Practical Guide to Hip and Knee Strengthening: Difference between revisions
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Revision as of 23:54, 25 March 2024
Original Editor - Wanda van Niekerk based on the course by Lee Herrington
Top Contributors - Wanda van Niekerk and Jess Bell
Progressive Overload for Strength Development[edit | edit source]
General principles to consider with progressive overload:
- Remember TWO things when dealing with a patient who requires strengthening[1]:
- establish the level of load they can currently cope with
- keep reassessing the situation as the patient progresses[2]
- Progressively expose an individual to load at a tissue and system level[3]
- Maximum tolerated loads are necessary to generate supraphysiological stress and low level of micro failure to create adaptation[4]
- Allow sufficient recovery time to enable adaptation
- Application of the appropriate load to drive the required adaptation
- Specific Adaptation to Imposed Demand (SAID) principle
- Adaptations produced by training are highly specific to the nature of the stimulus or overload applied[5]
- Adaptations are specific to strength, power, endurance, functional activity, joint angle, sequence of muscle activations, energy systems and virtually all other variables present.
- SAID principle is impacted by:
- position or length of the muscle (length-tension relationship)
- speed of contraction (force - velocity relationship)
- muscle contraction type (isometric, concentric, eccentric)
- Repetition maximums
- The repetition continuum or strength-endurance continuum is usually used to prescribe specific loading recommendations[5]
- For muscle strength, use low repetitions with heavy loads: 1 - 5 repetitions per set with 80% - 100% of 1 -repetition max (1RM)
- For muscle hypertrophy, use moderate repetitions with moderate loads: 8 - 12 repetitions per set with 60% - 80% of 1RM
- For muscle endurance, use high repetitions with light loads: 15 + repetitions per set with loads below 60% of 1RM
- Read more: Loading Recommendations for Muscle Strength, Hypertrophy, and Local Endurance: A Re-Examination of the Repetition Continuum[5]
- The repetition continuum or strength-endurance continuum is usually used to prescribe specific loading recommendations[5]
- Percentage (%) repetition maximum
- If you'd like you can read more about:
- Read more about the principles of rehabilitation such as where to start, underpinning theories, key issues when reloading injured tissues, monitoring the impact of load and progressing load here.
Modified Daily Adjustable Progressive Resistance Exercise (DAPRE) System[edit | edit source]
- System introduced by Knight[8]
- Below is a short summary of the DAPRE system[9]:
- 5 RM TO 7 RM 4-set system
- System allows patients to train at their fullest potential while still accounting for variations in strength levels
- Sets 1 and 2 are warm-up sets, sets 3 and 4 are maximum effort sets
- Sets are designed around a "working weight"
- The working weight is the weight used in set 3
- Weights used for sets 1 and 2 is a percentage of the working weight (set 1 uses 50% of the working weight, set 2 uses 75% of the working weight, set 3 uses the full working weight)
- Maximum repetitions performed in set 3 determine the weight to be used in set 4
- Number of repetitions performed in set 4 is used to determine the working weight for the next training session
- This system is ideal for rehabilitation, regardless of the degree of the patient's strength or deconditioning
- Recommended article to read: The Daily Adjustable Progressive Resistance Exercise System: Getting Reacquainted With an Old Friend[9]
Number of repetitions performed during set 3 | Set 4 | Next session |
---|---|---|
0 - 2 | decrease 2.5 - 5 kg (5 - 10 lbp) | decrease 2.5 - 5 kg (5 - 10 lbp) |
3 - 4 | decrease 2.5 kg (5 lbp) | keep the same |
5 -6 | keep the same | increase 2.5 - 5 kg (5 - 10 lbp) |
7 -10 | increase 2.5 - 5 kg (5 - 10 lbp) | increase 2.5 - 7.5 kg (5 - 15 lbp) |
more than 10 | increase 5 - 7.5 kg (10 - 15 lbp) | increase 5 - 10 kg (10 - 20 lbp) |
Isolated Muscle Work Around Muscles of the Hip and Knee[edit | edit source]
- Isolated muscle work is often presented as the amount of electromyographic (EMG) activity. It is important to know that for strengthening purposes the level of EMG activity needs to be greater than 70 - 80% of an individual's maximum isometric voluntary contraction (MIVC).[1]
- Repetition to failure of a selected exercise must be between 8 -10 repetitions for strength training.[5]
Gluteus Maximus[edit | edit source]
Table 2 shows examples of exercises for gluteus maximus recruitment. The percentage maximum isometric voluntary contraction (MIVC) is shown to indicate the rank order for these exercises. The addition of bands to weight-bearing activity will significantly increase gluteus maximus activity.[10]
Exercise | % MIVC |
---|---|
Front plank with hip extended | 100 |
Single leg squat | 72 |
Side plank | 71 |
Lateral step up | 64 |
Single leg deadlift | 59 |
Forward step-up | 55 |
Single leg bridge | 54 |
Hip clam | 53 |
Below are some examples of exercises targeting gluteus maximus.
