Electromyographic Analysis of Gluteus Maximus, Gluteus Medius and Tensor Fascia Latae During Therapeutic Exercises With and Without Elastic Resistance

Research Review: Electromyographic Analysis of Gluteus Maximus, Gluteus Medius, and Tensor Fascia Latae During Therapeutic Exercises With and Without Elastic Resistance

By Jason Gonzales, MS, NASM PES & CES, NASE CSS Level II, Ironman U Coach

Edited by Brent Brookbush DPT, PT, COMT, MS, PES, CES, CSCS, ACSM H/FS

Original Citation:

Bishop, B. N., Greenstein, J., Etnoyer‐Slaski, J. L., Sterling, H., & Topp, R. (2018). Electromyographic analysis of gluteus maximus, gluteus medius, and tensor fascia latae during therapeutic exercises with and without elastic resistance. International Journal of Sports Physical Therapy, 13(4), 668. ARTICLE

Introduction:

Research has demonstrated that a decrease in gluteus maximus and gluteus medius activity, and an increase in tensor fascia latae (TFL) activity, is correlated with lumbar spine, sacroiliac joint and lower extremity dysfunction (1 - 16). Several additional studies have compared various exercises with the intent of maximizing gluteus maximus and gluteus medius activity, while minimizing the recruitment of synergists (17 - 22). In this 2018 study by researcher in San Diego, CA, electromyographic analysis of gluteus maximus , gluteus medius and TFL activity was compared for thirteen commonly recommended gluteus maximus /medius activation exercises. The findings suggest that the clam exercise had the lowest TFL activity relative to glute activity, while the standing hip extension with resistance on the moving leg had the highest TFL activity relative to glute activity.

Study Summary

Study Design	Repeated measures cohort study
Level of Evidence	III - Comparative/Observational Research
Participant Characteristics	Demographics: Age: 27.18 ± 7.33 years Gender: 5 male and 6 female Number of participants: 11 Healthy, physically active adults Inclusion Criteria: No history of hip, back or lower extremity injury/surgery in the past year Exclusion Criteria: N/A
Methodology	Participants performed a 5 minute warm up on stationary bike without resistance. Manual muscle testing was performed to determine maximal voluntary isometric contraction (MVIC) for each muscle tested. 3 repetitions held for 5 seconds each. Highest average peak value recorded as MVIC. Dominate leg determined by asking participants which leg they used to kick a soccer ball. Surface electrodes were positioned on the dominate side muscles as recommended by Rainoldi et al. (23) Surface electromyography (EMG) was used to quantify the normalized EMG activity of the gluteus maximus, gluteus medius and tensor fascia latae while performing 13 exercises. The order in which the exercises were performed was randomized to minimize the effect of fatigue. Three of the exercises were performed with and without elastic resistance. Green resistance bands were used with males. Red resistance bands were used with females. Band placement was determined as recommended by Cambridge et al. (22).
Data Collection and Analysis	Data Collection Surface EMG was performed using a Noraxon Myosystem 1400A (Noraxon USA, Inc, Scottsdale, AZ) Sampling frequency 1000 Hz. Visual onset and offset EMG signal amplitude used to select. EMG signals were smoothed, rectified, and analyzed using a root-mean-square algorithm of 100 ms to determine the peak activation for the gluteus maximus, gluteus medius and tensor fascia latae Elastic resistance provided by either green or red resistance bands (TheraBand®, Performance Health, Akron, OH) The equation used to determine the GTA Index was GTA Index= {[(GMED/TFL) x GMED)] +[(Gmax/TFL) x GMAX]}/2 in accordance with Selkowitz et al. (26).
Outcome Measures	EMG signal amplitude was used to select the middle three of five repetitions of each of the 13 trials The gluteal-to-TFL muscle activation (GTA) index (26) was used to rate exercises Repeated analysis of variance (R-ANOVA) was calculated to determine differences in muscle activation of GMAX, GMED, and TFL. The significant main effect (p<0.05) was detected by R-ANOVA.
Results	Exercises ranked highest on the GTA Index: The clams with resistance (99.54) Clams without resistance (87.89) Running man GMAX exercise on the stability trainer without resistance (70.55) Exercises that ranked lowest on the GTA index: Quadruped hip extension without resistance (28.29) Standing hip extension with resistance on stance leg (23.94) Standing hip extension with resistance on movement leg (19.60) Muscle activation differentiation Clam exercise with and without resistance produced significantly higher GTA index scores and mean percent activation score compared to the other exercises. All comparable exercises with and without resistance showed improved mean percent activation in both the GMAX and GMED with the exception of the quadruped hip extension. The quadruped hip extension only showed higher activation for the GMAX. (See Table 1 for full GTA Index results and rankings.)
Our Conclusions	The study demonstrates the effectiveness of the clam exercise for GMAX and GMED activation with minimal activation of the TFL. This adds to the body of research in support of the Brookbush Institute's series of gluteus maximus activation exercises.
Researchers' Conclusions	The clam exercise with and without the elastic resistance was shown to be the most effective at activating the GMAX and GMED with minimal TFL activation.

