Manual Therapy 22 (2016) 211e215

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Manual Therapy
journal homepage: www.elsevier.com/math

Original article

Modifying the hip abduction angle during bridging exercise can

facilitate gluteus maximus activity
Sun-Young Kang a, Sung-Dae Choung b, Hye-Seon Jeon c, *
a
Department of Physical Therapy, The Graduate School, Yonsei University, 1 Yonseidae-gil, Wonju, Kangwon-do, Republic of Korea
b
Department of Physical Therapy, Baekseok University, Anseo-dong, Dongnam-gu, Cheonan-si, Chungcheongnam-do, Republic of Korea
c
Department of Physical Therapy, College of Health Science, Yonsei University, 1 Yonseidae-gil, Wonju, Kangwon-do, Republic of Korea

a r t i c l e i n f o a b s t r a c t

Article history: Purpose: To investigate how the erector spinae (ES) and gluteus maximus (GM) muscle activity and the
Received 6 January 2015 anterior pelvic tilt angle change with different hip abduction angles during a bridging exercise.
Received in revised form Methods: Twenty healthy participants (10 males and 10 females, aged 21.6 ± 1.6) voluntarily participated
23 December 2015
in this study. Surface electromyography (EMG) signals were recorded from the ES and GM during
Accepted 26 December 2015
bridging at three hip abduction angles: 0
, 15
, and 30
. Simultaneously, the anterior pelvic tilt angle was
measured using Image J software.
Keywords:
Results: The EMG amplitude of the GM muscle and the GM/ES EMG ratio were greatest at 30
hip
Bridging exercise
Electromyography
abduction, followed by 15
and then 0
hip abduction during the bridging exercise. In contrast, the ES
Gluteus maximus EMG amplitude at 30
hip abduction was significantly lesser than that at 0
and 15
abduction. Addi-
Hip abduction tionally, the anterior pelvic tilt angle was significantly lower at 30
hip abduction than at 0
or 15
.
Conclusions: Bridging with 30
hip abduction can be recommended as an effective method to selectively
facilitate GM muscle activity, minimize compensatory ES muscle activity, and decrease the anterior pelvic
tilt angle.
© 2015 Elsevier Ltd. All rights reserved.

1. Introduction observed in patients performing bridging exercises, and the re-

Bridging exercises are commonly included in physical therapy
programs to facilitate pelvic motions and reinforce back and hip
extensors in individuals with back and hip pathologies (Stevens
et al., 2006). Bridging allows weight bearing through the feet and
is an important precursor to assuming the kneeling position and in
developing sit-to-stand control. In addition, performing bridging
exercises in rehabilitation programs has several important func-
tional implications, including bed mobility, use of a bedpan, pres-
sure relief, movement from sit-to-stand, and stair climbing
(O'Sullivan et al., 2013).
However, uncontrolled excessive lumbar lordosis, dominant
erector spinae (ES) activity, and anterior pelvic tilts frequently are
This work should be attributed to the Department of Physical Therapy, Yonsei
University.
* Corresponding author. Department of Physical Therapy, Graduate School, Yon-
sei University, 1 Yonseidae-gil, Wonju, Republic of Korea. Tel.: þ82 33 760 2498;
fax: þ82 33 760 2496.
E-mail address: hyeseonj@yonsei.ac.kr (H.-S. Jeon).
petitive motion of this activity induces increased compression
stress on the lumbar and pelvic areas (Sahrmann, 2002; Massoud
Arab et al., 2011). Furthermore, repeating the bridging exercise
without correcting any unwanted lumbopelvic motions may cause
secondary lumbopelvic dysfunction (McConnell, 2002). Therefore,
many recent studies have investigated how to control unwanted
lumbar and pelvic movement during bridging. Kim et al. (2009)
suggested that bridging with an abdominal drawing-in maneuver
(ADIM) is an effective method to prevent excessive contraction of
ES activity. Clark and Scott (2010) recommended maintaining the
shoulders, hips and knee in a straight line during bridging in order
to prevent excessive anterior pelvic tilt with dominant ES. In
addition, Choi et al. (2015) applied isometric hip abduction using a
Thera-band during bridging and showed increased GM muscle
activity and reduced anterior pelvic tilt.
One of the essential factors considered during exercise is fiber
arrangement within the muscles and joint positions (Soderberg,
1983). When the line of action of the muscle matches the line of
fiber of the muscle, the effect of muscle contraction is augmented
(Smidt and Rogers, 1982). In terms of the downward and outward

