“If I hear one more person tell me to do the clam, I might just scream.” says my sister Barbara. Barb is an MD in Seattle and she has seen a few PTs over the years. They have all given her “the clam” to eliminate knee and back pain. She has done the clam over and over, but alas, the pain persists and it has stopped Barb in her tracks whenever she tries to run. She has another doctor friend who is hindered by Iliotibial band (ITB) pain while on the bike. He has been told to do the clam, but that’s not working for him either.

If the clam is “the” exercise, why isn’t it workworking?

Chris Powers, Professor at USC, says Barb and her friend’s problems are all about hip strength. Chris has devoted years of research to finding the right exercise in the right sequence to make hips strong enough to eliminate common lower extremity problems. Using fine-wire EMG, Powers evaluated a number of exercises to determine which ones specifically activate the posterior hip muscles (gluteal muscles) while not firing anterior hip muscles (the pesky tensor fascia lata/ITB and psoas). Weak glutes lead to poor control of hip motion, which can cause a host of problems: knee, hip, ankle and back pain. Here is how that happens:

good step down 1    bad step down 1

Strong glutes keep the hip from falling in and the knee from collapsing. Because the gluteus maximus and medius are endurance muslces, they need to be able to fire for a long time. Minimum requirements:

  • Fire for at least a minute under sizeable resistance
  • Fire strongly in isolation (i.e. no help from the TFL or psoas)

So start with the basics:

  • Begin lying down, because if you can’t activate the glutes lying down, how can you expect them to work when you need them in the bumps or on the trails?
  • Start with isometrics. These muscles need to hold a contraction for a sustained      period of time – a minute is what Powers recommends.
  • Once you know what you need to recruit, you can quickly get off the ground and start    doing more functional exercise so that running, riding, hiking, or just managing a flight of stairs can happen without pain. What a concept.
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    Clam Shell Video

If you have had a poor firing pattern for a while, you may need some help learning the exercises. How do you keep the TFL and psoas relatively quiet? That’s the key–doing the clam and getting the burn in exactly the right place makes all the difference. You can feel for the right muscle and you can also look at the front of your hip and see if you are firing there. If you activate the TFL, you tighten the ITB, the hip rolls in, and stress shows up in multiple joints.

Having the right muscle fire might take some fine-tuning. Maybe you’ll need a trained eye to see those little compensations. If so, make an appointment. Firing the right muscle while the other muscles are quiet is when magical changes start to happen.

A solution is waiting for you.

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