How this study contributes to the body of research:

This study examined the surface electromyography (EMG) of the gluteus maximus , gluteus medius and tensor fascia latae (TFL) while executing 13 different exercises with and without resistance. This study included more exercises than many of the previous studies, and further compared the addition of band resistance. This findings of the study may be used to aid in optimizing exercise selection based on glute to TFL activity ratio, and further demonstrates that band resistance may also improve glute to TFL activity ratio.

How the Findings Apply to Practice:

The data provided by this study can be used to rank the 13 exercises investigated based on glute to TFL ratio (higher values = more glute ). If evaluation/assessment findings during practice suggest that increasing gluteus maximus , gluteus medius while reducing TFL activity is recommended, selecting “higher ranked” activities may be beneficial. Human movement professionals should be using comparative studies like this to continually refine exercise selection with the intent of optimizing practice.

GTA Index Results (Higher values = More Glute and less TFL ):

Exercise	GTA Index
1. Clams with resistance	99.54
2. Clams without resistance	87.89
3. Running Man on the Stability Trainer without resistance	70.55
4. Bridge with resistance	48.86
5. Prone Hip Extension without resistance	48.57
6. Side-lying Hip Abduction without resistance	44.75
7. Bridge without resistance	41.59
8. Quadruped Hip Extension with resistance	36.11
9. Standing Hip Abduction with resistance on movement leg	29.59
10. Standing Hip Abduction with resistance on the stance leg	29.34
11. Quadruped Hip Extension without resistance	28.29
12. Standing Hip Extension with resistance on the stance leg	23.94
13. Standing Hip Extension with resistance on the movement leg	19.60

Single Leg Touch Down with Posterior Pull

Strengths

The use of previously validated assessments, measurements, and protocols increase confidence in the study findings.
The comparison of 13 exercises was more exercises than most studies investigate, allowing for direct comparison of many commonly recommended exercises.
The exercises used in the research study are commonly recommended, use little equipment, and are relatively easy to teach, making the study more replicable and easy to apply to practice.

Weakness and limitations

Failing to include exercise experience as an exclusion/inclusion criterion may have resulted in variability in findings, as some participants may have had some experience with a few of the exercises.
The methodology did not explicitly detail the instructions used to teach the participants each exercise. It is possible that some exercises had lower GTA values due to failures in form.
Inclusion of additional musculature in the EMG data may have provided additional data that has not been provided by previous research.

How the study relates to Brookbush Institute Content?

This study compares exercises, with and without resistance, for gluteus maximus activation and gluteus medius activation while minimizing TFL activity. A decrease in gluteus maximus , gluteus medius activity and increase in TFL activity is correlated with Lumbo Pelvic Hip Complex Dysfunction (LPHCD) and Lower Extremity Dysfunction (LED) . The Brookbush Institute recommends the inclusion of gluteus maximus activation and gluteus medius activation exercises when addressing muscle imbalances related to these dysfunctions. The clam shell exercise exhibiting the best glute to TFL ratio in this study, is the first exercise recommended in these activation progressions. The Brookbush Institute will continue to pursue optimal practices by continually integrating research findings and patient outcomes into an evidence based, systematic, outcomes-driven approach.

Sample Videos:

Gluteus Maximus Activation Circuit:

Gluteus Maximus and Transverse Abdominis Activation:

Gluteus Maximus Reactive Activation:

Bibliography:

