Resistance training and running

Resistance Training (RT) means the use of some form of resistance against muscular actions of the body. Commonly this can involve free weights, such as dumbells or kettlebells or weights machines such as leg press, leg extension or hamstring curl.

RT and distance running haven't always had an easy relationship. Many people believe that RT isn't helpful for distance runners and can even have a negative impact on performance. Some go as far as saying “performing weights using a machine should NEVER be done by any runner.”

The arguments against RT usually centre around a few points suggesting it isn't functional, can negatively affect performance and may reduce activity of stability muscles. These arguments may be valid but I've never seen them presented with any research evidence to support them.

Regular readers might remember we had a similar issue with the use of sidelying exercises for glutes. A number of people are adamant they shouldn't be used for rehab despite extensive research showing they have a role. This appears to be the case with RT, and once again I would urge people to remember that nothing is set in stone with physiotherapy or exercise science. As soon as you declare something to be an absolute certainty someone will find evidence to the contrary. I think it's important to be relaxed in your opinions and open to the ideas of others. To that end, I would recommend you read the article that the quote above comes from. That way you can see both sides of the debate and make an informed decision.

The National Strength and Conditioning Association (NSCA) recommends RT for endurance athletes;

“Intelligent use of the weight room, just like intelligent implementation of a running program, can have a dramatic influence on the success of the competitor. This success can be defined as faster running times, but can also be extended to include reduced injury risk, and an overall heightened enjoyment of the sport, a goal that many athletes surely have.” Erikson 2005

More evidence for the use of RT comes from excellent articles by Jung (2003) and Jones and Bampouras (2007 summary only). Their reviews of the literature will form the basis for our conclusions here.

We'll look at the effect of RT on a few key factors in running VO2 Max, lactate threshold, running economy, injury prevention and injury rehab.

VO2 Max

VO2 Max is the maximal capacity of an individual's body to uptake, transport and use oxygen during exercise. It is often used as a measure of physical fitness, more details available here.

Research has concluded that RT is unlikely to increase VO2 Max in trained individuals but also has been shown not to decrease it. I.e. while it might not help, it doesn't hinder.

Lactate Threshold

Lactate threshold isn't easy to describe. This very useful article defines it as “the fastest pace you can run without generating more lactic acid than your body can utilize and reconvert back into energy”

There wasn't a great deal of research into RT and lactate threshold. 1 study showed an increase in untrained individuals but no change has been shown in distance runners. Once again RT was shown not to have a negative impact.

Considering the nature of RT we wouldn't expect it to improve VO2 Max or lactate threshold in trained individuals. RT is not usually an activity that involves prolonged periods of exercise with high demands on the cardiovascular system. Instead it usually requires bursts of activity placing muscles under load. We wouldn't expect it to improve cardiovascular fitness and the research appears to have confirmed this.

Running Economy

Running Economy is how efficiently a person uses oxygen while running at a certain pace. It is a measure of running efficiency, a little like how much fuel a car would use at a certain speed. Imagine I asked you to run with a fridge on your back, it would drastically reduce your running economy but your VO2 max wouldn't change. You'd still be as fit physically, but you'd run a lot slower due to very poor running economy. On the upside, you could stop occasionally and snack on something from the fridge!

RT has been shown to improve running economy and Jones and Bampouras (2007) point out that there is a strong association between running economy and distance running performance.

The exact mechanism by which RT improves running economy hasn't been defined but there are several theories on how it works. A short version is this – resistance training improves muscle strength, neurological characteristic and 'stiffness' resulting in more efficient use of energy with every footfall. For the more technical amongst you it is thought to affect the Stretch Shortening Cycle improving efficiency of translation of ground reaction force into forward propulsion.

Thinking about it from a more common sense point of view, imagine if your legs were so weak you could barely get up from a chair, you wouldn't be able to run very well at all. Now imagine they are so strong and muscular that you look like Arnie in the 80's and your thighs are visible on GoogleEarth, you'd struggle to run then too! Somewhere there is a middle ground, an optimal amount of strength for the running you do.

