A Simple Tweak to Enhance the Effectiveness of Single Leg Exercises
In the last blog post I promised a small tweak to the more advanced exercises in the progression for treating lateral hip pain. I’m talking specifically about single leg, closed chain exercises. It’s simple, but it goes against what has become somewhat conventional wisdom:
Hold the weight on the stance side only first, then offset with (less) weight on the involved side, increasing it as tolerated until both sides are holding equal amounts of weight.
This shifts the effective center of mass medially towards the stance leg, reducing the stresses on the healing gluteus medius while allowing the client to load the hip extensors in a single-leg position. As people progress, we start to reload the opposite side as well, starting with lighter weights than what is carried on the side of the stance leg. Once the weights are equal and the movement still pain-free, we can either progress both sides at the same time (recommended) or by slightly (2.5 - 9 lbs) increasing the weight on the side of the stance leg before equalizing by adding weight to the opposite arm when further progression is needed.
I don’t typically overload the non-weight-bearing side, even when people are starting out and are healthy. Why? Many smart people recommend this to increase the involvement of the gluteus medius and hip external rotators, however there are a few reasons I respectfully disagree:
First, after adding more than 10-15lbs it makes the exercise more of a balance challenge. I rarely want balance to be a limiting factor in my client’s strengthening exercises. Second, as the hip flexes (ie, at the bottom of a squat or stiff-legged deadlift) the deep external rotators become more active as internal rotators. See the article below:
https://www.jospt.org/doi/10.2519/jospt.2010.3025#_i19
Finally, I don’t necessarily want more work for the glute medius during my single leg exercises. Simply being on one leg is typically sufficient for sagittal movements. And there’s this as well: because of the difference in the length of the lever arms from kettlebell to stance hip, simply holding equal weights bilaterally increases the relative adduction moment the hip abductors must resist as weight increases.
Assume that the distance from the stance (right) hip joint to the 30 lbs kettlebell is 1x, and from the other kettlebell to the stance hip is 3x. That means that the difference in frontal plane torque is 60x lbs.
(30 x 3x) - (30 x 1x) = 60x lbs
If we increase the weight of the kettlebells to 80 lbs, now the difference in frontal plane torque is 160lbs, further increasing the demands on the hip abductors.
Of course, there are some situations where I want more load on the gluteus medius. If that’s the case, we’ll add lunges with a lateral resistance (coming in a blog post soon!), advance side planks (progressing to unilaterally), isolate them during warm-ups or do loaded carries.
Take this simple tweak and bring a different perspective to how you choose to load your client’s single leg patterns, especially those folks recovering from lateral hip pain.