Progression of bridging exercise
The four videos below provide an example of progressing the bridge exercise. Performing a unilateral bridge with the other leg straight (lengthened lever arm) produces significantly greater EMG activity than a unilateral bridge with the other leg in 90 degrees hip flexion and 90 degrees knee flexion (shortened lever arm) in the gluteus maximus and gluteus medius muscles.[16] The addition of a band to the exercise further increases gluteal activity.[10]
Barbell hip thrust versus squat or split squat
In patients who are not able to tolerate a high amount of load very well (e.g. a patient with spinal problems), consider a hip thrust type of exercise with a weight across the pelvis instead of a squat or split squat exercise. The barbell hip thrust exercise produces greater gluteus maximus activity than the back squat and split squat.[21] See two examples of exercises below.
Gluteus medius[edit | edit source]
Table 3 shows the rank order of exercises for recruitment of gluteus medius based on EMG activity. The addition of bands has also been shown to increase gluteus medius activity significantly.[10]
Exercise | %MIVC |
---|---|
Side plank | 100 |
Single leg squat | 82 |
Front plank hip extended | 75 |
Hip abduction in sidelying | 63 |
Lateral step up | 60 |
Single leg deadlift | 56 |
Forward step-up | 55 |
Single leg bridge | 55 |
Hip Clam | 47 |
Below are some examples of exercises targeting gluteus medius.
Summaries of articles focusing on hip rehabilitation exercises
- Electromyographic analysis of gluteus medius and gluteus maximus during rehabilitation exercises. [11]
- This article provides a list of exercises and the percentage MIVC of the gluteal muscles that occurs during these various exercises. Images and instructions of all exercises are also provided.
- Gluteal muscle forces during hip-focused injury prevention and rehabilitation exercises[26](restricted access)
- Muscles forces in eight hip-focused exercises were compared and ranked. The exercises were performed with and without external resistance. Underlying fibre lengths, velocities and muscle activations were described by inputting data from motion capture, ground reaction forces and EMG into an EMG-informed neuromusculoskeletal model. Gluteus maximus, medius and minimus muscle forces were estimated in this model.
- Tier 1 exercises for Gluteus maximus were:
- loaded split squat, loaded single leg Romanian deadlift, loaded single-leg hip thrust[26]
- Tier 1 exercises for Gluteus medius were:
- Body weight side plank, loaded single leg squat, loaded single leg Romanian deadlift[26]
- Tier 1 exercises for Gluteus minimus were:
- loaded single leg Romanian deadlift, body weight side plank[26]
- Blog post to read: Hip-focused injury prevention and rehabilitation exercises: How to choose which one?[27]
- Useful infographic: Gluteal muscle forces during hip-focused injury prevention and rehabilitation exercises[28]
Hip Adductors[edit | edit source]
The rank order of exercises for the recruitment of adductor longus based on EMG is shown in Table 4. The mean peak normalised EMG (nEMG) results of a maximum voluntary contraction (MVC) of the adductor longus of the dominant leg are shown. Note in the study by Serner et al.[29] the dominant leg was defined as the preferred kicking leg.
Exercise | Mean peak normalised EMG (nEMG)% of MVC of the dominant leg (adapted from Serner et al.[29]) |
---|---|
Isometric adduction with ball between knees | 108 ± 6 |
Copenhagen adduction | 108 ± 5 |
Hip adduction with band | 103 ± 6 |
Hip adductor machine | 99 ± 6 |
Sliding hip abduction / adduction | 98 ± 6 |
Isometric adduction with a ball between ankles | 86 ± 6 |
Hip adduction sidelying | 64 ± 6 |
Hip adduction supine | 14 ± 6 |
Below are examples of some of the adductor exercises.
Hamstrings[edit | edit source]
"Hamstrings are activated differently during hip-based and knee-based tasks."[36] Hip extension exercises such as straight leg raise bridge or a unilateral stiff-leg deadlift (or Arabesque or single-leg Romanian variation in a Romanian deadlift) loads the biceps femoris more, while the Nordic hamstring exercise recruits semitendinosus more.[36]
Quadriceps[edit | edit source]
Adapting Closed Chain Exercises for Either Knee or Hip Bias[edit | edit source]
The relative contribution of the the knee or hip to a squatting task is influenced by:
- the amount of load during a deadlift[39] and lunge[40]
- the trunk position[41][42][43]
- the limb position
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Herrington, L. Practical Guide to Hip and Knee Strengthening. Course. Plus. 2024
- ↑ Suchomel TJ, Nimphius S, Bellon CR, Hornsby WG, Stone MH. Training for muscular strength: Methods for monitoring and adjusting training intensity. Sports Medicine. 2021 Oct;51(10):2051-66.