Injury Prevention

Perhaps somewhat surprisingly there is a lack of research on the use of RT in injury prevention in runners. Fields et al. 2010 commented that, “there are no prospective, primary prevention studies in runners” in their review of the research underlying the prevention of running injuries. They went on to conclude,

“In spite of numerous studies, strong evidence for prevention of running injury exists only for controlling training errors primarily by limiting total running mileage…While studies of strength, biomechanics, stretching, warm-up, nutrition, shoes, and psychological factors all raise intriguing questions about both the etiology and the prevention of running injuries, strong evidence that modifying any of these will prevent running injury requires further research.”

It makes sense that improving strength should reduce injury risk but we just don't have the research to back that theory up yet. Maybe it's because training error, particularly doing too much, is such a common cause of injury that adding in more exercise (in the form of RT) doesn't always help the situation. Fitting RT within a busy training schedule without impacting upon the quality of other workouts can be a challenge, we'll touch on how to manage this shortly.

Injury rehab

I feel RT has perhaps its biggest role here. Away from research for a moment, experience tells me that resistance training can be hugely beneficial when used as part of a comprehensive rehab programme. I've run lower limb rehab groups for over a decade and seen countless patients improve with progressive resistance training including free weights and machines.

We combine weight machines such as leg press, leg extension, hamstring curl and hip abduction/ adduction with squats, single leg dip, calf raises and lunges. We add balance and control exercises on rocker boards, wobble boards, BOSU's, trampette and balance cushions. We use agility and sport specific drills with ladders, cones and hurdles and add in plyometrics and multidirectional stability work. We make cardiovascular fitness part of the programme and get people running, cycling, rowing or cross training. RT isn't all of the rehab programme but certainly can be an important part of it.

We've talked before about the big three strength, balance and flexibility and how important they are in limb function and running. There is a wealth of research showing how RT can be used to develop the first of the big three, strength. Indeed tweaking of your resistance training allows you to target specific goals within the broader category of strength, including power, endurance and hypertrophy (increasing muscle size).

What your goals are post injury and how you use RT to achieve them will depend on the injury itself and what deficits you have. Identifying these weaknesses usually requires some help from a Physio or sports therapist. I would recommend having some guidance before embarking on a resistance programme to rehab an injury as it is easy to aggravate a problem and it's more effective when used to target specific problem areas. Resistance Training should be pain free, and I would recommend a gradual increase in resistance if rehabbing and injury.

Practicalities – how should I use RT?

As mentioned above RT is most likely to be effective if used to strengthen areas of weakness, rather than a scattergun approach of a bit of everything. That said, common weak areas include calf, quads, hamstrings and glutes and all of these can be targeted with RT. In the coming weeks we will be adding videos to the blog on how to 'blitz' some of these muscles with 3-5 minutes of intense exercise.

When introducing a RT programme it is best to do it slowly, with gradual increase in load and frequency. Ideally RT should be done at least twice per week although you will see changes with a once weekly session. Allow at least 8 hours between running and then doing resistance training, ideally have a 24-48 hour gap. The research is less clear on doing resistance training and then running, I would suggest a similar 24-48 hour gap if possible. Running on legs that are recovering from RT is challenging and can risk injury. So a weeks schedule could be;

Monday rest Tuesday run Wednesday RT Thursday run Friday RT Saturday rest Sunday long run.

The long run is 'bracketed' by rest days and you have 24 hours between running and RT. Juggling running 5 or more times per week with RT is a real challenge. You may need to be doing both in the same day, if so consider doing one morning and one in the evening to allow at least 8 hours and choosing that day to do a recovery run rather than interval or hill work. Erikson (2005) and Paul and Bampouras (2007) both include upper limb strengthening in their RT programme, this could be done more easily on days when running and RT are combined.

Realistically for many runners, especially those of us with jobs, families, partners etc a once weekly RT session is more realistic. Hopefully the 'blitz' videos will provide a way of doing strength work in a short period of time to make it more feasible.

What about repetitions (reps), sets and loads?

This is a vital, and often neglected part of RT. Like choosing which muscle group to work on, selecting reps, sets and loads should ideally be based on specific deficits. There are 4 main categories strength, power, hypertrophy and endurance. The American College of Sports Medicine (ACSM) produced these guidelines which form the basis of the recommendations below;

Strength is about production of force, plain and simple. Building strength is increasing the force a muscle group can produce. To build strength do 8-12 reps using a moderate to heavy load (so the final 2 reps are challenging and you probably wouldn't manage an extra rep) do 3 sets each separated by a rest period of 2-3 minutes. Increase the load by 2-10% when you can manage 1-2 reps above your target e.g. If you're aiming for 12 reps with a certain load but can do 14. Strength work often forms the basis of power, endurance and hypertrophy training. Although distance running is an endurance event it may be that building strength with RT will be more appropriate for some runners, as mentioned before it will depend on the individual.

