[ research report ]

CHARLOTTE GANDERTON, PhD1 • TANIA PIZZARI, PhD1 • JILL COOK, PhD1 • ADAM SEMCIW, PhD1,2

Gluteus Minimus and Gluteus Medius

Muscle Activity During Common
Rehabilitation Exercises in Healthy
Postmenopausal Women

T
he gluteus medius (GMed) and gluteus minimus
Downloaded from www.jospt.org at on June 9, 2021. For personal use only. No other uses without permission.

segments of the GMin are struc-

(GMin) are important for locomotion and mobility.25,28,31 turally and functionally suited to
Anatomically, these muscles provide lateral stability provide femoroacetabular stabil-
ity.25,44 High levels of gluteal mus-
of the hip joint and pelvis, as they help to control the
cle activation are evident during
Copyright © 2017 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

contralateral pelvic position during unilateral stance in the hip abduction for all GMin and
frontal plane.27 A 1978 study49 reported segmental differences in GMed GMed segments,44,48 and weakness of this
electromyography (EMG) muscle activity. More recently, cadaveric and musculature has been associated with
ultrasound-guided intramuscular EMG Based on their morphological and increased pelvic obliquity.2 Strength im-
studies have validated those findings, re- activation properties, the anterior and pairments of the GMin and GMed may
porting that the GMed and GMin muscles middle GMed segments are believed to result in difficulty climbing stairs, walk-
have 3 and 2 distinct segments, respective- contribute largely to providing pelvic ing, moving from sitting to standing, or
ly,43 each with a unique activation ampli- stability on a fixed lower limb,25,48 while any single-limb weight-bearing task that
tude and timing during the gait cycle.44,48 the posterior GMed segment and both requires optimal pelvic and femoroac-
Journal of Orthopaedic & Sports Physical Therapy®

UUSTUDY DESIGN: Controlled laboratory study,
cross-sectional.
UUBACKGROUND: The gluteus medius (GMed)
and gluteus minimus (GMin) provide dynamic
stability of the hip joint and pelvis. These muscles
are susceptible to atrophy and injury in individuals
during menopause, aging, and disease. Numerous
studies have reported on the ability of exercises
to elicit high levels of GMed activity; however, few
studies have differentiated between the portions of
the GMed, and none have examined the GMin.
UUOBJECTIVES: To quantify and rank the level
of muscle activity of the 2 segments of the GMin
(anterior and posterior fibers) and 3 segments of
the GMed (anterior, middle, and posterior fibers)
during 4 isometric and 3 dynamic exercises in a
group of healthy, postmenopausal women.
UUMETHODS: Intramuscular electrodes were in-
serted into each segment of the GMed and GMin in
10 healthy, postmenopausal women. Participants
completed 7 gluteal rehabilitation exercises, and
average normalized muscle activity was used to
rank the exercises from highest to lowest.
UURESULTS: The isometric standing hip hitch with
contralateral hip swing was the highest-ranked ex-
ercise for all muscle segments except the anterior
GMin, where it was ranked second. The highest-
ranked dynamic exercise for all muscle segments
was the dip test.
UUCONCLUSION: The hip hitch and its variations
maximally activate the GMed and GMin muscle
segments, and may be useful in hip muscle
rehabilitation in postmenopausal women. J Orthop
Sports Phys Ther 2017;47(12):914-922. Epub 15
Oct 2017. doi:10.2519/jospt.2017.7229
UUKEY WORDS: hip, physical therapy, postmeno-
pause, rehabilitation
etabular stability.
It is known that the GMed and GMin
are particularly vulnerable to atrophy
and dysfunction with advancing age and
across a range of pathological conditions.
Many of these conditions, such as hip os-
teoarthritis52 and lateral hip pain,51 are
accompanied by marked atrophy of both
muscles, with particular susceptibility of
the GMin. Atrophy of specific GMed and
GMin segments (eg, anterior portion)
also has been reported in healthy aging,12
as well as in a population following total
hip replacement36 and in a sample of el-
derly cadavers,23 with the anterior GMin
being principally affected. Fatty degen-
eration of the GMin also has been associ-
ated with an increased risk of falls.29 To
compound these age-related degenerative

1
Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia. 2School of
Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia. The La Trobe University Human Ethics Committee approved this study (UHEC 14-056). The
authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed
in the article. Address correspondence to Dr Charlotte Ganderton, Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and
Engineering, La Trobe University, Bundoora, VIC 3086 Australia. E-mail: C.Ganderton@latrobe.edu.au t Copyright ©2017 Journal of Orthopaedic & Sports Physical Therapy®

914 | december 2017 | volume 47 | number 12 | journal of orthopaedic & sports physical therapy

