December 2011 JOSPT presented an article by Davis AM et al on interrater and intrarater reliability of the Active Hip Abduction Test (AhABD).  It can be found here (subscription required).  This post isn’t about its results but has got me thinking about using it as a screening tool, but also some other thoughts.

This test has been shown to predict LBP during sustained standing periods.  I would highly agree based on lower kinetic chain involvement.  Pelvic drop due to weakness of the gluteus medius in particular will have a compounding effect both caudally and cephalically to the hip. 

I tend to say the “gluteus medius is the rotator cuff of the lower extremity”.  

Just an easy analogy that most patients can relate (as they have heard from friends/family that they have ‘torn’ their rotator cuff, rotatory cup, or whatever comes out of their mouths!).  Needless to say, its important in function, especially standing and walking!

I would like to ask fellow colleagues out there what their thoughts are on not just the form and alignment, but how you assess overall muscle performance of gluteus medius in particular.  Manual muscle testing of the gluteus medius in Side-Lying is all good and dandy but its just short-duration, not intended to assess the performance over 5-10 thousand steps/day.  I just don’t like this too much. 

Obviously depending on pain/presentation, etc., I sometimes get the patient to perform up to 30 repetitions of hip abduction (if able).  Isn’t Hip abduction linked as highest EMG exercise for the gluteus medius?  It would make sense to test it this way then, right?  I can get them to rate difficulty on an ordinal scale comparing side to side from a 0 to 10 scale (such as perceived exertion scale).  It works somewhat but do you have anything better?

I don’t have a reason on 30 repetitions, just a start. Pending the amount that can be performed with good form (such as noted in AhABD Test), it gives me and the patient an idea of the quality of overall muscle performance (both strength and endurance).   

Mike Reinold does show assessing on steps as shown below:

Source: MikeReinold.com
But, my population would typically look something like this (meaning, most can’t negotiate a step and a fall risk!):

Source: samaritancare.com


What are your thoughts?  Any other ways of assessing gluteus medius performance?

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2 comments

  1. I’ve been thinking about gluteus medius, too. Doesn’t it participate in extension and external rotation, too? Or is it tested (and strengthened) in pure abduction for a particular reason, eg it is the only major abductor at 0 deg hip flexion/extension?

    What got me on this topic is whether lateral walks with tubing are all that effective, given that abducting with a flexed hip and while resisting the urge to externally rotate (the way you usually see them done) would seem to be a recipe for TFL recruitment…at least in my head. Any thoughts here?

    1. Adam,
      Good thoughts and I do not know if if these are correct, maybe someone else can chime in too. You test extension by making sure the hip stays in abduction, vs falling into flexion. You test ER by making sure the foot doesn’t fall down, or into IR. It is more of a static hold than actually moving into those directions.

      I would imagine TFL and gluteus medius do fire with the above exercise you describe fairly equally. So, in terms of answering your question, I would say you aren’t isolating the gluteus medius with that exercise but are activating fibers from TFL too.

      Hope this helps,
      Harrison

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