Power is closely related to strength but time becomes a factor. Power is essentially strength divided by time. A good example of power is Olympic Weightlifting – a huge weight is lifted at high speed. You'll need adequate strength before attempting power work so it's often best to work on strength first. When building power start with low to moderate weight and gradually build to heavy loads. Do 3-6 reps with an 'explosive tempo' I.e. quickly! 1-3 sets with a rest period of 2-3 minutes between each.

Hypertrophy means increasing muscle bulk. This is particularly useful if you have had an injury that resulted in muscle atrophy (reduction in muscle size). Again a basic level of strength is needed before doing hypertrophy work. There is some cross-over between the two and strength work is likely to result in some increase in muscle bulk. Initial loads and reps are similar to strength – 8-12 reps with moderate to heavy load, 1-3 sets separated by 1-2 minute rest period. This may progressed to heavier loads 1-12 reps (depending on load) 3-6 sets with a 2-3 minute rest period.

Endurance is how well a muscle produces the same amount of force when asked to continue to do so for a prolonged period of time. Use light to moderate loads, 15-25 reps, multiple sets (start at 2-3 and build up) with a 1-2 minute rest period between sets. I aim to fatigue a muscle group with endurance work, so the load you use should be sufficient to do that within 15-25 reps.

Reps and sets are somewhat redundant unless load is considered. Reps and load come together in something called Repetition Maximum or Rep Max (RM). 1RM is the maximum load you can lift once with good technique. 10RM is the maximal load you can lift 10 times with good technique. The load for 10RM will obviously be lower than 1RM. To work out 10RM pick an exercise and gradually increase the load until you find the amount you can lift 10 times (but couldn't manage 11). Just to confuse you, the loads recommended by research are often presented as a percentage of 1 rep max. I have included these and the details above in a table below for those that want that level of detail. For the rest of us, it's usually about lifting the heaviest load you can manage for the amount of reps you're doing, while maintaining a good, pain free technique.

The exact percentage of Rep Max and reps and sets recommended for strength, power, hypertrophy and endurance are subject to much debate. The guidelines from the ACSM looked at over 250 studies to produce their recommendations, despite this even their conclusions have been questioned. I'm very open to suggestions on reps, sets etc please feel free to put them in the comments section. What I have presented is a rough guide based on recommendations in research. Erikson's paper includes a sample RT programme including sets and reps as does Jones and Bampouras (if you can access it).

The ACSM make a host of other recommendations including that a mixture of free weights and machines are used and that concentric, eccentric and isometric work is included. For further details see their paper, linked above.

Study Limitations

There are limitations to the findings from the literature, as ever. Jung (2003) points out a sparcity of evidence showing improved race time as a result of RT. The methods used vary considerably, with some studies incorporating plyometrics as well as resistance training. A key point too is the population they have studied, again they varied from untrained individuals to elite athletes, although most were done in trained individuals (as measured by VO2 Max). One group that appears to be missing is injured runners, most of this work is done on 'healthy' subjects. The research done on injured individuals is often a) not specific to runners or b) involves a mixture of treatment approaches which may include RT. Even then research is seldom totally conclusive and there is a limitation in research itself – it's designed to allow you to apply a treatment approach or physical test to a certain population and yet, even within that population, people are incredibly different.

Even with a fairly specific population you'd have difficulties. If you studied runners, with patellofemoral pain syndrome between 20 and 40 years old, with no signs of arthritis on X-ray and you treated with resistance training you might only expect 30-40% to improve. Why? Because some will have it from over training, some from control issues, some with biomechanical problems, some with tissue flexibility issues etc etc. It's unlikely that research done is this manner will make definite conclusions.

Luckily though, we don't make decisions solely on research, we can use experience and learning too. It's often said as people we are each an experiment of 1 – see what works for you that's the key.

Final thoughts: Resistance Training has the potential to improve running economy and performance. It has long had a role in injury rehab and is likely to have one in injury prevention. The research reviewed here did not find that RT had a negative impact on VO2 Max, lactate threshold or running ability.