 changes, the decline in estrogen in aging
women further magnifies the deteriora-
tion in muscle and tendon morphology,
with evidence of increasing prevalence of
tendon abnormality, tendon thickening,14
and declining muscle strength.26 Consid-
ering the importance of the deep gluteal
muscles for optimal hip functioning and
their susceptibility to structural changes
with age and pathology, a greater knowl-
edge of the efficacy and feasibility of tar-
geted exercises for the recruitment of the
GMed and GMin would be beneficial.
Currently, no studies have investigat-
Downloaded from www.jospt.org at on June 9, 2021. For personal use only. No other uses without permission.
ed the activity of the GMin during various
hip exercises. There are, however, numer-
ous studies that have examined levels of
GMed muscle activity across a range of
potential rehabilitation exercises us-
Copyright © 2017 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
ing EMG.39 A major limitation of these
studies is the use of surface electrodes to
record activity of the GMed.5,32,33,39,41 Sur-
face electrode signals of middle GMed
activity are known to be susceptible to
cross-talk from surrounding muscles,46
and it is not possible to record activity
from the anterior and posterior portions
of the GMed, given their deep anatomi-
Journal of Orthopaedic & Sports Physical Therapy®
cal location.45 Another limitation of these
studies is that they typically evaluated
gluteal function in young, often healthy
populations,39 which limited the general-
izability of their findings to older adults,
in whom gluteal atrophy is common.
Using fine-wire electrodes, the prima-
ry aim of the current study was to quan-
tify and rank the activity level of different
portions of the GMed and GMin during
isometric and dynamic exercises in a
sample of older, postmenopausal women.
METHODS
Participants
T
en healthy postmenopausal older
women (mean ± SD age, 60.2 ± 2.7
years) with a wide range of activ-
ity levels (83.40 ± 54.15 kcal/d) partici-
pated in this study (TABLE 1). Participants
were recruited using flyers on commu-
nity notice boards and on social media
platforms. Postmenopausal status was
journal of orthopaedic & sports physical therapy | volume 47 | number 12 | december 2017 | 915
determined as greater than 12 months
of amenorrhea, as per the Australasian
Menopause Society guidelines,3 or re-
corded as the date of hysterectomy/oo-
phorectomy. Participants had no history
of congenital hip disease, hip or back
surgery, hip trauma, or any lower-limb or
lumbar spine pain or injury in the last 6
months. Participants had to be older than
40 years of age, and no upper age restric-
tion was implemented. Self-reported ac-
tivity was assessed using the Minnesota
Leisure Time Physical Activity Question-
naire.50 The La Trobe University Human
Ethics Committee (UHEC 14-056) grant-
ed approval for completion of the study,
and all participants provided written in-
formed consent prior to commencement.
Instrumentation and Electrode Insertions
Participants attended one 3-hour EMG
testing session and were asked to wear
comfortable walking shoes. Stainless-
steel, Teflon-coated, bipolar, fine-wire
intramuscular electrodes were prepared
according to the methods of Basmajian
and Stecko,6 and 5 sites were marked for
insertion based on surface landmarks.47
Using a sterile, 23-gauge, single-use
hypodermic needle, intramuscular elec-
trodes were inserted into the anterior and
posterior GMin segments and the ante-
rior, middle, and posterior GMed seg-
ments of the dominant stance leg (testing
leg) under real-time ultrasound guidance
(HDI 3000; Royal Philips, Amsterdam,
the Netherlands) using previously de-
TABLE 1 Participant Characteristics (n = 10)*
Characteristics
Age, y
Height, cm
Mass, kg
Body mass index, kg/m2
VISA-G questionnaire
MLTPAQ, kcal/d
Abbreviations: MLTPAQ, Minnesota Leisure Time Physical Activity Questionnaire; VISA-G, Victorian
Institute of Sport Assessment-tendinopathy questionnaire for greater trochanteric pain.
*Values are mean ± SD.
scribed procedures.45,47 Needle and wire
lengths were determined by the depth
and location of the muscle segment, as
ascertained by real-time ultrasound. For
the anterior and middle portions of the
GMed, the needle and wire lengths were
5 cm and 20 cm, respectively; for the pos-
terior GMed, they were 7 cm and 20 cm,
respectively; for the anterior GMin, they
were 9 cm and 25 cm, respectively; and
for the posterior GMin, they were 9 cm
and 25 cm, respectively. Leg dominance
was assessed using 3 previously described
tests: stamp out an imaginary fire, kick a
ball, and step up onto a block.9 The dom-
inant leg was the leg that completed at
least 2 of 3 tasks.
To record temporal aspects of dy-
namic exercises, foot switches (model
402; Interlink Electronics, Inc, Westlake
Village, CA) were positioned bilaterally
on the plantar aspect of the heel and the
interphalangeal joint of the hallux. In ad-
dition, triaxial accelerometers and mag-
netometers (built into the EMG sensors;
Delsys, Inc, Natick, MA) were secured to
the top of the iliac crest and distal lateral
femur.
Experimental Protocol
Prior to the commencement of data collec-
tion, participants were instructed to com-
plete a 3-minute warm-up to ensure that
the intramuscular electrodes had settled
into position within the muscle. The exer-
cise sequence was randomized by asking
the participants to select an exercise card
Value
60.2 ± 2.7
164.7 ± 4.3
70.0 ± 10.2
25.3 ± 3.5
97.2 ± 9.5
83.4 ± 54.2
 [ research report
from an opaque box. Participants were
allowed to practice each exercise prior to
testing to ensure correct technique. Four
isometric and 3 dynamic exercises were
completed (FIGURE 1; APPENDIX, available at
www.jospt.org).
For all single-leg weight-bearing exer-
cises, participants were allowed to place
their fingertips on a wall/chair for bal-
ance. Isometric exercises included the
hip hitch, hip hitch with toe tap, hip hitch
with hip swing, and isometric abduction.
Each isometric exercise was repeated 3
times and held for 15 seconds. Dynamic
Downloaded from www.jospt.org at on June 9, 2021. For personal use only. No other uses without permission.
exercises included the clam,16 sit-to-
stand,8 and dip tests.35All exercises had
standardized setup and instructions, and
participants were monitored throughout
the exercise trials to ensure proper tech-
Copyright © 2017 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
nique (see APPENDIX).
Two sets of 6 repetitions were com-
pleted for each dynamic exercise at a
standardized metronome timing of 2 sec-
onds for concentric and eccentric phases.
Participants were given a 1-minute rest
between each isometric repetition and
each set of dynamic exercises. A 2-min-
Journal of Orthopaedic & Sports Physical Therapy®
FIGURE 1. Exercises completed during the study: (A) hip hitch, (B) hip hitch with toe tap, (C) hip hitch with hip swing, (D) isometric hip abduction, (E) sit-to-stand, (F) dip test,
(G) clam.
916 | december 2017 | volume 47 | number 12 | journal of orthopaedic & sports physical therapy
]
ute rest was given between each exercise
to reduce the potential for fatigue.
Maximum Voluntary Isometric Contrac-
tions  Following the exercises, partici-
pants performed 4 maximum voluntary
isometric contractions (MVICs) with
seatbelt resistance in a randomized or-
der, with standardized encouragement.10
Three of the 4 MVIC positions tested in
this study have been previously reported
by Bazett-Jones et al7: resisted hip abduc-
tion in sidelying with the hip maintained
in neutral flexion and seated hip internal
and external rotation with the hip flexed
to 90°. A sidelying clam MVIC (hip ab-
duction with external rotation) was per-
formed as an isometric equivalent to the
clam exercise. To reduce the effects of
fatigue, each MVIC trial was performed
3 times for 5 seconds, with a 3-minute
rest between each trial. The highest value
from the middle 1-second interval of each
MVIC trial was recorded for each portion
of each muscle.
EMG Data Processing and Analysis   Raw
signals collected by the EMG system
(common-mode rejection ratio greater
than 80 dB at 60 Hz, gain of 1000, band-
pass filtered at 20 to 900 Hz for intramus-
cular electrodes) were sampled at 2000
Hz. The EMGworks 4.0 signal analysis
software (Delsys, Inc) was used to process
EMG data. After removing the direct-
current offset, EMG data were high-pass
filtered at 50 Hz for intramuscular elec-
trodes using a fourth-order Butterworth
filter to remove low-frequency movement
artifact.11,24 The EMG signals were then
full-wave rectified and low-pass filtered
with a 6-Hz, fourth-order Butterworth fil-
ter to generate a linear envelope. Raw sig-
nals from the foot switches and from the
surface and intramuscular electrodes were
received by a Trigno wireless EMG system
(Delsys, Inc). For all single-leg exercises
(hip hitch, hip hitch with hip swing, and
hip hitch with toe tap), a heel foot switch
was used to obtain time points (in sec-
onds) for the start and end of the repeti-
tion, whereby the onset was determined
by heel-off pressure (a sudden decrease
below baseline) and termination/end of
repetition by heel-on pressure (an increase
in pressure). Additionally, accelerometer
 data were used to delineate between repe- Electromyography activation levels were square root of the total sample size.21
titions of the dynamic exercises. characterized as follows: very high, great- Effect-size thresholds of 0.2, 0.5, and
Data processing and analysis were er than 60%; high, 41% to 60%; moder- 0.8 were considered small, medium, and
completed based on procedures previ- ate, 21% to 40%; and low, 0% to 20%.39 large, respectively.13 All statistical analy-
ously validated, showing high intrarater Histograms and the Kolmogorov- ses were performed in SPSS Version 21
reliability (intraclass correlation coef- Smirnov test were used to explore as- (IBM Corporation, Armonk, NY) using
ficient model 2,1 = 0.965-1.000).44 To sumptions of normality.21 As data were an alpha of .05.
reduce learning and fatigue effects, the not normally distributed, a Friedman test
middle 8 seconds of the isometric ex- was performed to detect whether differ- RESULTS
ercises and middle 4 repetitions of the ences in muscle activity existed across the

