BackgroundClamshells are one of the most prescribed exercises for individuals with knee pain. This exercise is intended to target the hip abductors, specifically the gluteus medius muscle. EMG studies have found good activation of both the gluteus medius and gluteus maximus muscles during the clamshell. Additionally, the clamshell has been shown to preferentially activate the gluteus medius while minimizing activity in the tensor fascia latae (TFL).
Common CompensationsWhile the clamshell is intended to have good activation of the gluteal muscles, the exercise will only be as effective as the person instructing the movement. In regards to movement patterns, the body always takes the path of least resistance (i.e. the repetitive, facilitated movement pattern). Individuals who will benefit from performing the clamshell exercise likely have difficulty engaging the gluteus medius. Proper cueing is necessary to avoid compensatory motions.
How to PrescribeThe video below contains a 3-part progression for performing the clamshell exercise. When the client can perform 20-30 repetitions without compensation, I progress to the next level of the exercise. Author: Jim Heafner PT, DPT, OCS
Citations:
Sahrmann, S. (2002). Diagnosis and treatment of movement impairment syndromes. St. Louis: Mosby.
13 Comments
7/10/2017 10:16:44 pm
Exercise is the very necessary for everyone because through the exercise increase the life time. Always eating the normal diet daily and drink the milk, natural juice and pure water. Doctor also suggests the every patient for doing the exercise.
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Ali Demirkan
12/27/2017 09:41:09 am
This article has been useful for me, thank you!
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Emily
4/2/2018 02:34:11 pm
How do you do this without overusing your IT band thus hurting your knee?
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Jim
4/2/2018 10:51:27 pm
One strategy I use with people is rolling the hips and pelvis forward. This relatively decreases the mm activation of the TFL muscle and allows the gluteal to work.
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Sara
2/15/2019 06:16:40 pm
Yes! Exactly! I also have found it more useful to roll the top hip more forward... I get annoyed when other PTs and PTAs progress the patient to using a band around the knees because I personally think a band is never needed if the person is doing the exercise correctly. Using a band causes more compensation, TFL/QL activation and does not really work the PGM like they think it does. Ugh! But I seem to be the only one who feels this way!
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Andrea
3/26/2019 09:59:58 am
When I do a clamshell it feels like I’m engaging my anterior hip flexors, maybe the iliopsoas or the sartorius, and the front of my hip definitely feels “shaky” afterwards. Should the front hip flexors be turning on at all?
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Daniel Bankov
9/5/2019 09:57:03 pm
Same here. My iliopsoas really work hard on clamshells... Not sure how to do it so it doesn't get activated so much
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Lee
4/6/2020 12:24:54 am
I hv problem with my right hip. Maybe is hip spine syndrome. Clamshell makes me pain after doing. My whole buttock feels like inflammation and QL seems like spam too. I think i follow all instruction correctly. May i know what is wrong. I dont hv problems on left though
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Tony Rocklin
4/6/2020 07:23:21 am
This is common in many people who have an intra-articular hip problem such as labral tear, OA or FAIS...not everyone of course but many. You might also have done instability related to dysplasia. How old are you and have you had imaging of hip? Go see a PT who specializes in hip pathology.
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Question
5/9/2020 12:46:48 am
I 've started this exercise and I think my piriformis muscle hurts so much like it was tearing, it was incredibly painful, could you please advise why ?
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Renee
10/18/2020 05:46:50 pm
My PT has asked me to do 15 reps of these with resistance band, 2 rounds. Every time I do them, my hip is popping, and it is bringing on a burning sensation, to the point I am in tears. It is awful. I'm not sure what is happening, but definitely will stop using the resistance band until I can speak with her at our next appointment.
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Nikki
2/17/2021 05:45:44 pm
When I do this exercise my knees often feel stiff and sore afterwards. What could I be doing wrong?
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