RunningPhysio recommends that you see a health professional prior to starting a resistance training programme to help you identify specific deficits. This can make RT more effective and reduce risk of injury.

 

 

 

 

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RunningPhysio review – Ankle Foot MaXimizer

I arrived in our clinic @ThePhysioRooms and there, sat on the desk was a box with “Air Mail” written on it. Air mail? I never get Air Mail and yet here it was, looking fresh despite a long journey from Canada. I was like a child in a sweet shop. A very geeky child in a sweet shop that sells high-tech rehab equipment!

As soon as I’d torn off the tape and opened the box I knew we had a product on our hands. The first thing that greets you is the black AFX carry bag, neatly folded on top. Peel that away and the first sight is a little intimidating – the foot pad, the cables, the handles and pole – and yet I was pleasantly surprised to find it came ready to use, literally straight out of the box. It comes with fool proof instructions and a 30 minute instructional DVD.

In seconds the socks were off and AFX was on. It feels really comfortable on the foot, almost like it gives it a little hug. You can instantly feel the muscles around the foot and ankle working as you use it. But “feel” isn’t enough for me. I wanted something a bit more objective, so I put it through it’s paces with a 3 stage review process….

Stage 1 – EMG Tests

EMG (Electromyography) is an assessment used to determine the electrical activity within a muscle. It is a measure of how well a muscle is activating. In this case the higher the value the better. We used our EMG unit to assess how red, medium level AFX compared with black resistance band ( XX Heavy resistance from Stretchaband) Tables below detail the approximate resistance profiles of each. There are a lot of variables in this assessment and it was only done on 1 subject (me!) so it’s an approximation rather than firm scientific research.


Stretchaband is a latex free resistance band, ranging in strength from yellow to black. Further details can be found here.

Black was chosen as it’s resistance at 100% elongation (double normal length) was similar to the red level on AFX. These can only be approximated as resistance varies hugely depending on elongation, as the chart shows.

AFX comes in 4 levels of resistance from low in yellow to performance in blue.

For this stage we assessed the maximal EMG score achieved when testing a) gastrocnemius (calf) muscle contraction and b) Tibialis Anterior contraction. Best score of 5 attempts was recorded with maximal stretch on the resistance band or AFX.

Picture on the right shows EMG set up to test Tibialis Anterior.


Stage 2 – Fatigue test

We compared numbers of repetitions needed to fatigue the calf muscle using the black band and red AFX with maximal stretch.


Stage 3 – Group Evaluation

I work with a lovely team of experienced physios and they kindly gave up an hour of their time to try out the AFX, compare it to resistance band and discuss their findings. They had 2 main questions to answer;

  1. Does AFX have key advantages to resistance band?
  2. Are there disadvantages to AFX?


The results

Stage 1

AFX scored higher than resistance band for both gastrocnemius and tibialis anterior muscles in our EMG studies;

For the gastrocnemius muscle both AFX and resistance band scored less than a single leg calf raise. This isn’t surprising as this involves resistance of the entire body weight. That said, AFX scored 425 to single calf raise at 460. Had we used a harder AFX level we may well have achieved the same muscle activation.

Stage 2

Guest blogger and fellow Physio Andy took on this challenge (as he has calf muscles of solid steel!). He did AFX first and his calf muscle fatigued at 36 reps. He repeated the test with resistance band after a rest period…he stopped at 70 reps, and still hadn’t fatigued the calf.

Stage 3

At first I think our team were a little sceptical and I faced the question, “isn’t it just posh resistance band?” Their views soon changed once they’d had a chance to use the AFX. After some experimenting they answered the questions

  1. AFX does have key advantages to resistance band. It provides a harder resistance, appears to increase activity in the intrinsic muscles in the foot and proved an easier way of resisting foot and ankle movements. It also can be used for stretching and improving ankle range of movement, I found it especially useful for improving ankle inversion (turning in) which can be a challenging movement to stretch. Because AFX attaches to the toes and metatarsals it allows you to combine movements such as plantarflexion and toe flexion to work multiple areas. The way AFX attaches also prevents slippage that you can get with resistance band and maintains resistance throughout. Because of this it was easier to use than band for eccentric muscle work, especially on Tibialis Posterior.
  2. The only noted disadvantages were cost and portability. It was pointed out that resistance band could fit in a handbag or travelbag when AFX probably couldn’t.