F
dynamic exercises were processed for exercises. A related-samples Wilcoxon IGURE 2 presents box plots of GMed
each muscle segment (anterior GMin, signed-rank test was performed for post and GMin muscle activation during
posterior GMin, anterior GMed, middle hoc analysis to determine where signifi- 4 isometric and 3 dynamic exercises,
GMed, and posterior GMed). Average cant differences occurred. To establish ranked from the highest to the lowest
Downloaded from www.jospt.org at on June 9, 2021. For personal use only. No other uses without permission.

EMG amplitude was normalized to the the magnitude of such differences, ef- level of muscle activity. The Friedman
percentage of MVIC, and recorded as the fect sizes were calculated for each exer- test determined significant differences
largest muscle activation elicited for each cise comparison by dividing the z-score across the exercises for every muscle seg-
muscle portion during the MVIC trials. of the Wilcoxon signed-rank test by the ment investigated (anterior GMin: χ2 =
44.87, df = 6.00, P<.001; posterior GMin:
Copyright © 2017 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

χ2 = 19.50, df = 6.00, P = .003; anterior

A. Anterior GMin B. Posterior GMin
GMed: χ2 = 39.21, df = 6.00, P<.001; mid-
dle GMed: χ2 = 35.57, df = 6.00, P<.001;
EMG Amplitude, % MVIC

EMG Amplitude, % MVIC

140 140
120 120
100 100
posterior GMed: χ2 = 22.88, df = 6.00,
80 80 P = .001). Post hoc analyses showed sig-
60 60
nificant differences across all muscle seg-
40 40
20 20
ments, with medium to large effect sizes
0 0 for all significant comparisons (TABLE 2).
Hip Swing Toe Abd Dip STS Clam Swing Hip Toe Dip Abd STS Clam
Journal of Orthopaedic & Sports Physical Therapy®

Hitch tap test hitch tap test

DISCUSSION
C. Anterior GMed D. Posterior GMed

T
he current study evaluated GMed
EMG Amplitude, % MVIC

EMG Amplitude, % MVIC

140 140
120 120 and GMin muscle activation in old-
100 100
80 80
er, postmenopausal women during
60 60 a series of isometric and dynamic exer-
40 40 cises. The 3 highest-ranked exercises for
20 20
all segments were the isometric exercis-
0 0
Swing Hip Toe Dip Abd STS Clam Swing Hip Toe Dip STS Clam Abd es—hip hitch, hip hitch with toe tap, and
hitch tap test hitch tap test hip hitch with hip swing. Overall, higher
levels of muscle activity were observed
E. Middle GMed
during isometric exercises compared
EMG Amplitude, % MVIC

140
120
with dynamic exercises. The hip hitch
100 with hip swing was the highest-ranked
80 exercise for all muscle segments except
60
the anterior GMin, where it was ranked
40
20 second. The highest-ranked dynamic ex-
0 ercise for all muscle segments was the dip
Swing Hip Toe Dip Abd STS Clam test (FIGURE 2).
hitch tap test
The current study used fine-wire EMG
FIGURE 2. Box plots of GMed and GMin muscle activation, ranked and listed from highest to lowest. The dots methods to record GMin muscle activity
represent outliers (greater than 2 times the interquartile range above or below the median). Abbreviations: Abd, during a number of isometric and dynam-
isometric hip abduction; EMG, electromyography; GMed, gluteus medius; GMin, gluteus minimus; MVIC, maximum ic exercises. Five exercises elicited greater
voluntary isometric contraction; STS, sit-to-stand; Swing, hip hitch with hip swing; Toe tap, hip hitch with toe tap.
than 40% muscle activity in the posterior

journal of orthopaedic & sports physical therapy | volume 47 | number 12 | december 2017 | 917

 [ research report ]

TABLE 2 Post Hoc Analyses*

Dynamic Isometric
Clam Dip Test Hip Hitch Hip Hitch With Toe Tap Hip Hitch With Swing Hip Abduction
Anterior GMin
Dynamic
Sit-to-stand .093 (–0.53) .028 (0.69) .005 (0.89) .005 (0.89) .005 (0.89) .005 (0.89)
Clam .028 (0.69) .005 (0.89) .007 (0.85) .005 (0.89) .007 (0.85)
Dip test .005 (0.89) .009 (0.82) .007 (0.85) .017 (0.76)
Isometric
Hip hitch .028 (–0.69) .074 (–0.56) .093 (–0.53)
Hip hitch with toe tap .074 (0.56) .959 (–0.02)
Downloaded from www.jospt.org at on June 9, 2021. For personal use only. No other uses without permission.

