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Phys. Ther. Korea 2023; 30(1): 68-77

Published online February 20, 2023

https://doi.org/10.12674/ptk.2023.30.1.68

© Korean Research Society of Physical Therapy

The Application of Thera-band on Non-weight Bearing Leg Influence Hip Abductor Activities During Pelvic Drop Exercise in Patients With Gluteus Medius Weakness

Su-hwan Cha1,2 , PT, BPT, Seok-hyun Kim1 , PT, MSc, Seung-min Baik1 , PT, PhD, Heon-seock Cynn1 , PT, PhD

1Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, Wonju, 2Rehabilitation 1-Team, Severance Rehabilitation Hospital, Yonsei University Health System, Seoul, Korea

Correspondence to: Heon-seock Cynn
E-mail: cynn@yonsei.ac.kr
https://orcid.org/0000-0002-5810-2371

Received: November 17, 2022; Revised: December 20, 2022; Accepted: December 22, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Background: The weakness of the gluteus medius (GM) is associated with various musculoskeletal disorders. The increasing GM activity without synergistic dominance should be considered when prescribing pelvic drop exercise (PD). Isometric hip extension or flexion of the non-weight bearing leg using thera-band at the ankle during PD may influence hip abductor activities. Objects: To determine how isometric hip extension or flexion of the non-weight bearing leg using thera-band at the ankle during PD influences the activities of three subdivisions of GM (anterior, GMa; middle, GMm; posterior, GMp), tensor fasciae latae (TFL), contralateral quadratus lumborum (QL), and GMp/TFL, GMm/QL activity ratios in patients with GM weakness.
Methods: Twenty-three patients with GM weakness were recruited. Three types of PD were performed: PD, PD with an isometric hip extension of the non-weight bearing leg (PDE), and PD with an isometric hip flexion of the non-weight bearing leg (PDF). Surface electromyography (SEMG) was used to measure hip abductor activities. One-way repeated-measures analysis of variance was used to assess the statistical significance of muscle activities and muscle activity ratios.
Results: GMa, GMm, and GMp activities were significantly greater during PDF than during PD and PDE (p < 0.001, p = 0.001; p = 0.001, p = 0.005; p = 0.004, p = 0.004; respectively). TFL activity was significantly greater during PDE than during PD and PDF (p < 0.001, p < 0.001, respectively). QL activity was significantly greater during PDF than during PD (p = 0.003). GMp/TFL activity ratio was significantly lower during PDE than during PD and PDF (p = 0.001, p = 0.001, respectively). There were no significant differences in the GMm/QL activity ratio.
Conclusion: PDF may be an effective exercise to increase the activities of all three GM subdivisions while minimizing the TFL activity in patients with GM weakness.

Keywords: Electromyography, Hip abductor, Pelvic drop exercise, Thera-band

Article

Original Article

Phys. Ther. Korea 2023; 30(1): 68-77

Published online February 20, 2023 https://doi.org/10.12674/ptk.2023.30.1.68

Copyright © Korean Research Society of Physical Therapy.

The Application of Thera-band on Non-weight Bearing Leg Influence Hip Abductor Activities During Pelvic Drop Exercise in Patients With Gluteus Medius Weakness

Su-hwan Cha1,2 , PT, BPT, Seok-hyun Kim1 , PT, MSc, Seung-min Baik1 , PT, PhD, Heon-seock Cynn1 , PT, PhD

1Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, Wonju, 2Rehabilitation 1-Team, Severance Rehabilitation Hospital, Yonsei University Health System, Seoul, Korea

Correspondence to:Heon-seock Cynn
E-mail: cynn@yonsei.ac.kr
https://orcid.org/0000-0002-5810-2371

Received: November 17, 2022; Revised: December 20, 2022; Accepted: December 22, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: The weakness of the gluteus medius (GM) is associated with various musculoskeletal disorders. The increasing GM activity without synergistic dominance should be considered when prescribing pelvic drop exercise (PD). Isometric hip extension or flexion of the non-weight bearing leg using thera-band at the ankle during PD may influence hip abductor activities. Objects: To determine how isometric hip extension or flexion of the non-weight bearing leg using thera-band at the ankle during PD influences the activities of three subdivisions of GM (anterior, GMa; middle, GMm; posterior, GMp), tensor fasciae latae (TFL), contralateral quadratus lumborum (QL), and GMp/TFL, GMm/QL activity ratios in patients with GM weakness.
Methods: Twenty-three patients with GM weakness were recruited. Three types of PD were performed: PD, PD with an isometric hip extension of the non-weight bearing leg (PDE), and PD with an isometric hip flexion of the non-weight bearing leg (PDF). Surface electromyography (SEMG) was used to measure hip abductor activities. One-way repeated-measures analysis of variance was used to assess the statistical significance of muscle activities and muscle activity ratios.
Results: GMa, GMm, and GMp activities were significantly greater during PDF than during PD and PDE (p < 0.001, p = 0.001; p = 0.001, p = 0.005; p = 0.004, p = 0.004; respectively). TFL activity was significantly greater during PDE than during PD and PDF (p < 0.001, p < 0.001, respectively). QL activity was significantly greater during PDF than during PD (p = 0.003). GMp/TFL activity ratio was significantly lower during PDE than during PD and PDF (p = 0.001, p = 0.001, respectively). There were no significant differences in the GMm/QL activity ratio.
Conclusion: PDF may be an effective exercise to increase the activities of all three GM subdivisions while minimizing the TFL activity in patients with GM weakness.