Comerford, M. J., Mottram, S. L. (2001). Movement and stability dysfunction--contemporary developments. Manual Therapy, 6(1), 15-26.
Page, P., Frank, C., & Lardner, R. (2011). Assessment and treatment of muscle imbalance: the Janda approach. Journal of Orthopedic Sports Physical Therapy, 41(10), 799-800.
Juli, G., Janda, V. (1987). Muscles and motor control in low back pain: assessment and management. Physical Therapy of the Low Back. 1st ed. New York, NY: Churchill Livingston.
Powers, C. M. (2010). The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. Journal of Orthopedic Sports Physical Therapy, 40(2), 42- 51.
Bolgla, L. A,, Malone, T. R., Umberger, B. R., Uhl, T. L. (2011). Comparison of hip and knee strength and neuromuscular activity in subjects with and without patellofemoral pain syndrome. International Journal of Sports Physical Therapy, 6( 4), 285-296.
Marshall, A. R., Noronha, M., Zacharias, A., Kapakoulakis, T., Green, R. (2016). Structure and function of the abductors in patients with hip osteoarthritis: Systematic review and meta-analysis. Journal of Back and Musculoskeletal Rehabilitation, 29(2), 191-204.
Lauw, M., Deary, C. (2014). The biomechanical variables involved in the aetiology of iliohbial band syndrome in distance runners - A systematic review of the literature. Physical Therapy in Sport, 15(1), 64-75.
Noehren, B., Schmitz, A., Hempel, R., Westlake, C., Black, W. (2014). Assessment of strength, flexibility, and running mechanics in men with iliotibial band syndrome. Journal of Orthopedic Sports Physical Therapy, 44(3), 217-222.
Muragod, A., Patil, V.R., Nitsure, P. (2014). Immediate effects of static stretching versus myofascial release in iliotibial band tightness in long distance runners- A randomized clinical trial. European Journal of Sports Medicine, 2(1), 31-38.
Sims, K. J., Richardson, C. A., Brauer, S.G. (2002). Investigation of hip abductor activation in subjects with clinical unilateral hip osteoarthritis. Annals of Rheumatic Diseases, 61(8), 687-692.
Grimaldi A, Richardson C, Stanton W, Durbridge G, Donnelly W, Hides J. (2009). The association between degenerative hip joint pathology and size of the gluteus medius, gluteus minimus and piriformis muscles. Manual Therapy, 14(6), 605-610.
Tonamas, S., Hanna, F. S., Cicuttini, F. M., Wluka, A. E., Berry, P., Urquhart, D. M. (2009) Does knee malalignnent increase the risk of development and progression of knee osteoarthritis? A systematic review. Arthritis & Rheumatology, 61(4), 459-467.
Lariviere, C., Arsenault, A. B., Nadeau, S., Plamondon, A., Vadeboncoeur, R. (2010). Specificity of a back muscle exercise machine in healthy and low back pain subjects. Medical Science Sports Exercise, 42(3):592- 599.
McKeon, M. D., Albert, W. J., Neary, J. P. (2006). Assessment of neuromuscular and haemodynamic activity in individuals with and without chronic low back pain. Dynamic Medicine, 5, 6.
Cooper, N. A., Scavo, K. M., Strickland, K. J., Tipayamongkol, N., Nicholson, J. D., Bewyer, D. C., & Sluka, K. A. (2016). Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. European Spine Journal, 25(4),1258-1265.
Earl, J. E., Hertel, J. & Denegar, C. R. (2005). Patterns of dynamic malalignment, muscle activation, joint motion, and patellofemoral-pain syndrome. Journal of Sport Rehabilitation, 14(3), 216-233.
Distefano, L. J., Blackburn, J. T., Marshall, S. W., & Padua, D. A. (2009). Gluteal muscle activation during common therapeutic exercises. Journal of Orthopedic Sports Physical Therapy, 39(7), 532-540.
Philippon, M. J., Decker, M. J., Giphart, J. E., Torry, M. R., Wahoff, M. S., & LaPrade, R. F. (2011). Rehabilitation exercise progression for the gluteus medius muscle with consideration for iliopsoas tendinitis: an in vivo electromyography study. American Journal of Sports Medicine, 39(8), 1777-1785.
Bolgla, L. A., & Uhl, T. L. (2005). Electromyographic analysis of hip rehabilitation exercises in a group of healthy subjects. Journal of Orthopedic Sports Physical Therapy, 35(8), 487-494.
Reiman, M. P., Bolgla, L. A., & Loudon, J. K. (2012). A literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises. Physiotherapy Theory Practice, 28(4), 257-268.
Youdas, J. W., Adams, K. E., Bertucci, J. E., Brooks, K. J., Nelson, M. M., & Hollman, J. H. (2014). Muscle activation levels of the gluteus maxirnus and medius during standing hip-joint strengthening exercises using elastic-tubing resistance. Journal of Sport Rehabilitation, 23(1), 1-11.
Cambridge, E. D., Sidorkewicz, N., Ikeda, D. M., & McGill, S. M.. (2012). Progressive hip rehabilitation: the effects of resistance band placement on gluteal activation during two common exercises. Clinical Biomechanics (Bristol, Avon), 27(7), 719-724.
Rainoldi, A., Melchiorri, G., & Caruso, I. (2004). A method for positioning electrodes during surface EMG recordings in lower limb muscles. Journal of Neuroscience Methods, 134(1), 37-43.
Neumann, D. A.. (2010). Kinesiology of the hip: A focus on muscular actions. Journal of Orthopedic Sports Physical Therapy, 40(2), 82-94.
Lyons, K., Perry, J., Gronley, J. K., Barnes, L., Antonelli, D. (1983). Timing and relative intensity of hip extensor and abductor muscle action during level and stair ambulation. An EMG study. Physical Therapy, 63(10), 1597-1605.
Selkowitz, D. M., Beneck, G. J., Powers, C. M. (2013). Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes. Journal of Orthopedic Sports Physical Therapy, 43(2), 54- 64.
Steele, J., Bruce-Low, S., & Smith, D. (2015). A review of the clinical value of isolated lumbar extension resistance training for chronic low back pain. PM&R Journal, 7(2), 169-187.
Page, P., and Ellenbecker, T. S. (2003). The scientific and clinical application of elastic resistance. Champaign, IL: Human Kinetics.

Questions, comments, and criticisms are welcomed and encouraged -