Hip hitch with swing .241 (–0.37)

Posterior GMin
Dynamic
Sit-to-stand .208 (–0.45) .069 (0.65) .025 (0.71) .017 (0.84) .017 (0.84) .123 (0.54)
Clam .036 (0.74) .017 (0.84) .017 (0.84) .017 (0.84) .069 (0.64)
Copyright © 2017 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

Dip test .484 (0.25) .484 (0.25) .327 (0.35) .779 (–0.10)
Isometric
Hip hitch .26 (0.38) .059 (0.60) .139 (–0.47)
Hip hitch with toe tap .038 (0.69) .859 (–0.06)
Hip hitch with swing .139 (–0.47)
Anterior GMed
Dynamic
Sit-to-stand .009 (–0.82) .059 (0.60) .007 (0.85) .005 (0.89) .007 (0.85) .059 (0.60)
Clam .005 (–0.89) .005 (0.89) .005 (0.89) .005 (0.89) .005 (0.89)
Journal of Orthopaedic & Sports Physical Therapy®

Dip test .022 (0.09) .074 (0.56) .037 (0.66) .959 (–0.02)
Isometric
Hip hitch .799 (0.08) .508 (0.21) .241 (–0.37)
Hip hitch with toe tap .139 (0.47) .059 (–0.60)
Hip hitch with swing .013 (–0.79)
Table continues on page 919.

GMin, and 4 exercises elicited greater
than 40% muscle activity in the anterior
GMin. The dip test elicited very high levels
of muscle activation in the posterior GMin
(63%), but only moderate levels in the an-
terior GMin (22%). Differences in activity
could reflect the differing moment arms in
the sagittal plane. The anterior GMin has
a flexion moment arm,17 while the posteri-
or GMin has an extension moment arm,17
indicating that the potential for targeting
muscle acitvity during this exercise would
be greater for the posterior GMin than for
the anterior GMin.
Anterior GMin activity can be encour-
aged during weight-bearing tasks when
the hip is in a neutral position (eg, hip
hitch tasks). Previous research in young,
healthy adults found large bursts of activ-
ity in the mid to late stages of stance dur-
ing walking,44 suggesting that stimulus
for the anterior GMin to contract may oc-
cur when the hip is in a neutral to extend-
ed position. It has been proposed that
this activity reflects a role in stabilizing
the anterior hip joint.1 For conditions in
which anterior GMin atrophy is a specific
concern (eg, total hip replacement36), the
clinician should consider weight-bearing
exercises in positions that place the hip
joint in a neutral or extended position.
The GMed is a large, fan-shaped
muscle with a broad proximal attach-
ment that extends to its distal tendinous
insertion on the posterolateral aspect of
the greater trochanter.22 Its morphology
and large abduction moment arm enable
this muscle to stabilize the pelvis on the
femur.17 This may explain why exercises
that require unilateral stance recruited
the GMed at a higher level than those
in bilateral stance. Three of the 4 single-
leg isometric exercises (hip hitch, hip
hitch with toe tap, and hip hitch with hip
swing) investigated in this study elicited
moderate to very high levels of average
muscle activity in segments of the GMed
(anterior, greater than 68%; middle,
greater than 40%; and posterior, greater
than 44%). Likewise, the dip test, a dy-
namic exercise performed in unilateral

918 | december 2017 | volume 47 | number 12 | journal of orthopaedic & sports physical therapy


TABLE 2 Post Hoc Analyses* (continued)

Dynamic Isometric
Clam Dip Test Hip Hitch Hip Hitch With Toe Tap Hip Hitch With Swing Hip Abduction
Middle GMed
Dynamic
Sit-to-stand .203 (–0.40) .028 (0.69) .022 (0.73) .022 (0.73) .005 (0.89) .575 (0.49)
Clam .005 (0.89) .005 (0.89) .005 (0.89) .005 (0.89) .028 (0.69)
Dip test .799 (0.08) .799 (0.08) .333 (0.31) .047 (–0.63)
Isometric
Hip hitch .959 (0.02) .285 (0.34) .005 (–0.89)
Hip hitch with toe tap .721 (0.11) .013 (–0.79)
Downloaded from www.jospt.org at on June 9, 2021. For personal use only. No other uses without permission.

Hip hitch with swing .009 (–0.82)

Posterior GMed
Dynamic
Sit-to-stand .953 (–0.02) .139 (0.49) .025 (0.79) .015 (0.81) .011 (0.85) .26 (–0.375)
Clam .260 (0.38) .036 (0.74) .038 (2.073) .021 (0.77) .594 (–0.18)
Copyright © 2017 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

Dip test .017 (0.84) .051 (0.65) .011 (0.85) .859 (–0.06)
Isometric
Hip hitch .953 (–0.02) .110 (0.53) .015 (–0.81)
Hip hitch with toe tap .169 (0.44) .241 (–0.37)
Hip hitch with swing .005 (–0.89)
Abbreviations: GMed, gluteus medius; GMin, gluteus minimus.
*Values are P value (effect size) and are positive when the magnitude of median muscle activity of the exercise listed in the horizontal row is greater than that of
the exercise name listed in the vertical column. Values are negative when the magnitude of median muscle activity of the exercise name listed in the horizontal
row is less than that of the exercise listed in the vertical column.
Journal of Orthopaedic & Sports Physical Therapy®

