Introduction: Excessive hip adduction and internal rotation are common movement impairments associated with patellofemoral pain (PFP). As such, strengthening of the hip abductors and external rotators commonly is recommended. Because tensor fascia latae (TFL) is a hip internal rotator in addition to being an abductor, it is important to select exercises that target the superior gluteus maximus (SUP-GMAX) and gluteus medius (GMED) while minimizing activation of the TFL.
Objective: To identify hip-targeted exercises resulting in greater activation of the SUP-GMAX and GMED relative to the TFL in persons with PFP.
Methods: Twelve individuals with PFP participated. Electromyographic (EMG) signals were obtained from the GMED, SUP-GMAX, and TFL using fine-wire electrodes while participants performed 11 hip-targeted exercises. Normalized EMG of GMED and SUP-GMAX was compared to that of the TFL for each exercise using repeated measures ANOVAs and descriptive statistics.
Results: Of the 11 hip exercises evaluated, only the clam exercise with elastic resistance resulted in significantly greater activity of both gluteal muscles (SUP-GMAX = 24.2 ± 14.4%MVIC, p = .05; GMED = 37.2 ± 19.7%MVIC, p = .008) relative to the TFL (12.5 ± 11.7%MVIC). Five exercises exhibited significantly lower activation of SUP-GMAX relative to TFL: 1) unilateral bridge: SUP-GMAX = 17.7 ± 9.8%MVIC, TFL = 34.0 ± 17.7%MVIC, p = .01; 2) bilateral bridge: SUP-GMAX = 10.0 ± 6.9%MVIC, TFL = 14.0 ± 7.5%MVIC, p = .04; 3) abduction: SUP-GMAX = 14.2 ± 11.1%MVIC, TFL = 33.0 ± 11.9%MVIC, p = .001; 4) hip hike: SUP-GMAX = 14.8 ± 12.8%MVIC, TFL = 46.8 ± 33.7%MVIC, p = .008; and 5) step-up: SUP-GMAX = 15.0 ± 5.4%MVIC, TFL = 31.7 ± 19.9 %MVIC, p = .02). No differences in gluteal activation relative to TFL were found for the remaining 6 exercises (all p > .05).
Conclusion: The clam with elastic resistance exercise was effective at activating the SUP-GMAX and GMED greater than TFL. No other exercises achieved a similar level of muscular recruitment. When attempting to strengthen the gluteal muscles in persons with PFP, care should be taken in assuming that common hip-targeted exercises result in the desired recruitment patterns.
Keywords: Patellofemoral pain; electromyography; exercise therapy.