Moore Damien, Semciw Adam I, Pizzari Tania
Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Victoria, Australia.
Int J Sports Phys Ther. 2020 Dec;15(6):856-881. doi: 10.26603/ijspt20200856.
The gluteus medius (GMed) and gluteus minimus (GMin) muscle segments demonstrate different responses to pathology and ageing, hence it is important in rehabilitation that prescribed therapeutic exercises can effectively target the individual segments with adequate exercise intensity for strengthening.
The purpose of this systematic review was to evaluate whether common therapeutic exercises generate at least high ( > 40% maximum voluntary isometric contraction (MVIC)) electromyographic (EMG) activity in the GMed (anterior, middle and posterior) and GMin (anterior and posterior) segments.
Seven databases (MEDLINE, EMBASE, CINAHL, AusSPORT, PEDro, SPORTdiscus and Cochrane Library) were searched from inception to May 2018 for terms relating to gluteal muscle, exercise, and EMG. The search yielded 6918 records with 56 suitable for inclusion. Quality assessment, data extraction and data analysis were then undertaken with exercise data pooled into a meta-analysis where two or more studies were available for an exercise and muscle segment.
For the GMed, different variations of the hip hitch/ pelvic drop exercise generated at least high activity in all segments. The dip test, and isometric standing hip abduction are other options to target the anterior GMed segment, while isometric standing hip abduction can be used for the posterior GMed segment. For the middle GMed segment, the single leg bridge; side-lying hip abduction with hip internal rotation; lateral step-up; standing hip abduction on stance or swing leg with added resistance; and resisted side-step were the best options for generating at least high activity. Standing isometric hip abduction and different variations of the hip hitch/ pelvic drop exercise generated at least high activity in all GMin segments, while side-lying hip abduction, the dip test, single leg bridge and single leg squat can also be used for targeting the posterior GMin segment.
The findings from this review provide the clinician with confidence in exercise prescription for targeting individual GMed and GMin segments for potential strengthening following injury or ageing.
Level 1.
Previous reviews on GMed exercises have been based on single electrode, surface EMG measures at middle GMed segment. It is not known whether these exercises effectively target the other segments of GMed or the GMin at a sufficient intensity for strengthening.
This review provides the clinician with confidence in exercise prescription of common therapeutic exercises to effectively target individual GMed and GMin segments for potential strengthening.
臀中肌（GMed）和臀小肌（GMin）肌段对病理变化和衰老表现出不同反应，因此在康复治疗中，规定的治疗性锻炼能够以足够的锻炼强度有效针对各个肌段进行强化训练非常重要。
本系统评价的目的是评估常见的治疗性锻炼是否能在臀中肌（前、中、后）和臀小肌（前、后）肌段产生至少较高水平（>最大自主等长收缩（MVIC）的40%）的肌电图（EMG）活动。
检索了7个数据库（MEDLINE、EMBASE、CINAHL、AusSPORT、PEDro、SPORTdiscus和Cochrane图书馆），从建库至2018年5月，检索与臀肌、锻炼和肌电图相关的术语。检索共得到6918条记录，其中56条适合纳入。随后进行质量评估、数据提取和数据分析，将锻炼数据汇总进行荟萃分析，前提是针对某项锻炼和肌段有两项或更多研究可用。
对于臀中肌，不同变式的髋部上提/骨盆下降锻炼在所有肌段均能产生至少较高水平的活动。深蹲试验和等长站立髋外展是针对臀中肌前肌段的其他选择，而等长站立髋外展可用于臀中肌后肌段。对于臀中肌中间肌段，单腿桥；髋关节内旋的侧卧位髋外展；侧向上步；在支撑腿或摆动腿上增加阻力的站立髋外展；以及抗阻侧步是产生至少较高水平活动的最佳选择。站立等长髋外展和不同变式的髋部上提/骨盆下降锻炼在所有臀小肌肌段均能产生至少较高水平的活动，而侧卧位髋外展、深蹲试验、单腿桥和单腿深蹲也可用于针对臀小肌后肌段。
本评价的结果使临床医生在为损伤或衰老后可能需要强化的个体臀中肌和臀小肌肌段制定锻炼处方时更有信心。
1级。
以往关于臀中肌锻炼的综述基于在臀中肌中间肌段进行的单电极表面肌电图测量。尚不清楚这些锻炼是否能以足够强化的强度有效针对臀中肌的其他肌段或臀小肌。
本综述使临床医生在为常见治疗性锻炼制定锻炼处方时更有信心，这些锻炼能有效针对个体臀中肌和臀小肌肌段进行潜在强化。