http://dx.doi.org/10.1016/j.math.2015.12.010
1356-689X/© 2015 Elsevier Ltd. All rights reserved.
212 S.-Y. Kang et al. / Manual Therapy 22 (2016) 211e215
fiber direction within the GM muscle, Kang et al. (2013) examined
the effects of different hip abduction angles during prone hip
extension with knee flexion. The results of their study showed that
30
hip abduction was the best way to maximize the GM amplitude
and advance the firing time of the GM muscle relative to the
hamstring. However, regardless of lumbar and pelvic compensation
related to back and hip extension movement, their study did not
measure ES muscle activity or the pelvic anterior tilt angle (Kang
et al., 2013). In addition, lifting the leg in the prone position is
considered an open kinetic exercise, and no study has reported on
the effects of the hip abduction angle during closed kinetic exercise,
such as bridging in the supine position.
Therefore, as an alternative method to prevent unwanted lum-
bar and pelvic compensation, this study aimed to examine the in-
fluence of various hip abduction angles during bridging on back and
hip extensor muscle activity and anterior pelvic tilt angle. We hy-
pothesized the following: GM muscle activity would increase, ES
muscle activity would decrease, and the anterior pelvic tilt angle
would be reduced as the hip abduction angle increased.
2. Methods
2.1. Participants
A power analysis was performed with G*Power software ver.
3.1.5 (Franz Faul, University of Kiel, Kiel, Germany) using the results
of a pilot study involving 6 participants (Faul et al., 2007). The
calculation of the sample size was carried out with a power of 0.80,
an alpha level of 0.05 and an effect size of 0.79. The provided
sample size was 16. Therefore, we recruited participants from
Yonsei University in Korea, and 20 asymptomatic subject (10 males
and 10 females) volunteered for the study (Table 1). Prior to testing,
the principal investigator explained the entire procedure, and all
participants voluntarily gave informed consent.
The exclusion criteria were as follows: (1) a history of lumbar,
sacroiliac or lower limb injury within the past year, (2) past or
present neurological, musculoskeletal and cardiopulmonary dis-
eases, (3) hip flexor shortness by the Thomas Test (Magee, 2002),
(4) adductor muscle shortness according to the Adduction
Contracture Test (Magee, 2002), or (5) lumbar or hip pain when
performing bridging exercises. These musculoskeletal examina-
tions of the lower extremities were performed to avoid compen-
sations related to muscle shortness by a principal investigator who
is certified orthopedic physical therapist. The study protocol was
approved by the Yonsei University Wonju Institutional Review
Board.
2.2. Instrumentation
Surface electromyography (EMG) was used to record the ES and
GM muscle activity during the bridging exercise. EMG data were
collected using a wireless TeleMyo DTS (Noraxon Inc., Scottsdale,
AZ, US) with a sampling rate of 1000 Hz. The raw signal was filtered
using a 60-Hz notch filter and a digital band-pass filter (Lancosh
Table 1
General characteristics of participants (N ¼ 20).
Mean ± SDb
Age (year) 21.6 ± 1.6
Height (cm) 169.3 ± 7.7
Weight (kg) 62.4 ± 10.6
BMIa (kg/m2) 21.5 ± 3.2
a
Body mass index.
b
Mean ± standard deviation.
FIR) between 20 and 450 Hz. The collected EMG data were analyzed
using Noraxon MyoResearch Master Edition 1.08 XP software
(Noraxon Inc., Scottsdale, AZ, US).
In addition, two reflective markers, a digital camera and Image J
software (National Institutes of Health, Bethesda, MD, US), were
used to measure the anterior pelvic tilt angle using the same
method as that described by a previous study (Choi et al., 2015). The
main investigator attached two markers to the anterior superior
iliac spine (ASIS) and the posterior superior iliac spine (PSIS) of the
testing dominant kicking leg. The digital camera was consistently
placed at a 1.2-m distance from the participant, and it recorded the
participant's pelvic position during the bridging exercise. After
completion, the video files were transferred to the Image J software
program, and the anterior pelvic tilt angle was calculated. In this
study, the anterior pelvic tilt angle was defined as the angle be-
tween the line connecting the ASIS and PSIS and the vertical line
from the ASIS.
2.3. Bridging exercise procedure
Each participant began in the supine hook-lying position with
90
knee flexion. Their feet were a hip's width apart, and their arms
were crossed over the chest. In the preparation stage, the examiner
attached stickers to the midpoints of the patella and the ASISs
bilaterally. The 0
hip abduction position was defined as when the
stickers on the ASISs and mid-patellae were aligned in a straight
line. The 15
and 30
of hip abduction angles were determined
using a goniometer. Once the desired hip abduction position was
achieved, two plastic poles were placed vertically along the lateral
aspect of the bilateral knee joint to prevent any compensative hip