AFX in action;

Conclusion

Overall AFX is an exciting new product that has multiple uses and our testing indicates it’s a more effective way of strengthening the foot and ankle. The AFX certainly “feels” like it works the muscle harder and the EMG results suggest it achieves better muscle contraction than resistance band. Not only this, but it fatigues muscles more efficiently – with resistance band it took double the reps needed with AFX to reach fatigue. Our usual rep range to improve endurance is 15-25 reps. Fatigue was achieved at 36 with the AFX, with 2 harder levels of resistance available it is likely we could work in this range using a harder level. Resistance band needed over 70 reps to reach fatigue with the hardest band available to us, at maximal stretch. It’s unlikely this would improve strength or endurance and this is consistent with what I’ve found with patients – resistance band doesn’t offer enough resistance to improve most people’s calf muscle strength. It is probably adequate for the smaller muscles involved in inversion and eversion but for calf rehab I would definitely choose AFX over resistance band.

This review isn’t just about AFX vs band. AFX stands on its own as a product. In many areas in rehab we have several tools that aim to achieve a similar goal, each with their own benefits. Take wobble boards, rocker boards, balance cushions, BOSU balls etc etc. they all work balance in slightly different ways. Resistance band certainly has a role and this review shows that AFX does too. The only downside is cost. Bought in bulk, bands can be as little as £1 to £2 per metre. Currently AFX is not available in the UK but manufacturers are hoping to introduce it in Autumn/ Winter. In Canada and the US it is available in 2 different packages, standard at $99 and “Pro” at $129.

To put this into perspective though, a BOSU ball in the US cost $109 (at BOSU.com) and my running shoes (Gel Kayano 18) around $140. For individuals it may be at the top end of their budget but for a product that could really help rehab foot and ankle problems, which are very common in runners, it could be money well spent. As it’s easy to clean, physiotherapy clinics could invest in an AFX and potentially use it for multiple clients.

Final thoughts: AFX is an exciting and innovative new product in foot and ankle rehab. It shows great potential for strengthening and stretching and has clear advantages over resistance band if you’re happy to pay the extra cost.

For more information on this product check out their website or chat to Matt on @afxonline on Twitter.

 

Gluteus Medius – evidence based rehab

This is in part advice for runners and in part something else….

…you’ve heard of a “dance off” and probably a “sing off” this my friends is a geek off!

It’s come about after I’ve heard lots of people being advised not to bother with sidelying exercises for glutes because they “aren’t functional”. Several well-meaning websites even describe them as harmful and more likely to cause “regression” than rehab. I say in my home page for this site that I appreciate everyone’s opinion and I do. I also agree that sidelying work isn’t functional, but I feel it still has a valuable place in glutes rehab and it shouldn’t be treated as ineffective quackery! My point here isn’t that sidelying work is the best, but simply that it has it’s value in rehabbing glutes and should be used as part of a comprehensive programme including weight bearing exercises.

So let’s examine some glutes exercises you can do and some research behind them. All pictures are reproduced from research articles freely available on the web and will be referenced and linked.

Sidelying abduction – reproduced from Distefano et al. 2009 (below). There is also a video although it doesn’t work on the iPad. This page contains links to videos for all the exercises in this article (links may take you to a “mobile page” if using iPad or iPhone. Use the search box and you can locate the full article without signing in).

Distefano et al. 2009 used an EMG study to determine which exercises produced most activation of Gluteus Medius. EMG (Electromyography) uses electrodes to examine muscle activation. They compared a number of exercises including hip clam, single limb squat, single limb deadlift, lateral band walks, multiplanar lunges and multiplanar hops. They concluded that,

“The best exercise for Gluteus Medius was side-lying abduction”

They found single limb squat to produce the second most EMG activity and lateral band walk the third.

Now you may be wondering does this translate to changes that I can feel and see? Will it improve my symptoms? It’s fair to question this, EMG change is all good in theory but what about in practice?

Fredericson, who’s written quite widely on ITB problems and their treatments did a study on runners in 2000. They found that,

“Long distance runners with ITBS have weaker hip abduction strength in the affected leg compared with their unaffected leg and unaffected long-distance runners….symptom improvement with a successful return to the pre injury training program parallels improvement in hip abduction strength.”

So hip abduction, one of the roles of Gluteus Medius, is weaker on the side runners have ITBS. No great surprise there. What exercises did they use to rehab it and return people to running?…..