stance, was found to elicit the highest
level of muscle activity in all segments
compared to other dynamic exercises (sit-
to-stand, clam).
The clam exercise was the least active
dynamic exercise across all segments,
yet remains a popular GMed exercise
in the clinical setting. It has been inves-
tigated in 2 other fine-wire studies.42,48
Selkowitz et al42 reported activation of
the middle GMed to be 26.7% ± 18.0%
of MVIC with TheraBand (Performance
Health, Akron, OH) resistance; at maxi-
mum resistance during an MVIC task,
Semciw et al48 found low (2%) and high
(43%) activity of anterior and posterior
segments, respectively. Together with
the results from our study, this body of
literature suggests that, regardless of the
intensity level prescribed, the clam exer-
cise would elicit negligible activity in the
anterior and middle GMed and, at most,
high activity in the posterior GMed dur-
ing a maximum contraction. The clam ex-
ercise could be considered to strengthen
the gluteals in non–weight-bearing indi-
viduals, for whom the posterior GMed is
the target muscle.
In general, isometric exercises elicited
greater average muscle activity than dy-
namic exercises, based on the methods
used in this study. The exception was the
dip test, which outperformed isometric
abduction, the clam, and the sit-to-stand
for all muscle segments except the ante-
rior GMin. One explanation for the lower
muscle activation during the dynamic ex-
ercises is the shorter time under tension.
In addition, dynamic exercises involve an
eccentric component, requiring lower neu-
romotor demand for a given submaximal
load.30 If these exercises were performed
with an isometric phase, the muscle ac-
tivation would likely be higher. Similarly,
if intensity, speed, or load were modified,
then our study findings may have differed.
Prescription of exercises should in-
volve an evaluation of muscle activity
elicited and also an assessment of the
suitability of the exercises to the individ-
ual. If an individual has difficulty with
single-leg weight bearing (eg, pain), then
the isometric abduction exercise in dou-
ble-leg standing elicits sufficient muscle
activity (greater than 40%) in the ante-
rior GMin and posterior GMin to achieve
strength gains.4,19 However, other exer-
cises may have to be considered for the
GMed. Additionally, a whole-lower-body
functional exercise like the sit-to-stand
would be reasonable to prescribe, given
its moderate activation level (GMed and
posterior GMin) and applicabilty to daily
tasks (getting out of a bed, chair, or car).
It is important to confirm these findings
in a symptomatic hip population.
A decline in gluteal muscle strength
and an increase in muscle atrophy and
fatty infiltration not only occur with

journal of orthopaedic & sports physical therapy | volume 47 | number 12 | december 2017 | 919