- ↑ Taberner M, Allen T, Cohen DD. Progressing rehabilitation after injury: consider the ‘control-chaos continuum’. British journal of sports medicine. 2019 Sep 1;53(18):1132-6.
- ↑ Herrington, L. General Principles of Exercise Rehabilitation Course. Plus. 2022.
- ↑ 5.0 5.1 5.2 5.3 Schoenfeld BJ, Grgic J, Van Every DW, Plotkin DL. Loading recommendations for muscle strength, hypertrophy, and local endurance: a re-examination of the repetition continuum. Sports. 2021 Feb 22;9(2):32.
- ↑ 6.0 6.1 Jukic I, Helms ER, McGuigan MR. The fastest repetition in a set predicts the number of repetitions completed to failure during resistance training: The impact of individual characteristics. Physiology & Behavior. 2023 Jun 1;265:114158.
- ↑ Fukuda DH. Assessments for sport and athletic performance. Human Kinetics; 2018 Dec 5.
- ↑ Greig L, Stephens Hemingway BH, Aspe RR, Cooper K, Comfort P, Swinton PA. Autoregulation in resistance training: addressing the inconsistencies. Sports medicine. 2020 Nov;50:1873-87.
- ↑ 9.0 9.1 9.2 Wilson ME. The daily adjustable progressive resistance exercise system: getting reacquainted with an old friend. Strength & Conditioning Journal. 2008 Apr 1;30(2):76-8.
- ↑ 10.0 10.1 10.2 Forman DA, Alizadeh S, Button DC, Holmes MW. The Use of Elastic Resistance Bands to Reduce Dynamic Knee Valgus in Squat-Based Movements: A Narrative Review. International Journal of Sports Physical Therapy. 2023;18(5):1206.
- ↑ 11.0 11.1 11.2 Boren K, Conrey C, Le Coguic J, Paprocki L, Voight M, Robinson TK. Electromyographic analysis of gluteus medius and gluteus maximus during rehabilitation exercises. International journal of sports physical therapy. 2011 Sep;6(3):206.
- ↑ The Barbell Physio. Front Plank Hip Extensions. Available from: https://www.youtube.com/watch?v=kVycltIECKM [last accessed 03/03/2024]
- ↑ Rehab My Patient. Full squat single leg. Available from: https://www.youtube.com/watch?v=ZrYPt_pBces [last accessed 03/03/2024]
- ↑ Rehab My Patient. How to do a Side plank. Available from:https://www.youtube.com/watch?v=vQKLvMTYA9Q [last accessed 03/03/2024]
- ↑ Rehab My Patient. How to do a clam. Available from: https://www.youtube.com/watch?v=1ECrWm-3SKo [last accessed 03/03/2024]
- ↑ Lehecka BJ, Edwards M, Haverkamp R, Martin L, Porter K, Thach K, Sack RJ, Hakansson NA. Building a better gluteal bridge: electromyographic analysis of hip muscle activity during modified single-leg bridges. International journal of sports physical therapy. 2017 Aug;12(4):543.
- ↑ Rehab My Patient.Pilates Shoulder bridge 2. Available from:https://www.youtube.com/watch?v=r9rgEAB13yM [last accessed 03/03/2024]
- ↑ Rehab My Patient. Pilates Shoulder bridge 3. Available from: https://www.youtube.com/watch?v=R7yrLIC0uJs [last accessed 03/03/2024]
- ↑ Rehab My Patient. Bridge with Band Exercise - Level 1. Available from: https://www.youtube.com/watch?v=xrS2naqqB1E [last accessed 03/03/2024]
- ↑ Rehab My Patient.Bridge with Band Exercise - Level 6. Available from:https://www.youtube.com/watch?v=nJAE9Pg4hAg [last accessed 03/03/2024]
- ↑ Williams MJ, Gibson NV, Sorbie GG, Ugbolue UC, Brouner J, Easton C. Activation of the gluteus maximus during performance of the back squat, split squat, and barbell hip thrust and the relationship with maximal sprinting. The Journal of Strength & Conditioning Research. 2021 Jan 1;35(1):16-24.