movement. Also, a wooden target bar was placed at the mid-point
of line between ASIS and mid-patella to maintain a consistent
height of pelvic lifting for each trial. The height of the target bar was
set as the height of the thigh when the shoulders, hips and knees
were aligned in a straight line during bridging.
The participants were asked to lift their pelvis off the table at a
self-selected speed, slightly touch the wooden target bar and then
hold the end bridging position for 5 s. At the same time, the
participant was instructed to maintain the lateral aspects of the
knee joint in slight contact with the vertical plastic poles. Data from
attempts where the participant failed to maintain the standardized
position were discarded. Before data acquisition, all participants
had practiced the bridging exercise for 5 min to familiarize them-
selves with the procedure. Then, for data acquisition, the partici-
pants performed the bridging exercise three times for each hip
abduction angle with a 30-s inter-trial period. The order of the hip
abduction angles was randomized using a computer-based
randomization program, and a 2-min break was given between
the conditions. This randomization was done to minimize threats to
the study's internal validity (Youdas et al., 2008).
2.4. Data collection and processing
EMG data of ES and GM were collected from the dominant
kicking leg with a pair of AgeAgCl surface electrodes 2 cm in
diameter. Prior to electrode placement, the electrode sites were
shaved and rubbing alcohol was used to reduce skin impedance.
The EMG electrode for the ES was placed over the muscle mass
approximately 2 cm away from the spine at the level of the iliac
crest. The electrode for the GM was placed half the distance from
the greater trochanter to the second sacral vertebra at an oblique
angle (Criswell, 2011).
The raw EMG signals were processed into the root mean square
(RMS) moving window for 300 ms. The maximal voluntary iso-
metric contraction (MVIC) was used to normalize EMG data for
 S.-Y. Kang et al. / Manual Therapy 22 (2016) 211e215
each tested muscle, and MVIC testing protocols were performed
according to Kendall's manual muscle testing positions (Kendall
et al., 2005). The EMG amplitude was expressed as a percentage
of the calculated RMS of MVIC (%MVIC). The EMG data at three hip
abduction positions were recorded for 5 s and calculated from the
middle 3-s. The mean value of the middle 3-s contraction of the
three trials for each condition was used for data analysis. To
calculate the GM/ES EMG ratio, the normalized GM amplitude was
divided by the normalized ES amplitude.
2.5. Statistical analysis
Descriptive statistics were obtained for all variables. A Kolmo-
goroveSmirnov Z-test was performed to assess whether contin-
uous data approximated a normal distribution. The descriptive data
were expressed as a mean and standard deviation. A one-way
repeated-measures analysis of variance (ANOVA) was used to
compare muscle activity with the anterior pelvic tilt angle among
the three hip abduction angles. The level of statistical significance
was set at 0.05. If a significant difference were found, a Bonferroni
correction was performed, which divided the significance level by
the number of pairwise comparisons (0.05/3 ¼ 0.025). All statistical
analyses were performed using PASW Statistics ver. 21.0 (SPSS, Inc.,
Chicago, IL, US).
Additionally, intra-tester reliability of the EMG amplitudes of
the GM and ES, and the anterior pelvic tilt and anterior pelvic tilt
angle was established by repeating the measurements for six par-
ticipants on two separate occasions, seven days apart, and then
determining the intraclass correlation coefficients (ICC). The stan-
dard error of measurement (SEM) was calculated with the
pffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
following formula: SEM ¼ SD  1  ICC. The minimal detectable
change (MDC) was determined using the data from the two tests:
MDC90 ¼ √2  1:65  ðSEMÞ (Eliasziw et al., 1994).
3. Results
Results of the KolmogoroveSmirnov Z-test indicated that all
variables were normally distributed. The measurements of the ES
EMG amplitudes had an ICC of r ¼ 0.89 (p ¼ 0.012) with an SEM of
0.74 (%MVIC) and an MDC90 of 1.74 (%MVIC). The measurements of
the GM EMG amplitudes had an ICC of r ¼ 0.91 (p ¼ 0.000) with an
SEM of 1.09 (%MVIC) and an MDC90 of 1.12 (%MVIC). The mea-
surements of the anterior pelvic tilt angle had an ICC of r ¼ 0.87
(p ¼ 0.001) with an SEM of 0.34
and an MDC90 of 0.82
.
EMG amplitudes of the GM and ES, the GM/ES ratio, and the
anterior pelvic tilt angle were significantly different among the
three hip abduction angles (Table 2). The GM EMG amplitude was
greatest at 30
of hip abduction, followed by 15
and then 0
of hip
abduction during the bridging exercise (F ¼ 43.081, padj ¼ 0.000,
h2 ¼ 0.683). The ES EMG amplitude at 30
hip abduction was
significantly lower than that for 0
hip abduction (F ¼ 10.025,
Table 2
Back and hip extensor muscle activity and anterior pelvic tilt angle in hip abduction angles.
Hip abduction angle
0

