Practical Guide to Hip and Knee Strengthening

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]

The following points highlight general principles that should be considered with progressive overload.

  • Please remember the following TWO points when working with a patient who requires a strengthening programme[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]
  • Allow sufficient recovery time to enable adaptation
  • Application of the appropriate load is needed 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[4]
    • adaptations are specific to strength, power, endurance, functional activity, joint angle, sequence of muscle activations, energy systems and virtually all other variables present
    • the 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
      • percentage (%) repetition maximum
        • training as a percentage of repetition maximum (RM)[5]
          • e.g. 80% of 1 RM
            • the 1 RM strength test assesses the maximal strength of the muscle groups engaged during a single specified movement.[6] Read more about 1 RM here.
        • repetitions to failure[5]
          • maximum number of repetitions a person can lift to failure[1]
            • e.g. 80% of 1 RM = 7-10 repetitions to failure
  • If you'd like, you can read more about:
  • Please read this article if you would like to learn more about the DAPRE system: The Daily Adjustable Progressive Resistance Exercise System: Getting Reacquainted With an Old Friend[7]
  • Optionally, you can also read more about the principles of rehabilitation here. This article covers where to start, underpinning theories, key issues when reloading injured tissues, monitoring the impact of load and progressing load.

Isolated Muscle Work Around the 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.[4]

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.[8]

Table 2. Rank order of exercises for recruitment of gluteus maximus based on EMG (adapted from Boren et al.[9])
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.[14] The addition of a band to the exercise further increases gluteal activity.[8]

Barbell hip thrust versus squat or split squat

For patients who cannot tolerate a high 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.[19] Two examples of a hip thrust exercise are shown in the videos 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.[8]

Table 3. Rank order of exercises for gluteus medius recruitment based on EMG activity (adapted from Boren et al.[9])
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[edit | edit source]

Hip Adductors[edit | edit source]

The rank order of exercises for the recruitment of adductor longus based on EMG[1] is shown in Table 4.

Table 4. Rank order of exercises for adductor longus recruitment based on EMG activity[1] (adapted from Serner et al.[27])
Exercise Mean peak normalised EMG (nEMG)% of MVC (adapted from Serner et al.[27])
Copenhagen adduction 110%
Isometric adduction with a ball between ankles 100%
Isometric adduction with ball between knees 86 %
Hip adduction sidelying 64 %

Below are examples of some of the adductor exercises.

Hamstrings[edit | edit source]

"Hamstrings are activated differently during hip-based and knee-based tasks."[34] 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), load the biceps femoris more, while the Nordic hamstring exercise recruits semitendinosus more.[34]


Quadriceps[edit | edit source]

The basic open chain knee extension exercise is a useful exercise for developing quadriceps strength. In patients with weakness in the shortened position of the quadriceps, it may be useful to add the isolated band pullback exercise to isolate the inner range position and develop strength in this range.[1]

Adapting Closed Chain Exercises for Either Knee or Hip Bias[edit | edit source]

The relative contribution of the knee or hip to a squatting task is influenced by:

  • the amount of load during a deadlift[38] and lunge[39]
  • the trunk position[40][41][42]
  • the limb position

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Herrington, L. Practical Guide to Hip and Knee Strengthening. Course. Plus. 2024
  2. 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.
  3. 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.
  4. 4.0 4.1 4.2 4.3 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.
  5. 5.0 5.1 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.
  6. Fukuda DH. Assessments for sport and athletic performance. Human Kinetics; 2018 Dec 5.
  7. 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.
  8. 8.0 8.1 8.2 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.
  9. 9.0 9.1 9.2 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.
  10. The Barbell Physio. Front Plank Hip Extensions. Available from: [last accessed 03/03/2024]
  11. Rehab My Patient. Full squat single leg. Available from: [last accessed 03/03/2024]
  12. Rehab My Patient. How to do a Side plank. Available from: [last accessed 03/03/2024]
  13. Rehab My Patient. How to do a clam. Available from: [last accessed 03/03/2024]
  14. 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.
  15. Rehab My Patient.Pilates Shoulder bridge 2. Available from: [last accessed 03/03/2024]
  16. Rehab My Patient. Pilates Shoulder bridge 3. Available from: [last accessed 03/03/2024]
  17. Rehab My Patient. Bridge with Band Exercise - Level 1. Available from: [last accessed 03/03/2024]
  18. Rehab My Patient.Bridge with Band Exercise - Level 6. Available from: [last accessed 03/03/2024]
  19. 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.
  20. Rehab My Patient. Barbell Hip Thrust | Hamstring | Strength and Conditioning Exercises. Available from: [last accessed 03/03/2024]
  21. Rehab My Patient. Kettlebell Hip Thrust | Hamstring | Strength and Conditioning Exercises. Available from: [last accessed 03/03/2024]
  22. Rehab My Patient. Single Leg Kettlebell Deadlift | Deadlift | Strength and Conditioning Exercises. Available from: [last accessed 03/03/2024]
  23. Rehab My Patient. Gluteus medius strengthening 1. Available from:[last accessed 03/03/2024]
  24. 24.0 24.1 24.2 24.3 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.
  25. Collings, T. Hip-focused injury prevention and rehabilitation exercises: How to choose which one. (accessed 22 March 2024). Available from
  26. YLMSportscience. Gluteal muscle forces during hip-focused injury prevention and rehabilitation exercises. Published 4 June 2023. Available from
  27. 27.0 27.1 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.
  28. Rehab My Patient. How to tone your thighs. Available from: [last accessed 08/03/2024]
  29. Rehab My Patient. Copenhagen Adductor Straight Leg Exercise. Available from:[last accessed 08/03/2024]
  30. Rehab My Patient. How to strengthen your adductor longus. Available from: [last accessed 08/03/2024]
  31. Rehab My Patient. Adductor Towel Slides. Available from: [last accessed 08/03/2024]
  32. Rehab My Patient. How to get your upper legs stronger. Available from:[last accessed 08/03/2024]
  33. Rehab My Patient. Hip adduction side lying. Available from: [last accessed 08/03/2024]
  34. 34.0 34.1 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.
  35. Rehab My Patient. Nordic Hamstring Curl 2. Available from: [last accessed 08/03/2024]
  36. Rehab My Patient. Single Leg Extension | Machine | Strength and Conditioning Exercises. Available from: [last accessed 03/03/2024]
  37. Rehab My Patient. VMO Single leg inner range quadriceps with band. Available from:[last accessed 08/03/2024]
  38. 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.
  39. 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.
  40. 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.
  41. 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.
  42. 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.