- ↑ Rehab My Patient. Barbell Hip Thrust | Hamstring | Strength and Conditioning Exercises. Available from: https://www.youtube.com/watch?v=76t0z3Tdx6Q [last accessed 03/03/2024]
- ↑ Rehab My Patient. Kettlebell Hip Thrust | Hamstring | Strength and Conditioning Exercises. Available from: https://www.youtube.com/watch?v=D2nNU3FonZE [last accessed 03/03/2024]
- ↑ Rehab My Patient. Single Leg Kettlebell Deadlift | Deadlift | Strength and Conditioning Exercises. Available from: https://www.youtube.com/watch?v=TCAsn966t_s [last accessed 03/03/2024]
- ↑ Rehab My Patient. Gluteus medius strengthening 1. Available from: https://www.youtube.com/watch?v=gNvzHTyPujs[last accessed 03/03/2024]
- ↑ 26.0 26.1 26.2 26.3 Collings TJ, Bourne MN, Barrett RS, Meinders EV, GONçALVES BA, Shield AJ, Diamond LE. Gluteal Muscle Forces during Hip-Focused Injury Prevention and Rehabilitation Exercises. Medicine and Science in Sports and Exercise. 2023 Apr 1;55(4):650-60.
- ↑ Collings, T. Hip-focused injury prevention and rehabilitation exercises: How to choose which one. (accessed 22 March 2024). Available from https://www.sportsmith.co/articles/hip-focused-injury-prevention-and-rehabilitation-exercises-how-to-choose-which-one/
- ↑ YLMSportscience. Gluteal muscle forces during hip-focused injury prevention and rehabilitation exercises. Published 4 June 2023. Available from https://ylmsportscience.com/2023/06/04/gluteal-muscle-forces-during-hip-focused-injury-prevention-and-rehabilitation-exercises/
- ↑ 29.0 29.1 29.2 Serner A, Jakobsen MD, Andersen LL, Hölmich P, Sundstrup E, Thorborg K. EMG evaluation of hip adduction exercises for soccer players: implications for exercise selection in prevention and treatment of groin injuries. British journal of sports medicine. 2014 Jul 1;48(14):1108-14.
- ↑ Rehab My Patient. How to tone your thighs. Available from: https://www.youtube.com/watch?v=gzg7d4uXM8Y&t=20s [last accessed 08/03/2024]
- ↑ Rehab My Patient. Copenhagen Adductor Straight Leg Exercise. Available from: https://www.youtube.com/watch?v=q8u3rP2kPLY[last accessed 08/03/2024]
- ↑ Rehab My Patient. How to strengthen your adductor longus. Available from: https://www.youtube.com/watch?v=s0gKvvbFX2I [last accessed 08/03/2024]
- ↑ Rehab My Patient. Adductor Towel Slides. Available from: https://www.youtube.com/watch?v=s91uCD2wmT0&t=1s [last accessed 08/03/2024]
- ↑ Rehab My Patient. How to get your upper legs stronger. Available from: https://www.youtube.com/watch?v=vsXjFlVpW9Q[last accessed 08/03/2024]
- ↑ Rehab My Patient. Hip adduction side lying. Available from: https://www.youtube.com/watch?v=knGLKc1jbWs [last accessed 08/03/2024]
- ↑ 36.0 36.1 Bourne MN, Williams MD, Opar DA, Al Najjar A, Kerr GK, Shield AJ. Impact of exercise selection on hamstring muscle activation. British journal of sports medicine. 2017 Jul 1;51(13):1021-8.
- ↑ Rehab My Patient. Nordic Hamstring Curl 2. Available from: https://www.youtube.com/watch?v=ypBDnCQy1h4 [last accessed 08/03/2024]
- ↑ Rehab My Patient. VMO Single leg inner range quadriceps with band. Available from: https://www.youtube.com/watch?v=cxN01SEa8aM[last accessed 08/03/2024]
- ↑ Swinton PA, Stewart A, Agouris I, Keogh JW, Lloyd R. A biomechanical analysis of straight and hexagonal barbell deadlifts using submaximal loads. The Journal of Strength & Conditioning Research. 2011 Jul 1;25(7):2000-9.
- ↑ Riemann BL, Lapinski S, Smith L, Davies G. Biomechanical analysis of the anterior lunge during 4 external-load conditions. Journal of athletic training. 2012 Jul 1;47(4):372-8.
- ↑ Graber KA, Halverstadt AL, Gill SV, Kulkarni VS, Lewis CL. The effect of trunk and shank position on the hip-to-knee moment ratio in a bilateral squat. Physical Therapy in Sport. 2023 May 1;61:102-7.
- ↑ Barrack AJ, Straub RK, Cannon J, Powers CM. The relative orientation of the trunk and tibia can be used to estimate the demands on the hip and knee extensors during the barbell back squat. International Journal of Sports Science & Coaching. 2021 Aug;16(4):1004-10.
- ↑ Straub RK, Barrack AJ, Cannon J, Powers CM. Trunk inclination during squatting is a better predictor of the knee-extensor moment than shank inclination. Journal of Sport Rehabilitation. 2021 Feb 16;30(6):899-904.