 [ research report
aging, but are also further implicated
in the presence of lower-limb patholo-
gy.15,37-39,52 There are many exercises de-
scribed in the literature to strengthen the
GMin and GMed musculature,39 some of
which may not be appropriate for the
older population (eg, single-limb deadlift
and single-leg squat,16 lunge,16,18,20 prone
plank18). Thus, maximizing gluteal activa-
tion with exercises that can be performed
easily in the home environment may be
useful in the rehabilitation of gluteal
musculature in an array of pathologies.
The isometric exercises investigated in
Downloaded from www.jospt.org at on June 9, 2021. For personal use only. No other uses without permission.
the current study would be expected to
provide sufficient stimulus to obtain hy-
pertrophy and strength in the GMin and
GMed. Following this, it may be impor-
tant to progress to dynamic exercises to
Copyright © 2017 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
incorporate motor patterning, balance,
proprioception, and gait retraining to re-
flect functional movements.
Limitations
As this study was performed solely in
healthy older women, its generalizabil-
ity may be limited beyond this popula-
tion. The current study only investigated
Journal of Orthopaedic & Sports Physical Therapy®
1 exercise that incorporated a rotatory
movement and did not investigate muscle
activity of the gluteus maximus. Further
research may investigate exercises that
incorporate rotatory elements (trans-
verse plane) that utilize the rotation mo-
ment arms of muscle segments within
the GMed and GMin and sagittal plane
movements for the gluteus maximus.
Furthermore, our study did not include
exercises with added external resistance.
This was done to minimize fatigue of par-
ticipants and to reflect baseline exercise
prescription for this population. Although
techniques of exercises were monitored
closely and standardized instruction was
given, trunk positioning and weight shift
during the exercises were not specifically
measured or recorded.
Recommended MVICs for the hip are
commonly performed in non–weight-
bearing positions. In some participants,
the hip hitch and hip hitch with hip
swing elicited muscle activity in the pos-
920 | december 2017 | volume 47 | number 12 | journal of orthopaedic & sports physical therapy
terior GMin and anterior GMed greater
than that recorded during the MVIC.
Similarly, isometric hip abduction also
elicited higher levels of posterior GMin
activity than those recorded during the
MVIC in some participants. Thus, the
MVIC for these segments was in fact
the exercise itself. This suggests that the
greatest neural drive for these muscles to
contract may in fact be in weight-bear-
ing positions. Future studies may want
to consider weight-bearing positions if
the intent is to identify the muscle’s peak
neuromuscular output.
The main outcome of this study was
muscle activation, and, although recom-
mendations have been made, they do not
account for the entire scope of assess-
ment measures commonly used in the
exercise prescription process (eg, level of
difficulty, available joint range of motion,
purpose of the exercise).
As this is an exploratory study, an al-
pha of .05 was used and a Bonferroni ad-
justment was not performed.34 This was
to prevent accepting the null hypothesis
when the alternative is true and commit-
ting a type II error.40
CONCLUSION
T
he current study quantified and
ranked the level of median muscle
activity of all segments of the GMin
and GMed muscles during 4 isometric
and 3 dynamic exercises in a group of
older, postmenopausal women. The hip
hitch and its variations elicited the high-
est muscle activation in all portions of
the GMin and GMed, and the clam ex-
ercise was the least active of all exercises
tested (for all portions of the GMin and
GMed except the posterior GMed, where
it ranked second to last). Overall, isomet-
ric exercises were found to elicit higher
median muscle activity in all muscle seg-
ments when compared with dynamic
exercises. As a decline in gluteal muscle
structure and function is associated with
many lower-limb pathologies, isometric
exercises may be useful to elicit high lev-
els of muscle activation in older women
]
and prevent the onset and progression of
musculoskeletal disorders resulting from
gluteal muscle deficits. t
KEY POINTS
FINDINGS: The hip hitch and its variations
elicited the highest muscle activation
in all portions of the gluteus minimus
(GMin) and gluteus medius (GMed),
and the clam exercise was the least ac-
tive of all exercises tested (for all por-
tions of the GMin and GMed except
the posterior GMed).
IMPLICATIONS: The hip hitch and its varia-
tions can be performed in the home
environment, and may be useful in hip
muscle rehabilitation.
CAUTION: This study was performed in
healthy older women and may have limit-
ed generalizability outside this population.
REFERENCES
1. Al-Hayani A. The functional anatomy of
hip abductors. Folia Morphol (Warsz).
2009;68:98-103.
2. Allison K, Bennell KL, Grimaldi A, Vicenzino
B, Wrigley TV, Hodges PW. Single leg stance
control in individuals with symptomatic gluteal
tendinopathy. Gait Posture. 2016;49:108-113.
https://doi.org/10.1016/j.gaitpost.2016.06.020
3. Australasian Menopause Society. Diagnosing
menopause. Available at: https://www.
menopause.org.au/hp/information-sheets/420-
diagnosing-menopause. Accessed May 14, 2014.
4. Ayotte NW, Stetts DM, Keenan G, Greenway
EH. Electromyographical analysis of selected
lower extremity muscles during 5 unilateral
weight-bearing exercises. J Orthop Sports Phys
Ther. 2007;37:48-55. https://doi.org/10.2519/
jospt.2007.2354
5. Barbosa AC, Carvalho RA, Bonifácio DN, Martins
FL, Barbosa MC. Increased activation amplitude
levels of gluteus medius in women during
isometric and dynamic conditions following a
4-week protocol of low-load eccentric exercises.
Physiother Res Int. 2016;21:257-263. https://doi.
org/10.1002/pri.1643
6. Basmajian JV, Stecko G. A new bipolar
electrode for electromyography. J Appl Physiol.
1962;17:849.
7. Bazett-Jones DM, Cobb SC, Joshi MN,
Cashin SE, Earl JE. Normalizing hip muscle
strength: establishing body-size-independent
measurements. Arch Phys Med Rehabil.
2011;92:76-82. https://doi.org/10.1016/j.
apmr.2010.08.020
8. Bennell KL, Egerton T, Pua YH, et al. Efficacy
 of a multimodal physiotherapy treatment
program for hip osteoarthritis: a randomised
placebo-controlled trial protocol. BMC
Musculoskelet Disord. 2010;11:238. https://doi.
org/10.1186/1471-2474-11-238
9. Bullock-Saxton JE, Wong WJ, Hogan N. The
influence of age on weight-bearing joint
reposition sense of the knee. Exp Brain Res.
2001;136:400-406. https://doi.org/10.1007/
s002210000595
10. Campenella B, Mattacola CG, Kimura IF. Effect
of visual feedback and verbal encouragement
on concentric quadriceps and hamstrings peak
torque of males and females. Isokinet Exerc Sci.
2000;8:1-6.
11. Chapman AR, Vicenzino B, Blanch P, Knox
JJ, Hodges PW. Intramuscular fine-wire
Downloaded from www.jospt.org at on June 9, 2021. For personal use only. No other uses without permission.
electromyography during cycling: repeatability,
normalisation and a comparison to surface
electromyography. J Electromyogr Kinesiol.
2010;20:108-117. https://doi.org/10.1016/j.
jelekin.2008.11.013
12. Chi AS, Long SS, Zoga AC, et al. Prevalence
Copyright © 2017 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
and pattern of gluteus medius and minimus
tendon pathology and muscle atrophy in
older individuals using MRI. Skeletal Radiol.
2015;44:1727-1733. https://doi.org/10.1007/
s00256-015-2220-7
13. Cohen J. Statistical Power Analysis for the
Behavioral Sciences. 2nd ed. Hillsdale, NJ:
Lawrence Erlbaum Associates; 1988.
14. Cook JL, Bass SL, Black JE. Hormone therapy is
associated with smaller Achilles tendon diameter
