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The APA Physiotherapy conference devoted a small amount of time to a topic that fascinates me – hip muscle strength ratios; and the speaker was a Specialised Sports Physiotherapist who now is full-time doing research in the UAE with International Football players.
Her name is Andrea Mosler, and she has become known as the “Push-lady” in elite football circles (see the video for why!) due to her dynamic approach in strength testing of hip abductor and adductor muscles.It fascinates me because we teach so much about muscle imbalances around joints being key to understanding dysfunction and effective rehab…and one imbalance we teach is that the adductors tend to dominate the abductors in injured hips and lower limbs. Hmm what does the research say about this? 1. Firstly though, enjoy the video below of how strength testing of hip abductors (“ABD”) and adductors (“ADD”) can be carried out by anyone in the gym or clinic. Hence why she is called the “Push-lady!”. The big question is: are your client’s ABDs or ADDs stronger in the isometric eccentric test?? **NEW IDEA FOR YOU**      
Perhaps you could substitute the Hand-held Pressure Reading Equipment (SEE THE VIDEO) for 5 / 10 / 20 kg sandbags and perch them onto the client’s lower leg – the idea would be to stop-watch timehow long they can hold the leg up into ABD and then ADD. 2. OK so here is what Andrea and others have found through review and research about ratios between these two muscles:
  • Elite soccer players demonstrate a ratio of 1.2 : 1.0 (stronger ADD than ABDs). Also, in athletes with groin and hip pain, that ratio goes down – signifying simply weakness of the ADD due to injury. Simple: rehab is to strengthen ADD muscles by any means.
  • Hockey Players have ADD and ABD ratios that are closer to 0.95 : 1.0.  In other words, “normal” is different in different sports – in Hockey the ABD should be stronger. Because of the nature of always bending over on one leg, they probably have to do more ABD strengthening if injured.
Confused yet? Well, I think this is all very relevant BUT only if you are an elite hockey or soccer player! Not if you are a common gym-goer or Personal Trainer even. In that instance I think this is more relevant:
  • In a 2014 Review Article by Menges et al (click here for full review), “It has been shown that a smaller ABD/ADD strength ratio is correlated with an increase in the risk of lower extremity injury, such as patello-femoral pain syndrome(*). Therefore, exercises that cause an increase in the ABD/ADD strength ratio would be considered effective for decreasing the risk of lower extremity injury.”
SUMMARY: If you are a non-ELITE athlete (95% of the fitness population), and you don’t do certain sports that have high demand on the ADD muscles, then the key to rehab and injury prevention is regular, varied, and specific ABD muscle (Gluteus Medius) training. Work your Gluteus Medius in a 100 different ways; regularly. End of complicated story! Next week I will give you an article and video on our fool-proof Gluteus Medius isolation drill, designed by Chris Mallac our International and Senior Rehab Educator. I love it! See you then, Ulrik
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