…..you guessed it side lying abduction and pelvic drops.

Update 3/6/12:

Thanks to Stuart Palma (a nice bloke despite being a Liverpool fan!) we also have another article to add to the mix. McBeth et al. 2012 compared 3 sidelying exercises sidelying abduction, the clam, and sidelying abduction with external rotation in healthy runners. Unlike previous articles they used a leg weight and a “biofeedback unit” to monitor trunk position. They compared muscle activation in Gluteus Medius, Gluteus Maximus, anterior hip flexors and Tensor Fascia Latae with each exercise. They concluded that,

The sidelying hip abduction exercise was the best for activating Gluteus Medius with little activation of Tensor Fascia Latae and anterior hip flexors”

A few key points here then;

  1. It gives us an indication of specificity – sidelying abduction appears to be able to activate the muscle we are targeting without working the muscles we are not targeting.
  2. Gluteus Medius activation was similar to Distefano’s earlier work at 79.1% of MVIC.
  3. Important to note there is no comparison with weightbearing exercise


Now I could stop there. I’ve made my point – sidelying abduction clearly has a role, but part of this is not about cherry picking a couple of articles to prove a point, it’s about looking at the bigger picture even if that includes research that goes against your theories….

Side plank abduction

This is reproduced from Boren et al. 2011 who did an excellent study and also compared their results with earlier work. Their top 3 exercises for Glute Medius were side plank abduction with dominant leg down, side plank abduction with dominant leg up and single leg squat (in that order). Notice again that these positions, despite being “non-functional” do create a lot of activity in Glute Medius and again more so than weight bearing positions such as single leg squat. Of note too is that they found less activity with side-lying abduction than the previous studies. This raises a good point with research and rehab. Nothing is concrete. You simply cannot say “this exercise has no role” as you will find evidence to support your claim and evidence to refute it. Also they used a slightly different technique which might account for the difference.

The Clam

Again reproduced from Boren et al. 2011 but I’ve modified them with some instructions to clarify (thanks to Debra for the suggestion). The link above also includes detailed descriptions of this exercise and its progressions (it’s all in the appendix at the end of the article). Most people think of the clam as the exercise described in Clam 1 above. In this study 3 progressions of the exercise were included. In many exercises they can be progressed by increasing resistance, this one is progressed by a change in position. The article demonstrated an increase in glutes activity from Clam 1 being lowest to Clam 4 being the highest. Compared to other exercises in the study Clam 4 had a high level of Gluteus Medius activity (77% of MVIC – Maximal Volitional Isometric Contraction) only slightly lower than Single Limb Squat (81% of MVIC). Distefano et al 2009 showed lower levels of activity with the clam but didn’t include the same progressions.

So we’ve seen 3 exercises, all in sidelying, that produce high levels of Gluteus Medius activation, at least comparable to, and in some cases higher than weight bearing exercise. It’s no great surprise then that the English Insitute of Sport uses a selection of sidelying exercises in its “Glutes Circuit”. We were given this by one of their team at a Strength and Conditioning lecture but sadly can’t reproduce it online.

Next we look at weight bearing exercise

Single Limb Squat

Once again from Boren et al. 2011. Single Limb Squat as above showed good Gluteus Medius and Gluteus Maximus contraction with 81% of MVIC for Gluteus Medius and 71% for Gluteus Maximus. Both muscles are hugely useful for runners and so this exercise clearly has its benefits. As a result it’s one I use regularly. The only issue here is the risk of aggravating pain. The deep dip position places greater stress on the ITB and patellofemoral joint. As a result I often start with a shallow knee dip or use this exercise after first rehabbing with sidelying exercises. There is also an issue of control, some patients struggle to even balance on one leg let alone perform a squat.

Distefano et al. 2009 used the slightly different technique shown above, they also reported good activation of both Glute Med and Max. Lateral Band Walk shown below, also showed good Gluteus Medius activation (although less than side lying abduction). This doesn’t appear to have been assessed by Boren et al. 2011.

Wall Press – reproduced from O’Sullivan, Smith and Sainsbury 2010. In the picture below the right Gluteus Medius is being exercised by pushing the left knee, hip and ankle against the wall and maintaining a contraction for 5 seconds.

Wall press was compared to Pelvic Drop and Wall Squat and achieved the highest MVIC of 76%.

