Researchers using electromyography (EMG) have shown that the GMed is most active during a single-plane, side-lying hip-abduction (ABD) exercise as compared with a variety of other exercises ( Figure 1). Side-lying, open-chain exercises often are performed early in the rehabilitation process to produce appropriate neuromuscular control and strength, supporting more functional exercises later. 23, 24 Therefore, clinicians need to thoroughly understand the activity of major muscle groups of the hip during common strengthening exercises.
22 The functional anatomy of the hip is complex, and actions of muscles often change depending on the position of the hip. 15–21 Clinicians often use a variety of strengthening exercises based on knowledge of anatomical structure and function of the hip, whereas little empirical evidence might exist to confirm the activation of particular muscles during a specific movement. Incorporating hip strengthening into rehabilitation programs for overuse injuries has been associated with positive outcomes, including reduction of symptoms and correction of positional malalignment. These concepts of hip weakness leading to dynamic valgus and lower extremity injury provide the clinical foundation for why strengthening the hip abductors is a common and important component of preventing and rehabilitating these injuries. 6, 7 Evidence that hip muscle weakness is associated with overuse injuries, such as PFPS 8–2 and ITBS, 13, 14 supports this theory. 5 Researchers believe weakness of the hip musculature, specifically the hip abductors and external rotators, contributes to a person assuming a position of dynamic valgus each time he or she is in single-legged stance. 5 Dynamic valgus has been described as a malalignment characterized by pelvic drop, which is inferior movement of the contralateral side of the pelvis during single-legged stance femoral adduction and internal rotation genu valgum tibial internal rotation and hyperpronation, and it occurs when the hip muscles cannot overcome the external torque caused by gravity acting on the body's center of mass. 3 Athletic trainers routinely work to prevent, diagnose, and rehabilitate running-related injuries, so they must possess knowledge of the current research in which exercises commonly used to treat these injuries have been investigated.Ī contemporary clinical theory that might explain the cause of PFPS and ITBS is that of proximal muscle weakness leading to dynamic valgus of the knee joint. 3, 4 The most frequent injuries affecting runners include patellofemoral pain syndrome (PFPS), iliotibial band syndrome (ITBS), injuries to the gluteus medius muscle (GMed), and greater trochanteric bursitis.
2, 3 The lower leg (25% for male and female runners) and foot (14% for male and 13% for female runners) are the next most commonly injured areas. Epidemiologic evidence indicates that 19% to 79% of runners will sustain a lower extremity injury, 1–4 and the knee is the most common site of injury. Although the increase in physical activity has many health benefits, it also brings the inherent increased risk of lower extremity injuries. The growth might be attributed partly to the known health benefits, the non–equipment-intensive nature, and the ability to individualize both running intensity and duration. The side-lying hip-abduction with external rotation exercise might activate and strengthen the tensor fascia latae beyond the goal of rehabilitation.īoth recreational and competitive running have grown in popularity in recent years.
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