I do enjoy reading others work, but inevitably, I don’t always agree with what I read as I’m sure others don’t always agree with my thoughts on this blog. I don’t usually worry about it a huge amount because everyone is entitled to their opinion and I certainly don’t know everything there is to know so am just trying to find my way.
However, I recently read an article describing how you need to rehab the gluteus medius in side lying using abduction. I have a big problem with this. It seems unlikely to me that this is ever a good way to work a muscle. There may be very isolated, individual cases, where it is appropriate, but these are very few and very far between. I think to stop this rant getting too long I’ll give my 3 top reasons it isn’t a good idea to do side lying abduction.
- It’s a Conscious, Isolated Movement
- That’s not how the Glute Med. Works in Function
- Poor Carryover from the treatment
1. It’s a Conscious, Isolated Movement
This is massive! Normal function is subconscious, so to me it makes sense to find ways of training/rehabbing any movement or muscle subconsciously. Personally, I believe the conscious mind clouds movement, as it just cannot cope with so many different pieces of information in one go. Therefore, I think it is inevitable that the timing of contraction, stiffness in tissues and joints, strength of contraction, coordination with neighbouring tissues…etc…etc…will be altered. Which will not only slow down the rheab process, but may well regress it!!
In function the glute med. will never work in isolation…so why would you try and isolate it in rehab? It makes sense to me that each muscle learn to work with its local and global friends in order that they continue to do so when their are functioning in real life outside the clinic. Don’t train the muscle…train the movement!
2. That’s not how the Glute Med. Works in Function
The glute med is a much under-estimated muscle. It’s importance isn’t under-estimated, but it’s capability is. It’s often labeled as a simple hip abductor, which is why these side-lying hip abduction exercises seem to be so common. It is understood by most that the glute med. also functions to prevent excessive frontal plane motion in the pelvis. However, this role is rarely addressed in rehab.
I would say that the glute med. is capable of a role in decelerating flexion, extension, adduction, internal and external rotation…that’s a lot of capability for one muscle and why I think it is vastly underestimated.
If we take gait as the baseline function, we know that glute med. helps in flexion, adduction and internal rotation during the front foot loading phase and in extension and internal rotation as a back foot. This is why it is such a good stabiliser and why you shouldn’t lie on your side and abduction your leg!
3. Poor Carryover from the Treatment
A massive aim of my treatment sessions is that the patient carries the benefits of treatment over into their function and that the patient regresses as little as possible in between treatments. The closer the rehab is to the function the better the carryover for your patients. From a proprioception point of view side lying hip abduction couldn’t be further from true function. In function the glute need never has to abduct from an unloaded, adducted position, it never has to go through such a large concentric range of motion and it never…ever…works in isolation!!
In summary, I’ve had a little rant!! I can only apologies I think now I have talked about how I don’t like side lying abduction is a good way to rehab glute med. I think I need to go through the strategies that I do use. So on Thursday we’ll have a look at some of those
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