If you're still doing clamshell, here's why you should stop!
Need to strengthen your gluteals? Clamshell is a really good exercise to strengthen them! Or are they? Here below we try to explain why we're not fans of this exercise any longer. And it's not just us at Mike Stamp Physio & Pilates, there are plenty of studies to support this new way of thinking. First of all, it may be better to explain what the clamshell exercise was targeted at. Clamshell was used as a really effective way to strengthen up the gluteus medius.
The gluteus medius is the medium sized of the gluteal muscles and sits underneath the gluteus maximus (the muscle that shapes your buttocks) The reason that strengthening gluteus medius is important, is because it is paramount in balance & mobility. Clamshell exercise stems from a Pilates exercise that Joseph Pilates concepted whilst a POW during WWII to prevent his own muscular deconditioning and loss of strength. Pilates realised that using your own arms and legs as long levers you can utilise your own body weight for strengthening purposes, without the use of weights. Clamshell places the gluteus medius into all of the ranges of motion it is expected to perform. Those are:
Abduction
Lateral Rotation
Extension
Whilst stabilising the hip
Therefore what is the problem with this exercise? As our profession's knowledge grows with studies, research and experiential learning, we now understand that this specific exercise can be a contributing factor to one of the most common problems reported from the hip: Gluteal Tendinopathy.
People report pain to the lateral (outside) aspect of their hip. Historically, physiotherapists would prod it and diagnose trochanteric bursitis. A period of rest and ibuprofen was suggested and it would go away. Bursitis is inflammation of the fluid filled sac that in this instance sits under the IT band. What we now understand from extensive research, is that in people with pain in this area, do not necessarily have bursitis yet they all demonstrated tendon related problems (when examined under ultrasound). The tendinopathy occurs from excess compression of the tendon against the greater trochanter (hip bone). One tests that Physiotherapists use to test for gluteal tendinopathy involves moving the hip into the position that compresses the tendon to get a pain response. This movement is identical to that of the clamshell exercise. What we as a profession have identified with longitudinal studies is that movements like the clamshell have exacerbated the risk of gluteal tendinopathy. This is the reason why we at Mike Stamp Physio & Pilates do not give out clamshell exercise for strengthening your gluteus medius. If you're still doing clamshell, I hope this is reason enough to at least reconsider doing so.