in active post-menopausal women. Scand J
Journal of Orthopaedic & Sports Physical Therapy®
Med Sci Sports. 2007;17:128-132. https://doi.
org/10.1111/j.1600-0838.2006.00543.x
15. Deasy M, Leahy E, Semciw AI. Hip strength
deficits in people with symptomatic knee
osteoarthritis: a systematic review with
meta-analysis. J Orthop Sports Phys Ther.
2016;46:629-639. https://doi.org/10.2519/
jospt.2016.6618
16. Distefano LJ, Blackburn JT, Marshall SW, Padua
DA. Gluteal muscle activation during common
therapeutic exercises. J Orthop Sports Phys
Ther. 2009;39:532-540. https://doi.org/10.2519/
jospt.2009.2796
17. Dostal WF, Soderberg GL, Andrews JG. Actions of
hip muscles. Phys Ther. 1986;66:351-361. https://
doi.org/10.1093/ptj/66.3.351
18. Ekstrom RA, Donatelli RA, Carp KC.
Electromyographic analysis of core trunk,
hip, and thigh muscles during 9 rehabilitation
exercises. J Orthop Sports Phys Ther.
2007;37:754-762. https://doi.org/10.2519/
jospt.2007.2471
19. Escamilla RF, Lewis C, Bell D, et al. Core muscle
activation during Swiss ball and traditional
abdominal exercises. J Orthop Sports Phys
Ther. 2010;40:265-276. https://doi.org/10.2519/
jospt.2010.3073
20. Farrokhi S, Pollard CD, Souza RB, Chen YJ,
Reischl S, Powers CM. Trunk position influences
the kinematics, kinetics, and muscle activity
journal of orthopaedic & sports physical therapy | volume 47 | number 12 | december 2017 | 921
of the lead lower extremity during the forward
lunge exercise. J Orthop Sports Phys Ther.
2008;38:403-409. https://doi.org/10.2519/
jospt.2008.2634
21. F ield A. Discovering Statistics Using SPSS. 3rd
ed. London, UK: SAGE Publications; 2009.
22. F lack NA, Nicholson HD, Woodley SJ. The
anatomy of the hip abductor muscles. Clin
Anat. 2014;27:241-253. https://doi.org/10.1002/
ca.22248
23. F lack NA, Nicholson HD, Woodley SJ. A review
of the anatomy of the hip abductor muscles,
gluteus medius, gluteus minimus, and tensor
fascia lata. Clin Anat. 2012;25:697-708. https://
doi.org/10.1002/ca.22004
24. F ranettovich M, Chapman A, Blanch P, Vicenzino
B. Continual use of augmented low-Dye taping
increases arch height in standing but does
not influence neuromotor control of gait.
Gait Posture. 2010;31:247-250. https://doi.
org/10.1016/j.gaitpost.2009.10.015
25. G ottschalk F, Kourosh S, Leveau B. The functional
anatomy of tensor fasciae latae and gluteus
medius and minimus. J Anat. 1989;166:179-189.
26. G reising SM, Baltgalvis KA, Lowe DA, Warren GL.
Hormone therapy and skeletal muscle strength:
a meta-analysis. J Gerontol A Biol Sci Med Sci.
2009;64:1071-1081. https://doi.org/10.1093/
gerona/glp082
27. G rimaldi A. Assessing lateral stability of the hip
and pelvis. Man Ther. 2011;16:26-32. https://doi.
org/10.1016/j.math.2010.08.005
28. H ase K, Stein RB. Turning strategies
during human walking. J Neurophysiol.
1999;81:2914-2922.
29. K iyoshige Y, Watanabe E. Fatty degeneration of
gluteus minimus muscle as a predictor of falls.
Arch Gerontol Geriatr. 2015;60:59-61. https://
doi.org/10.1016/j.archger.2014.07.013
30. K omi PV, Kaneko M, Aura O. EMG activity of the
leg extensor muscles with special reference to
mechanical efficiency in concentric and eccentric
exercise. Int J Sports Med. 1987;8 suppl 1:22-29.
31. L yons K, Perry J, Gronley JK, Barnes L, Antonelli
D. Timing and relative intensity of hip extensor
and abductor muscle action during level and
stair ambulation. An EMG study. Phys Ther.
1983;63:1597-1605. https://doi.org/10.1093/
ptj/63.10.1597
32. O
 ’Dwyer C, Sainsbury D, O’Sullivan K. Gluteus
medius muscle activation during isometric
muscle contractions. J Sport Rehabil.
2011;20:174-186. https://doi.org/10.1123/
jsr.20.2.174
33. O
 ’Sullivan K, Smith SM, Sainsbury D.
Electromyographic analysis of the three
subdivisions of gluteus medius during weight-
bearing exercises. Sports Med Arthrosc
Rehabil Ther Technol. 2010;2:17. https://doi.
org/10.1186/1758-2555-2-17
34. P
 erneger TV. What’s wrong with Bonferroni
adjustments. BMJ. 1998;316:1236-1238. https://
doi.org/10.1136/bmj.316.7139.1236
35. P
 errott MA, Pizzari T, Opar M, Cook J.
Development of clinical rating criteria
for tests of lumbopelvic stability. Rehabil
Res Pract. 2012;2012:803637. https://doi.
org/10.1155/2012/803637
36. Pfirrmann CW, Notzli HP, Dora C, Hodler J,
Zanetti M. Abductor tendons and muscles
assessed at MR imaging after total hip
arthroplasty in asymptomatic and symptomatic
patients. Radiology. 2005;235:969-976. https://
doi.org/10.1148/radiol.2353040403
37. Prins MR, van der Wurff P. Females with
patellofemoral pain syndrome have weak hip
muscles: a systematic review. Aust J Physiother.
2009;55:9-15.
38. Rasch A, Byström AH, Dalen N, Berg HE.
Reduced muscle radiological density, cross-
sectional area, and strength of major hip
and knee muscles in 22 patients with hip
osteoarthritis. Acta Orthop. 2007;78:505-510.
https://doi.org/10.1080/17453670710014158
39. Reiman MP, Bolgla LA, Loudon JK. A literature
review of studies evaluating gluteus maximus
and gluteus medius activation during
rehabilitation exercises. Physiother Theory Pract.
2012;28:257-268. https://doi.org/10.3109/09593
985.2011.604981
40. Rothman KJ. No adjustments are needed
for multiple comparisons. Epidemiology.
1990;1:43-46.
41. Schmitz RJ, Riemann BL, Thompson T. Gluteus
medius activity during isometric closed-chain
hip rotation. J Sport Rehabil. 2002;11:179-188.
https://doi.org/10.1123/jsr.11.3.179
42. Selkowitz DM, Beneck GJ, Powers CM. Which
exercises target the gluteal muscles while
minimizing activation of the tensor fascia
lata? Electromyographic assessment using
fine-wire electrodes. J Orthop Sports Phys
Ther. 2013;43:54-64. https://doi.org/10.2519/
jospt.2013.4116
43. Semciw A, Pizzari T, Green R. Intramuscular
EMG placement for two segments of gluteus
minimus and three segments of gluteus medius
with unique orientation and function [abstract].
J Sci Med Sport. 2011;14:e92-e93. https://doi.
org/10.1016/j.jsams.2011.11.191
44. Semciw AI, Green RA, Murley GS, Pizzari T.
Gluteus minimus: an intramuscular EMG
investigation of anterior and posterior segments
during gait. Gait Posture. 2014;39:822-826.
https://doi.org/10.1016/j.gaitpost.2013.11.008
45. Semciw AI, Green RA, Pizzari T, Briggs C.
Verification of a standardized method for
inserting intramuscular EMG electrodes into
uniquely oriented segments of gluteus minimus
and gluteus medius. Clin Anat. 2013;26:244-252.
https://doi.org/10.1002/ca.22055
46. Semciw AI, Neate R, Pizzari T. A comparison
of surface and fine wire EMG recordings of
gluteus medius during selected maximum
isometric voluntary contractions of the hip.
J Electromyogr Kinesiol. 2014;24:835-840.
https://doi.org/10.1016/j.jelekin.2014.08.015
47. Semciw AI, Pizzari T, Green RA. Technical
 [ research report
application and the level of discomfort
associated with an intramuscular
electromyographic investigation into gluteus
minimus and gluteus medius. Gait Posture.
2013;38:157-160. https://doi.org/10.1016/
j.gaitpost.2012.10.010
48. Semciw AI, Pizzari T, Murley GS, Green RA.
Gluteus medius: an intramuscular EMG
investigation of anterior, middle and posterior
]
49. S oderberg GL, Dostal WF. Electromyographic
study of three parts of the gluteus medius
muscle during functional activities. Phys Ther.
1978;58:691-696.
50. T aylor HL, Jacobs DR, Jr., Schucker B, Knudsen
J, Leon AS, Debacker G. A questionnaire for the
assessment of leisure time physical activities.
J Chronic Dis. 1978;31:741-755. https://doi.
org/10.1016/0021-9681(78)90058-9
J Orthop Sports Phys Ther. 2008;38:313-328.
https://doi.org/10.2519/jospt.2008.2685
52. Zacharias A, Pizzari T, English DJ, Kapakoulakis
T, Green RA. Hip abductor muscle volume
in hip osteoarthritis and matched controls.
Osteoarthritis Cartilage. 2016;24:1727-1735.
https://doi.org/10.1016/j.joca.2016.05.002