a
EMG amplitude (% MVIC)
Erector spinae (ES) 50.68 ± 4.93b
Gluteus maximus (GM) 16.62 ± 1.09
GM/ES EMG ratio 0.33 ± 0.04
Anterior pelvic tilt angle (
) 8.27 ± 1.19
a
Electromyography.
b
Mean ± standard deviation.
c
p < 0.05.
213
padj ¼ 0.001, h2 ¼ 0.334). However, there were no significant dif-
ferences between 0
and 15
hip abduction or between 15
and 30

hip abduction (padj ¼ 0.068 and 0.220, respectively). The GM/ES
ratio was greatest at 30
of hip abduction, followed by 15
and then
0
of hip abduction during the bridging exercise (F ¼ 40.777,
padj ¼ 0.000, h2 ¼ 0.671). In addition, the anterior pelvic tilt angles
among the three hip abduction angles showed a gradual decrease
as the angle of hip abduction increases (F ¼ 71.288, padj ¼ 0.000,
h2 ¼ 0.781). The results of all variables are shown in Fig. 1.
4. Discussion
The purpose of this study was to determine if the application of
hip abduction (0
, 15
and 30
) during the bridging exercise would
have significant effects on hip extensor muscle activity and the
anterior pelvic tilt angle. As we hypothesized, the GM EMG
amplitude were greatest at 30
of hip abduction (20.34%MVIC),
followed by 15
(17.96%MVIC) and then 0
(16.62%MVIC) of hip
abduction. The finding indicates that the GM muscle activity
functionally increases when the angle of hip abduction is greater.
On the other hand, the ES amplitude at 30
(46.82%MVIC) of hip
abduction was significantly lower than at 0
(48.69%MVIC) and 15

(50.68%MVIC) of hip abduction, meaning that the ES muscle activity
functionally decreases when the angle of hip abduction is greater.
Additionally, the anterior pelvic tilt angle at 30
(4.66
) of hip
abduction was significantly lower than that at 0
(8.27
) or 15

