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Damien Moore, Tania Pizzari, Jodie McClelland and Adam I. Semciw

Gluteus medius (GMed) activity levels have been evaluated across a range of therapeutic exercises. 1 In most cases, single-leg weight-bearing exercises show greater activity levels than non-weight-bearing exercises when measured with a single-surface electrode over the middle GMed region. 1

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Hae-rim Han, Chung-hwi Yi, Sung-hyun You, Heon-seock Cynn, One-bin Lim and Jae-ik Son

Biomechanically, the gluteus medius (GMED) controls femoral motion during dynamic lower-extremity motion, and counteracts gravity to stabilize the pelvis in a single-leg stance. 1 , 2 However, when the GMED becomes weak, numerous neuromuscular problems including hip joint pathology, lateral hip

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Karrie L. Hamstra-Wright and Kellie Huxel Bliven

Clinical Scenario:

The gluteus medius (GM) is thought to play an important role in stabilizing the pelvis and controlling femoral adduction and internal rotation during functional activity. GM weakness, resulting in decreased stabilization and control, has been suggested to be related to lower extremity dysfunction and injury. Many clinicians focus on strengthening the GM to improve lower extremity kinematics for the prevention and rehabilitation of injury. An indirect way to measure GM strength is through electromyography. It is generally assumed that exercises producing higher levels of activation will result in greater strengthening effects.3 Understanding what exercises result in the greatest level of GM activation will assist clinicians in their injury prevention and rehabilitation efforts.

Focused Clinical Question:

In a healthy adult population, what lower extremity exercises produce the greatest mean GM activation, expressed as a percentage of maximum voluntary isometric contraction?

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Randy J. Schmitz, Bryan L. Riemann and Timothy Thompson

Objective:

To determine whether gluteus medius (GM) activity increases in response to isometric closed-chain external hip rotation.

Design:

Subjects performed single-leg stances in 3 different conditions: 0° knee flexion, 0° hip flexion (C1); 0° knee flexion, 20° hip flexion (C2); and knee flexed 20–30°, 20° hip flexion (C3). Posteriorly directed forces of 8.9 N (F1), 17.8 N (F2), and 26.7 N (F3) were applied at the lateral pelvis of the nonstance side during each condition.

Subjects:

20 college students.

Measurements:

Surface EMG RMS amplitude from the GM and kinematic data from the trunk, hip, and knee.

Results:

Statistical analyses revealed a significant Condition 3 Force interaction and significant increases of EMG activity from C1F1 and C1F2 to C1F3 and from C3F1 to C3F2 and C3F3. F2 and F3 of C2 were significantly less than F2 and F3 of both C1 and C3.

Conclusions:

GM activity increases in response to isometric, closed-chain, external hip-rotation forces, and forward movement of the upper body with respect to the base of support decreases GM activity.

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Catriona O’Dwyer, David Sainsbury and Kieran O’Sullivan

Context:

Functional subdivisions are proposed to exist in the gluteus medius (GM) muscle. Dysfunction of the GM, in particular its functional subdivisions, is commonly implicated in lower limb pathologies. However, there is a lack of empirical evidence examining the role of the subdivisions of the GM.

Objectives:

To compare the activation of the functional subdivisions of the GM (anterior, middle, and posterior) during isometric hip contractions.

Design:

Single-session, repeated-measures observational study.

Setting:

University research laboratory.

Participants:

Convenience sample of 15 healthy, pain-free subjects.

Intervention:

Subjects performed 3 maximal voluntary isometric contractions for hip abduction and internal and external rotation on an isokinetic dynamometer with simultaneous recording of surface electromyography (sEMG) activity of the GM subdivisions.

Main Outcome Measures:

sEMG muscle activity for each functional subdivision of the GM during each hip movement was analyzed using a 1-way repeated-measures ANOVA (post hoc Bonferroni).

Results:

The response of GM subdivisions during the 3 different isometric contractions was significantly different (interaction effect; P = .003). The anterior GM displayed significantly higher activation across all 3 isometric contractions than the middle and posterior subdivisions (main effect; both P < .001). The middle GM also demonstrated significantly higher activation than the posterior GM across all 3 isometric contractions (main effect; P = .027). There was also significantly higher activation of all 3 subdivisions during both abduction and internal rotation than during external rotation (main effect; both P < .001).

Conclusions:

The existence of functional subdivisions in the GM appears to be supported by the findings. Muscle activation was not homogeneous throughout the entire muscle. The highest GM activation was found in the anterior GM subdivision and during abduction and internal rotation. Future studies should examine the role of GM functional subdivisions in subjects with lower limb pathologies.

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Jay R. Ebert, Peter K. Edwards, Daniel P. Fick and Gregory C. Janes

Context:

Gluteus medius rehabilitation is of critical importance given its role in pelvic and lower limb stability, and the known link between gluteus medius weakness and many lower limb conditions.

Objective:

To systematically review the literature and present an evidence-based graduated series of exercises to progressively load gluteus medius.

Evidence Acquisition:

A systematic literature search was conducted in January 2016 to identify studies reporting gluteus medius muscle activity as a percentage of maximal volitional isometric contraction (MVIC), during rehabilitation exercises. Studies that investigated injury free participants were included. No restrictions were placed on the type or mode of exercise, though exercises that could not be accurately replicated or performed within an independent setting were excluded. Studies that did not normalize electromyographic activity to a side lying MVIC were excluded. Exercises were stratified based on exercise type and %MVIC: low (0% to 20%), moderate (21% to 40%), high (41% to 60%), and very high (> 61%).

