6/2/2013 10:00:05 am
I read this study and they only used surface EMG, which would be difficult to pick up glute med without cross talk nether mind the different portions of glute med. Id rather perform clams in 0 degrees as this is more of a functional position during gait and also minimise TFL activity (although this study disagrees)
Thanks for your comment Sam! I definitely agree that the use of surface EMG has its limitations in regards to "noise." It makes sense that clams in 0 degrees of hip flexion would focus more on the gluts and less on the TFL. However, we still like to try and stick to sidelying hip abduction if the patient is capable due to the higher muscle specificity and activation.
6/9/2013 07:01:32 am
I saw that you raised a question about sidelying abduction. It does have the highest recruitment of the glut med, but the highest recruitment of the TFL at the same time, per another study published in JOSPT in Feb 2013 by Selkowitz. In that study they tested 11 exercises, and the one with the best ratio of glut med to TFL activity was the clamshell. Only one functional exercise had good ratios... sidestepping. I definitely agree with you that we should have a focus on functional exercise. But I also want to use the best exercise there is for pure strength, which targets the muscles I want and minimizes the muscles I don't want. And in this case it is the clamshell, not sidelying abduction.
Thanks for the comment and article Justin! I'm glad to see a study like this that doesn't rely on surface emg. It would appear that the clamshell definitely has its uses then! Two questions come to mind for me: for the sidelying hip abduction, how was the exercise performed? If it was pure sidelying hip abduction, it would not surprise me that it would have high TFL activity. Was it performed a la Kendall MMT position (forward rotation of top hip, with some hip rotation)? I believe the purpose of this positioning is to decrease TFL activity. I know this is how I have my patients perform the exercise, especially because in pure sidelying you see that hip ER that increases TFL activity even more. I would be interested to know, but unfortunately didn't see it in the article. The second question is one that the post kind of presented already. How well do these supine/OKC exercises translate into functional strength/control? I know it would seem like a dumb question, but I wonder if we have to do some neuromuscular retraining to get that complete transition back to a level where we do not see impairments at the functional level.
9/13/2017 01:25:49 pm
Hi Chris, thanks for the interesting article! When I personally try to do a clam, the sartorius activates after 20 degrees lift. This article also seems to support that the side lying hip abduction is the best way to activate and strengthen the Gmed w little activation of the TFL or hip flexors: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3418110/
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