Hip Clamshell Exercise Progression for Glute Med Strengthening

In 2011, Boren et al. published a study comparing the gluteus medius and maximus activation levels using EMG of several different common rehab exercises (you can find the article HERE).  It is an excellent article in my opinion and definitely worth reading.  One trick I picked up from the article that I have had a lot of success with lately is a hip clamshell exercise progression.

Hip External Rotation Clamshell Exercise

Hip External Rotation Clamshell Exercise

The progression has four stages, with each stage activating the gluteus medius more than the previous.  The number at the end of each stage’s description is the percentage of gluteus medius maximum isometric contraction (MVIC).  The higher the percentage, the more electrically activity happening in the muscle.  This means more muscle fibers being recruited. Controlled tempo with a slight pause at the top with each movement.

  1.  Pictured top left: This is a standard hip external rotation clamshell exercise.  Position yourself in side-lying with your hips flexed to 45 degrees.  The exercise is performed by externally rotating the top leg while keeping the feet together. 47% MVIC
  2. Pictured top right: Same initial position of hip clam 1 but the top leg is internally rotated by lifting the foot up.  The knees remain in contact during the entire execution of the exercise.  62% MVIC
  3. Pictured bottom left: While sidelying with the hips flexed to 45 degrees, the top leg is raised and held parallel to the floor/bench. While maintaining this knee position, the top left is internally rotated. 67% MVIC
  4. Pictured bottom right: While sidelying with the hips in neutral (0 degrees of flexion), the top leg is raised and held parallel to the table.  While maintaining this knee position, the knee is internally rotated.  76% MVIC
Hip Clam Progression

Hip Clam Progression

Mike Reinold has also written a few good articles on the hip clam with other variations which can be read HERE and HERE.


Boren, K., Conrey, C., LeCoguic, J., Paprocki, L., Voight, M., & Robinson, K. (2011). Electromyographic Analysis of Gluteus Medius and Gluteus Maximus During Rehabilitation Exercises. The International Journal of Sports Physical Therapy, 6(3).

  One thought on “Hip Clamshell Exercise Progression for Glute Med Strengthening

  1. Rachelle
    February 13, 2014 at 11:28 pm

    Hello! First, thank you for this great article and reference pictures! I am confused with #4…..it says that the hips are in neutral position, 0 flexion. To me it appears as if the bottom hip is in a 45degree, and the top hip is neutral? I am new to exercising, so am likely overthinking, but would appreciate feedback :).

    • February 14, 2014 at 12:19 am

      bottom hip at 45 top at 0 would be correct

      • Rachelle
        February 14, 2014 at 1:45 am

        Thanks for the quick reply!

  2. Suzanne
    July 29, 2015 at 8:38 pm

    Is this an appropriate exercise for someone recovering from pelvic fractures?

    • July 30, 2015 at 4:33 am

      It can be but you would need to check with your medical team first Suzanne

  3. Virginia
    August 23, 2015 at 1:30 pm

    Should all four exercises be completed on one side before switching to the other side? How many reps of each progression?

    • August 23, 2015 at 1:32 pm


      They are a progression of exercises. If level one is easy, progress to the next. When you can do 20 reps at one level, its time to move to the next.

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