segments during gait. J Electromyogr Kinesiol.
2013;23:858-864. https://doi.org/10.1016/j.
jelekin.2013.03.007
Downloaded from www.jospt.org at on June 9, 2021. For personal use only. No other uses without permission.
Copyright © 2017 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
@ MORE INFORMATION
51. W oodley SJ, Nicholson HD, Livingstone V, et
al. Lateral hip pain: findings from magnetic
resonance imaging and clinical examination. WWW.JOSPT.ORG

PUBLISH Your Manuscript in a Journal With International Reach

JOSPT offers authors of accepted papers an international audience. The
Journal of Orthopaedic & Sports Physical Therapy®

Journal is currently distributed to the members of APTA’s Orthopaedic

and Sports Physical Therapy Sections and 33 orthopaedics, manual therapy,
and sports groups in 26 countries who provide online access either as
a member benefit or at a discount. As a result, the Journal is now
distributed monthly to more than 30,000 individuals around the world who
specialize in musculoskeletal and sports-related rehabilitation, health,
and wellness. In addition, JOSPT reaches students and faculty, physical
therapists and physicians at more than 1,500 institutions in 56 countries.
Please review our Information for and Instructions to Authors
at www.jospt.org in the Info Center for Authors and submit your manuscript
for peer review at http://mc.manuscriptcentral.com/jospt.

922 | december 2017 | volume 47 | number 12 | journal of orthopaedic & sports physical therapy

 [ research report ]
APPENDIX

EXERCISES COMPLETED DURING THE STUDY

Exercise Description Illustration
Isometric
Hip hitch Participant lifts the unaffected foot 1 cm off
the ground by hitching the hip upward,
maintaining full knee extension
Downloaded from www.jospt.org at on June 9, 2021. For personal use only. No other uses without permission.
Copyright © 2017 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

Hip hitch with toe tap Participant completes a hip hitch and then
taps the toes of the unaffected leg back
and forward onto/off a 7.5-cm step (po-
sitioned 10 cm in front of the starting
position)
Journal of Orthopaedic & Sports Physical Therapy®

Hip hitch with hip swing Participant completes a hip hitch and swings
the leg forward and backward 10° (pendu-
lum motion), maintaining full knee exten-
sion, at a swing rate of 50 Hz

Table continues on page A2.

journal of orthopaedic & sports physical therapy | volume 47 | number 12 | december 2017 | a1

 [ research report ]
APPENDIX

EXERCISES COMPLETED DURING THE STUDY (CONTINUED)

Exercise
Standing hip abduction
Downloaded from www.jospt.org at on June 9, 2021. For personal use only. No other uses without permission.
Description Illustration
Participant starts in double-stance position
(between-foot distance is measured as the
distance between the head of the fibula
and the lateral malleolus).10 A seatbelt
is secured around the proximal shank,
at the level of the head of the fibula, and
tightened until taut. Participant completes
isometric hip abduction by resisting out-
ward with 70% intensity, keeping feet flat

on the ground
Copyright © 2017 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

Dynamic
Dip test Participant rests the contralateral foot on a
step positioned behind her, and initiates
a single-leg squat on the affected leg to a
depth whereby the heel remains in contact
with the ground.37 The subject is instructed
to keep the trunk upright and is allowed to
lightly touch, but not to hold, the chair to
remain upright and balanced
Journal of Orthopaedic & Sports Physical Therapy®

Sit-to-stand Participant commences the trial seated in

a standard-height chair (46 cm), with
feet shoulder-width apart. Participant is
instructed to keep the trunk upright, stand
without using the hands, and return to
sitting

Clam Participant commences in sidelying, with

the hips and knees flexed to 45°, and
completes an abduction-external rotation
movement at the hip, while keeping the
hips stacked and the inside of the heels
in contact18

a2 | december 2017 | volume 47 | number 12 | journal of orthopaedic & sports physical therapy

 This article has been cited by:

1. Rachael Mary Cowan, Adam Ivan Semciw, Tania Pizzari, Jill Cook, Melissa Kate Rixon, Gaurav Gupta, Lindsey Marie
Plass, Charlotte Louise Ganderton. 2020. Muscle Size and Quality of the Gluteal Muscles and Tensor Fasciae Latae in
Women with Greater Trochanteric Pain Syndrome. Clinical Anatomy 33:7, 1082-1090. [Crossref]
2. Guilherme S. Nunes, Tania Pizzari, Rachel Neate, Christian J. Barton, Adam Semciw. 2020. Gluteal muscle activity
during running in asymptomatic people. Gait & Posture 80, 268-273. [Crossref]
3. Damien Moore, Adam I. Semciw, Trish Wisbey-Roth, Tania Pizzari. 2020. Adding hip rotation to therapeutic exercises
can enhance gluteus medius and gluteus minimus segmental activity levels – An electromyography study. Physical Therapy
in Sport 43, 157-165. [Crossref]
4. K. Aleisha Fetters. 2020. Exploring the Role of the Lateral Gluteal Muscles in Running: Implications for Training.
Strength & Conditioning Journal 42:1, 60-66. [Crossref]
5. Damien Moore, Tania Pizzari, Jodie McClelland, Adam I. Semciw. 2019. Rehabilitation Exercises for the Gluteus Medius
Muscle Segments: An Electromyography Study. Journal of Sport Rehabilitation 28:8. . [Crossref]
6. Damien Moore, Adam I. Semciw, Jodie McClelland, Henry Wajswelner, Tania Pizzari. 2019. Rehabilitation Exercises
for the Gluteus Minimus Muscle Segments: An Electromyography Study. Journal of Sport Rehabilitation 28:6, 544-551.
Downloaded from www.jospt.org at on June 9, 2021. For personal use only. No other uses without permission.

[Crossref]
7. Adam Ivan Semciw, Tania Pizzari, Stephanie Woodley, Anita Zacharias, Michael Kingsley, Rod A. Green. 2018. Targeted
gluteal exercise versus sham exercise on self-reported physical function for people with hip osteoarthritis (the GHOst
trial – Gluteal exercise for Hip Osteoarthritis): a protocol for a randomised clinical trial. Trials 19:1. . [Crossref]
Copyright © 2017 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

8. Charlotte Ganderton, Adam Semciw, Jill Cook, Euler Moreira, Tania Pizzari. 2018. Gluteal Loading Versus Sham
Exercises to Improve Pain and Dysfunction in Postmenopausal Women with Greater Trochanteric Pain Syndrome: A
Randomized Controlled Trial. Journal of Women's Health 27:6, 815-829. [Crossref]
Journal of Orthopaedic & Sports Physical Therapy®