Pelvic Drop – picture below reproduced from Bolgla 2005 who found reasonable activation of Glute Medius on pelvic drop of 57% of MVIC and was similar to Boren et al 2011 (58%). In Bolgla’s study it scored the highest of 6 exercises which also included sidelying abduction.

For pelvic drop the standing leg (right in this case) stays straight and you lower your other leg by lowering the pelvis on that side.

Krause et al. 2009 (abstract only) studied the effect of doing exercises on a balance cushion and found an increase in Gluteus Medius activity (compared to balancing on normal floor) although it should be noted this difference wasn’t thought to be statistically significant.

Lubahn et al. 2011 looked at the effect of using resistance band to pull the knee more medially (towards the other knee) during weightbearing exercises. The idea behind this is that the medial pull of the band should increase activation of Gluteus Medius. They found it didn’t increase activation during single limb squat or step up and may result in poorer limb alignment during the exercise.

 

Acknowledging Limitations and closing thoughts

An important part of any theory is acknowledging limitations. Like I’ve mentioned above nothing is concrete. I’ve barely scratched the surface of research in this area and I acknowledge there is more research out there, undoubtedly with different findings. I also realise that the main measure involved in these studies is surface EMG recording of muscle activity in healthy individuals. This measure is only related to Maximal Volitional Isometric Contraction presented in a percentage and has not included people with injuries. Endurance activity such as running rarely needs maximal voluntary contraction. So we can’t conclude that because sidelying abduction has a higher % of MVIC than single limb squat that it is a better exercise for rehab in return to running. Neither can we conclude that certain exercises are better for rehabbing certain conditions as the research above (with the exception of Fredericson et al. 2000) doesn’t examine the effect of exercise on injury. That said I think the research is a useful indication for strength work – Boren et al suggested that an MVIC of greater than 70% was needed for strength work while ealier research suggested a range of at least 40-60%. Sidelying and weightbearing exercises have both achieved greater than this range and should be capable of producing strength changes.

The aim of this blog was not to prove sidelying exercises are more effective but only to show that they create good levels of glutes activation and have a role in rehab. This idea that exercises must be functional is a slightly limited one. The very fact that sidelying work isn’t functional may be its advantage – it is a task that we don’t do as part of our day, a task that can potentially isolate a muscle to gain good activation. If functional tasks were so good at glutes rehab, we’d all have great glutes just from walking around, climbing stairs and running!

The other advantage of sidelying work is that it can often be done without aggravating symptoms if done correctly. For people with painful ITBS or irritable patellofemoral pain a range of weightbearing exercises can make symptoms worse.

Selecting exercises for yourself or a client is very individual and should be based on addressing specific weaknesses. Take sidelying abduction, some people can do 40-50 with good form and minimal glutes fatigue. There is little point asking them to do this as an exercise as it probably won’t overload the glutes to achieve strength changes. Some people get to 9 or 10 reps and start to fatigue or lose control and they are more likely to benefit from it. For some the issue actually isn’t strength at all, some studies show poor correlation with Glute strength and pelvic position, this is because control of movement can be poor even with good strength. In that situation it’s control and form that needs to be addressed and this is where functional weightbearing movements are more important. I think if your control of pelvic position is poor, but Glute strength is good it’s unlikely sidelying work will be of great benefit.

 

So what to do for your Glutes? The answer is what works for you. If you find sidelying exercises are getting you results without causing symptoms then great. If not try some of the others above and see which ones seem to work your glutes and get results.

 

What about reps and sets? Assuming we are working endurance roughly speaking people usually start at around 10-15 reps 3 sets in a session with a rest of 1-2 minutes between each set. Then progress up towards 25 reps, you’re aiming to fatigue the muscle so there will be lots of individual variation in the reps needed to do that. That said if you can do more than 30 reps without fatigue maybe you need a harder exercise? These recommendations are based on those by the American College of Sports Medicine research (abstract only) which I’ve summarised in a table below (click to expand). Remember too that form and control are very important and you should feel it in your glutes not the side of your knee or front of the thigh.

Closing thought, from the research I’ve read and patients I’ve seen, a combination of both functional weight bearing and less functional (sidelying) exercises is most likely to be effective in glutes rehab.

 

Please feel free to comment, I welcome other opinions even if very different from my own. Where possible back up any claims with research evidence.