Weakness in the gluteus maximus and gluteus medius is often cited in contributing to patellofemoral pain, IT band problems, hip pathology and even back pain. Side bridges (planks) and the clam exercise have been shown to be effective ways to strengthen the glutes. In this posting, I will review an exercise that combines both exercises.
Execution: Begin in a side lying position with both limbs flexed to about 60 degrees at the hip and knee. Position the elbow beneath the shoulder nearest the ground. Press the forearm into the ground and lift the hips off the floor into a side bridge. Hold this lateral pillar position, and subsequent clam by raising the top knee so that the hip is in 30 degree of abduction, before returning to the position while keeping both heels in contact with each other.
Often I will place a small towel roll between the feet to ensure consistent contact between them. Perform a set of 10-15 repetitions. Switch sides and repeat. Perform 2-3 sets.
Progression: 1) Add a mini-band above the knees to increase resistance. 2) Perform the exercise with an unstable surface beneath the forearm and use the mini-band.
Regression: If necessary, break the exercise into component parts (clam and side bridge) working to master form and endurance with each one. Additionally, you may opt to return to the floor after each clam allowing for a brief rest prior to performing each subsequent repetition.
Application: Engaging the gluteals and increasing hip abduction strength while minimizing TFL activation will help improve alignment and reduce femoral IR on the patella. In addition, improving gluteal activation will reduce undue strain on the back, hip, and knee.
Additional Notes: Fatigue may impact the height and form of the side bridge portion of the exercise, so it may be necessary to cue the athlete to keep the top hip up or toward the ceiling throughout. Avoid pelvic roll back that also occurs with weakness/fatigue by initially bracing the athlete from behind and/or providing tactile cues until satisfactory form in consistently achieved.
Brian Schiff, PT, OCS, CSCS, is a licensed physical therapist. Currently, he serves as the supervisor for EXOS API at Raleigh Orthopedic. For more information on his products and services, visit www.BrianSchiff.com