(7.30
) of hip abduction. This findings also indicated anterior pelvic
tilt functionally decreased when the angle of hip abduction is
greater. In brief, all three variables used in this study supported the
research hypothesis that, when the angle of hip abduction is
greater, the GM muscle activity will increase, the ES muscle activity
will decrease and the anterior pelvic tilt angle will be reduced.
Therefore, those findings could conclude that bridging exercises at
30
of hip abduction can be implemented as an effective method to
facilitate GM muscle activity, minimize compensatory ES muscle
activity and decrease the anterior pelvic tilt angle.
The direction of fiber alignment within a muscle is known to
influence the effectiveness of the muscle's contraction (Soderberg,
1983). According to a recent cadaver study, the mean fascicle
orientation of the GM was directed downward and outward from
about 32
to 45
below a horizontal line (Barker et al., 2014). In this
study, we did not choose a 32
e45
angle of hip abduction because
participants in a pilot study complained of the inconvenience and
failed to maintain the end position during bridging at an angle
greater than 30
of hip abduction. However, when performing
bridging at a gradually greater angle of hip abduction, the GM
muscle may lie in the direction of the line of pull of the muscle,
leading to increased muscle activity. This finding is the same as that
of a previous study, which reported the GM activity was greatest at
30
of hip abduction during prone hip extension with knee flexion
in an open kinetic chain condition (Kang et al., 2013). In addition,
15
30
p
48.69 ± 5.37 46.82 ± 5.06 0.002c
17.96 ± 1.53 20.34 ± 1.40 0.012c
0.38 ± 0.05 0.45 ± 0.08 0.000c
7.30 ± 0.95 4.66 ± 0.77 0.000c
214 S.-Y. Kang et al. / Manual Therapy 22 (2016) 211e215
Fig. 1. Post-hoc comparisons among three hip abduction positions. Means and SDs are shown as bars and hatches. *padj < 0.05/3. Abbreviations: ES ¼ erector spiane; GM ¼ gluteus
maximus; EMG ¼ electromyography.
our results support the explanation of Choi et al.'s study, which
reported that placing the limb at 30
of hip abduction in advance
before the bridging exercise may induce facilitation of the GM,
consequently increasing GM muscle activity (Choi et al., 2015).
Briefly, these results suggest that performing bridging at 30
of hip
abduction could be a good strategy to selectively increase GM
muscle activity.
The ES and GM work together in trunk extension and influence
each other as a synergistic muscle (Chance-Larsen et al., 2010;
Kang et al., 2013). When the movement occurs in the same
range of motion, increased muscle activity of one muscle can
create efficiencies in the movement, thereby decreasing the
workload of another muscle (Devlin, 2000; Jonkers et al., 2003).
In our experiment, the heights of pelvic lifting were kept constant
across hip positions using a wooden target bar. Therefore, the
decreased ES muscle activity at 30
of hip abduction may be
related with the increased activity of the GM, which is mechan-
ically advantageous for performing the bridging exercise at the
hip abduction angle. In brief, these results indicate that per-
forming 30
of hip abduction could be an effective method to
minimize ES activity as well as concurrently maximize GM
activity.
In addition, the decrease of the anterior pelvic tilt angle relative
to the increase of the hip abduction angle can be explained by the
increased GM activity. The GM functions as a posterior pelvic tilt to
counteract the anterior pelvic tilt as well as a powerful hip extensor
and external rotator (Frank and Netter, 1987). The advantage of
using the GM muscle in a more abducted position is that it may
position the pelvis more posteriorly, concurrently decreasing the
anterior pelvic tilt. This finding indicates that performing bridging
with 30
of hip abduction could be recommended as an effective
method to prevent excessive anterior pelvic tilt during bridging.
Hip flexor stiffness, weakness of the GM, deficits in abdominal
muscle control, and dominance of ES muscle activity are possible
contributing factors for the unwanted excessive lumbar lordosis
and anterior pelvic tilts that can occur during bridging (Sahrmann,
2002). GM weakness is one of the common characteristics of pa-
tients with low back pain (LBP) (Hossain and Nokes, 2005).
Therefore, when bridging exercise are provided to LBP patients
with GM weakness, bridging with 30
of hip abduction would be
appropriate of preventing unwanted excessive lumbar and pelvic
motion (Sahrmann, 2002; Massoud Arab et al., 2011).
This study had several limitations. First, in this experiment, the
way of abdominal muscle contraction was not considered even
 S.-Y. Kang et al. / Manual Therapy 22 (2016) 211e215
though previous studies have reported that hip extensor muscle
activity and anterior pelvic tilt angle during the bridging exercise
were influenced by firming the abdominal muscles through various
methods such as the ADIM (Oh et al., 2007; Kim et al., 2009).
Second, this study only measured unilateral dominant kicking leg,
although bridging exercise involves bilateral control of the ES and
GM muscles. Thus, further study will be needed to confirm the
effects of hip abduction to bilateral leg during bridging. Finally, the
generalizability of our results to populations with pathological
conditions was limited because our study included only young
healthy participants. Therefore, further clinical studies are neces-
sary to evaluate the effectiveness and applicability of the bridging
exercise in an abducted hip position for real patients as LBP.
5. Conclusions
Bridging exercises at 30
of hip abduction can be implemented
as an effective method to facilitate GM muscle activity, minimize
compensatory ES muscle activity, and decrease the anterior pelvic
tilt angle.
Acknowledgments
This work was supported by the National Research Foundation
of Korea Grant funded by the Korean Government (NRF-
2013S1A5B8A01055336).
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