Postoperative Gluteus Medius Rehab with Consideration of the Iliopsoas

Study Title: Rehabilitation Exercise Progression for the Gluteus Medius Muscle With Consideration for Iliopsoas Tendinitis
Authors: MJ. Philippon, MJ. Decker, E. Giphart, MR. Tory, MS. Wahoff & RF. LaPrade
Journal: American Journal of Sports Medicine
Date: 2011
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Summary:

• This paper is a MUST READ for rehabilitation and training professionals working in ice hockey, especially those of you in the "show". As you know, Dr. Marc Philippon is one of the world's leading hip surgeons and like the physician you refer your athletes with problematic hip injuries to. Published in AJSM, this paper looked identified the most appropriate EARLY postoperative hip exercises following hip surgery. With consideration of the fact that the Iliopsoas tendon occasionally becomes irritated or inflamed with early rehabilitation, the Dr. Philippon and friends utilized EMG to determine which of 13 exercises were most appropriate and when. To sum up the results, the exercises that demonstrated the highest peak gluteus medius muscle activation were the single-leg bridge, the prone heel squeeze, and the side-lying hip abduction (either performed with internal hip rotation, against a wall, or with external hip rotation). In comparison, the supine hip flexion, side-lying hip abduction with external rotation, and hip clam exercises  demonstrated moderate iliopsoas muscle activation. As a result, the exercises with the best ratios (high gluteus medius activity vs low iliopsoas activity) were the prone heel squeeze, single-leg bridge, and the side-lying hip abduction with internal rotation. Please note that all exercises were then classified into their most appropriate phase of rehabilitation: I, II, or III.
• What really caught my attention with this study was the lack of discussion pertaining to optimal and controlled muscle activation of the core musculature in general. It is my assumption that proper progression of early rehabilitation will respect optimal core control and integrity and subsequently optimal iliopsoas activity. It is difficult for me to swallow that those professionals adhering to proper progressions and appropriate rehabilitation principles actually elicit unwanted and increased iliopsoas activity. That said, this study must have been warranted and therefore must speak volumes of the rehabilitation protocols currently prescribed.
• Overall, I really enjoyed this paper and certainly walked away with a better understanding of EARLY postoperative gluteus medius and hip rehabilitation.

Philippon, M. et al. (2011). Rehabilitation exercise progression for the gluteus medius muscle with consideration for iliopsoas tendinitis. American Journal of Sports Medicine, Vol. 39(8); 1777-1785