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Sponsored: What’s the best way to perform “Monster Walks”?

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By Phil Page PhD, PT, ATC, CSCS, FACSM
Global Director of Clinical Education and Research for Performance Health
Article Reprinted With Permission Of Performance Health
Cramer_MedcoOfficial Education Partner of PFATS
 

Frankenstein must do them. “Monster Walks.” I’m not really sure where the name for that exercise came from, but I’ll be everyone has a little variation of the exercise they perform. Generally, an elastic band loop is placed between the knees or ankles while stepping laterally. So what’s the best way to perform the “Monster Walk?” Hopefully we can use research to find the answer.

Let’s start with a little background. Recently, the hip has become en vogue in rehab and sports training, particularly the gluteal muscles (maximus and minimus). It started with the realization that the hip extensors and abductors play an important role in stability and function, yet are often neglected and weak. More hip surgeries in younger patients, coupled with the focus on hip strengthening led to the popularity of the “Monster Walk”, however, a better name for this exercise is a “lateral band walk” (LBW). 

As with most new clinical exercises, the popularity of the LBW was likely spread through continuing education, word of mouth, or some internet ‘guru’ rather than research of its efficacy. Knowing that research often lags clinical practice (and vice-versa), clinicians continued to perform this exercise in their own ways…often without knowledge of the true muscle activation levels.

To date, 5 studies have analyzed the muscle activity of hip muscles with EMG during the lateral band walk. Each study looked at different components such as band placement (knee, ankle or foot), posture (upright or minisquat), muscles (Gluteus medius, gluteus maximus, TFL), and leg (moving or stance leg). Each study used different elastic resistances and some variation of elongation. The results from these studies have given us a pretty good idea of the best way to perform the LBW exercise. Note that all of these studies were performed on healthy subjects, which may not be representative of an injured population.

Here’s what we know from these studies:

  • The primary target muscle of this exercise, the gluteus medius, is activated anywhere between an average of 36-50% MVIC (maximal contraction) on the stance leg, compared to 19 to 33% on the moving leg.
  • The TFL is also activated during this exercise, which may be considered undesirable in patellofemoral rehab, particularly associated with muscle imbalance.
  • Lower TFL activation is seen in the squat position than an upright position
  • The squat position has higher activation than the upright posture while performing this exercise
  • The stance leg has more activation of muscles than the moving leg
  • The ankle or foot placement of the resistance products more EMG than at the knee

Based on what we now know, here are the recommendations for performing the lateral band walk exercise with elastic resistance for preferential activation of the gluteus medius muscle, particularly in patients with hip abductor weakness. Several TheraBand products can be used for this exercise including the TheraBand Band Loop, TheraBand Tubing with Cuffs, and TheraBand CLX.

  1. Place the resistance at the ankle or foot, rather than the knee (although the exercise may be regressed with knee placement)
  2. Perform the exercise in a mini-squat position with about 30 degrees of hip and knee flexion during movement. This provides more gluteus medius activation and less TFL activation
  3. Step laterally away from the injured (weak) side. Don't lead with the weaker hip, more muscle activity is seen in the stance leg. Don't perform this exercise “side-to-side” in both directions, particularly in knee patients with hip weakness.

While EMG studies are important to determine what’s happening during the exercise, more research is obviously needed in patient populations who may benefit from this exercise, including anterior knee pain, patellofemoral pain syndrome, hip osteoarthritis, and ITBand Syndrome. Exercise dosage and time-under-tension studies may be helpful, as well as outcome studies.

 

REFERNCES:

Berry JW et al. 2015. Resisted Side Stepping: The Effect of Posture on Hip Abductor Muscle Activation. J Orthop Sports Phys Ther. 45(9):675-82.

Cambridge E et al 2012. Progressive hip rehabilitation: the effects of resistance band placement on gluteal activation during two common exercises. Clin Biomech 27(7):719-24.

Distefano LJ, Blackburn JT, Marshall SW, Padua DA. 2009. Gluteal muscle activation during common therapeutic exercises J Orthop Sports Phys Ther 39(7):532-40.

Selkowitz et al. 2013 2013. Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes. J Orthop Sports Phys Ther 43(2):54-64

Youdas JW et al. 2013. Electromyographic analysis of trunk and hip muscles during resisted lateral band walking. Physiother Theory Pract. 29(2):113-23.

 

 

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