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Picture

Muscle Activation During Various Angles of Clam Exercises

5/28/2013

5 Comments

 
A common exercise you may see in the clinic is sidelying clam shells. We had previously been hesitant to utilize this exercise ourselves, as we were taught that it preferentially activates the TFL over the Gluteus Medius. With weakness in the Gluteus Medius being a frequent culprit in individuals with knee, hip, and back pathologies, you can understand our avoidance of this exercise.

In JOSPT's recent issue, one of the studies reported on the muscle activation pattern in the hip for various angles of clam exercises. The authors looked at EMG activity of the Gluteus Maximus, Gluteus Medius, and TFL during sidelying clam shell exercises with the hip in 0, 30, and 60 degrees of flexion. Additionally, they studied the effect of complete sidelying and a 35 degree backward rotation (reclined) had on muscle activation. Interestingly, TFL activity was low throughout all positions, while Gluteus Maximus and Gluteus Medius were highest in complete sidelying with 60 degrees of hip flexion. This shows that, with proper positioning, sidelying clam shell exercises can be useful for strengthening the Gluteus Medius (along with the Gluteus Maximums).

That being said, there are two items that come to mind. As much as the Gluts are targeted with sidelying clam shells, do they have increased activation compared to pure sidelying hip abduction for the Gluteus Medius (which is the MMT position)? Obviously, we want to choose the exercises that focus on the muscle the most. This study looked at hip muscle activation in several exercises and found sidelying hip abduction to be the most specific to strengthening of the Gluteus Medius. Additionally, clam shells are sidelying. To what extent do we want to continue sidelying/supine exercises, when they are not as functional as more advanced, standing exercises? That's not to say that clam shells do not serve a purpose for patients at lower functional levels, but are we relying on lower level exercises too much?
Picture
5 Comments
Sam
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)

Reply
Chris link
6/7/2013 07:55:07 am

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.

Reply
Justin
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.

Oh, and this study used fine-wire electrodes, not surface. Here's the article if you want to check it out.

Selkowitz DM, Beneck GJ, Powers CM. 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 Feb;43(2):54-64. doi: 10.2519/jospt.2013.4116.

Reply
Chris link
6/9/2013 02:12:19 pm

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.

Reply
Sharondakis
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/

Would be interested to hear your comments.

Reply



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