Evidence Synthesis:

20 studies were included in this review, reporting outcomes in 33 exercises (and a range of variations of the same exercise). Prone, quadruped, and bilateral bridge exercises generally produced low or moderate load. Specific hip abduction/rotation exercises were reported as moderate, high, or very high load. Unilateral stance exercises in the presence of contralateral limb movement were often high or very high load activities, while high variability existed across a range of functional weight-bearing exercises.

Conclusions:

This review outlined a series of exercises commonly employed in a rehabilitation setting, stratified based on exercise type and the magnitude of gluteus medius muscular activation. This will assist clinicians in tailoring gluteus medius loading regimens to patients, from the early postoperative through to later stages of rehabilitation.

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Vincent J. Leavey, Michelle A. Sandrey and Greg Dahmer

Context:

There are few outcomes-based studies that address hip strategy and gluteus medius strength (GMS) for maintaining dynamic postural control.

Objective:

To determine whether GMS training, proprioception training, or a combination of the 2 has an effect on dynamic postural control.

Design:

Pretest-posttest, repeated measures.

Setting:

Sports-medicine clinic.

Participants:

48 healthy male and female college students obtained via sample of convenience.

Interventions:

Three 6-wk programs including exercises for proprioception, GMS, and combined.

Main Outcomes Measures:

Eight Star Excursion Balance Test (SEBT) reach distances and GMS for the dominant leg.

Results:

There was no significant difference between groups. The combination group demonstrated the most improvements in SEBT reach distances, whereas the GMS group demonstrated the most improvement in GMS.

Conclusion:

Use of exercises for proprioception, GMS, or a combination of the 2 will help improve dynamic postural control in healthy, active individuals.

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Jennifer E. Earl

Context:

Gluteus medius (GM) contraction during single-leg stance prevents the contralateral pelvis from “dropping,” providing stability for lower extremity motion.

Objective:

To determine which combination of hip rotation and abduction exercise results in the greatest activity of the GM and whether the GM responds to increased loads in these exercises.

Design and Setting:

Repeated measures, laboratory.

Subjects:

20 healthy volunteers.

Interventions:

Resistance (2.26 and 4.53 kg) was provided to 3 variations of a single-leg-stance exercise: hip abduction only, abduction-internal rotation (ABD-IR), and abduction-external rotation.

Measurements:

Muscle activity was recorded from the anterior and middle portions of the GM using surface electromyography.

Results:

ABD-IR produced the most activity in the anterior and middle sections of the GM muscle. The 4.53-kg load produced significantly more activity than the 2.26-kg load (P < .05).

Conclusions:

The GM is most active when performing abduction and internal rotation of the hip. This information could be used to develop GM-strengthening exercises.

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Renan Lima Monteiro, Joana Hoverter Facchini, Diego Galace de Freitas, Bianca Callegari and Sílvia Maria Amado João

Context:

Pelvic-drop exercises are often used to strengthen the gluteus medius (GM) muscle with the aim of increasing or prioritizing its recruitment. However, the effect of hip rotation on the performance of the action of the GM is unknown.

Objective:

To evaluate the effect of hip rotation on the recruitment of the GM, tensor fasciae latae (TFL), and quadratus lumborum (QL).

Method:

Seventeen healthy subjects performed 2 sets of 4 repetitions of pelvic-drop exercise in random order with pelvic-drop lateral, medial, and neutral rotation of the hip.

Main Outcome Measures:

The electromyographic (EMG) activity of the GM, TFL, and QL was evaluated using surface electromyography.

Results:

There were significant increases in the activation of the GM with medial and neutral rotation compared with lateral rotation (P = .03, P = .01, respectively), and there was no difference between medial and neutral rotation (P = 1.00). There was no difference in EMG activity of the TFL and QL in any of the positions. The GM:TFL ratio was the same in all analyzed positions. Regarding the GM:QL ratio, there was a significant increase with medial rotation compared with lateral rotation (P = .02).

Conclusions:

Pelvic-drop exercises are more efficient for activating the GM when the hip is in medial rotation and neutral position.

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Roald Otten, Johannes L. Tol, Per Holmich and Rodney Whiteley

Study Design:

Cross-sectional.

Context:

Gluteus medius (GM) muscle dysfunction is associated with overuse injury. The GM is functionally composed of 3 separate subdivisions: anterior, middle, and posterior. Clinical assessment of the GM subdivisions is relevant to detect strength and activation deficits and guide specific rehabilitation programs. However, the optimal positions for assessing the strength and activation of these subdivisions are unknown.

Objective:

The first aim was to establish which strength-testing positions produce the highest surface electromyography (sEMG) activation levels of the individual GM subdivisions. The second aim was to evaluate differences in sEMG activation levels between the tested and contralateral (stabilizing) leg.

Method:

Twenty healthy physically active male subjects participated in this study. Muscle activity using sEMG was recorded for the GM subdivisions in 8 different strength-testing positions and analyzed using repeated-measures analysis of variance.

Results:

Significant differences between testing positions for all 3 GM subdivisions were found. There were significant differences between the tested and the contralateral anterior and middle GM subdivisions (P < .01). The posterior GM subdivision showed no significant difference (P = .154).

Conclusion:

Side-lying in neutral and side-lying with hip internal rotation are the 2 positions recommended to evaluate GM function and guide specific GM rehabilitation.