Keywords: Electromyography, Hip abductor, Pelvic drop exercise, Thera-band

Fig 1.

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Figure 1.Pelvic drop exercise (PD) with an isometric hip extension of the non-weight bearing leg (PDE) inducing isometric hip external rotation of weight bearing leg.
Physical Therapy Korea 2023; 30: 68-77https://doi.org/10.12674/ptk.2023.30.1.68

Fig 2.

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Figure 2.Pelvic drop exercise (PD) with an isometric hip flexion of the non-weight bearing leg (PDF) inducing isometric hip internal rotation of weight bearing leg.
Physical Therapy Korea 2023; 30: 68-77https://doi.org/10.12674/ptk.2023.30.1.68

Fig 3.

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Figure 3.Comparison of muscle activity (%MVIC) in the (A) GMa, (B) GMm, (C) GMp, (D) TFL, and (E) QL among PD, PDE, and PDF. %MVIC, %maximum voluntary isometric contraction; GMa, anterior subdivision of gluteus medius; GMm, middle subdivision of gluteus medius; GMp, posterior subdivision of gluteus medius; TFL, tensor fasciae latae; QL, quadratus lumborum; PD, pelvic drop exercise; PDE, pelvic drop exercise with an isometric hip extension of non-weight bearing leg; PDF, pelvic drop exercise with an isometric hip flexion of non-weight bearing leg. *By Bonferroni correction, p < 0.017.
Physical Therapy Korea 2023; 30: 68-77https://doi.org/10.12674/ptk.2023.30.1.68

Fig 4.

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Figure 4.Comparison of muscle activity ratio in the (A) GMp/TFL and (B) GMm/QL among PD, PDE, and PDF. GMp, posterior subdivision of gluteus medius; TFL, tensor fasciae latae; GMm, middle subdivision of gluteus medius; QL, quadratus lumborum; PD, pelvic drop exercise; PDE, pelvic drop exercise with an isometric hip extension of non-weight bearing leg; PDF, pelvic drop exercise with an isometric hip flexion of non-weight bearing leg. *By Bonferroni correction, p < 0.017.
Physical Therapy Korea 2023; 30: 68-77https://doi.org/10.12674/ptk.2023.30.1.68

Table 1 . Subject characteristics (N = 23).

Variable
Sex (male/female)23/0
Age (y)23.5 ± 2.4
Height (cm)170.0 ± 4.7
Weight (kg)74.0 ± 11.2
Body mass index (kg/m2)24.2 ± 3.3

Values are presented as number or mean ± standard deviation..

Table 2 . Comparison of muscle activity (%MVIC) in the GMa, GMm, GMp, TFL, and QL among PD, PDE, and PDF.

VariableMuscle activity (%MVIC)95% CI
PDPDEPDFPDPDEPDF
GMa19.2 ± 10.618.5 ± 8.028.9 ± 16.814.6–23.915.0–22.021.6–36.1
GMm21.1 ± 10.121.7 ± 11.426.7 ± 10.716.8–25.516.8–26.622.1–31.4
GMp16.8 ± 7.217.6 ± 7.421.7 ± 7.913.7–20.014.5–20.818.3–25.1
TFL11.3 ± 5.322.1 ± 9.113.6 ± 6.39.0–13.618.1–26.010.9–16.3
QL28.9 ± 18.635.4 ± 23.140.6 ± 24.220.8–36.925.4–45.830.2–51.1

Values are presented as mean ± standard deviation or number. %MVIC, %maximum voluntary isometric contraction; GMa, anterior subdivision of gluteus medius; GMm, middle subdivision of gluteus medius; GMp, posterior subdivision of gluteus medius; TFL, tensor fasciae latae; QL, quadratus lumborum; PD, pelvic drop exercise; PDE, pelvic drop exercise with an isometric hip extension of non-weight bearing leg; PDF, pelvic drop exercise with an isometric hip flexion of non-weight bearing leg; CI, confidence intervals..

Table 3 . Comparison of muscle activity ratio in the GMp/TFL and GMm/QL among PD, PDE, and PDF.

VariableMuscle activity ratio95% CI
PDPDEPDFPDPDEPDF
GMp/TFL1.9 ± 1.30.9 ± 0.52.1 ± 1.51.3–2.50.7–1.11.4–2.7
GMm/QL1.1 ± 1.00.9 ± 0.80.9 ± 0.70.7–1.60.6–1.20.6–1.2

Values are presented as mean ± standard deviation or number. GMp, posterior subdivision of gluteus medius; TFL, tensor fasciae latae; GMm, middle subdivision of gluteus medius; QL, quadratus lumborum; PD, pelvic drop exercise; PDE, pelvic drop exercise with an isometric hip extension of non-weight bearing leg; PDF, pelvic drop exercise with an isometric hip flexion of non-weight bearing leg; CI, confidence intervals..