated 1999
        • Winter D.A.
        • Yack H.J.
        EMG profiles during normal human walking: stride-to-stride and inter-subject variability.
        Electroencephalogr. Clin. Neurophysiol. 1987; 67: 402-411