Activate Dance Physio, Annandale and North Strathfield
Over the years many physios and Pilates instructors have taught ‘the Clam’ pre Pilates exercise to activate the lateral gluteal and deep hip rotator muscles. It is often a preliminary exercise during rehab. It can be an easy exercise for dancers to do to help improve the strength and control of their turnout muscles.
However ! Is it always the best exercise for all dancers? If a dancer is experiencing certain hip or pelvis problems and pain, it may not be the best exercise to chose to improve your turnout.
Here we discuss some pro’s and con’s for this common exercise.
Which muscles help you help your pelvis stay ‘tall’ on your leg and assist Hip Turnout?
Functionally, the side gluteus Medius muscle is a very important in keeping your pelvis stable whilst doing any single leg work. If it doesn’t work, the dancer will ‘sit into the hip’.
I have treated many front hip, low back/ pelvis and knee pain issues, where poor gluteus medius control has contributed to the problem. The ‘Clam’ exercise may be a good exercise to include in this case, as it is designed to activate these muscles.
If the tendons and tissues that attach to the side of the hip are repeatedly irritated, the ‘clam’ exercise may not be the best exercise to treat this condition. Pain may be exacerbated by the exercise In pathological conditions such as tendonopathy/ tear or trochanteric bursitis, so this exercise is not recommended. These conditions are not common in young dancers.
Quadratus Femoris is quite a large muscle in the lower part of the back of the hip, with a pure hip external rotator function. (Good for ballerinas!) It is proposed that a co contraction between other hip ‘rotator cuff’ muscles and quadratus femoris will assist in muscle stabilisation around the hip joint and assistance to turn out. The aim is to ‘centre’ of the hip bone (head of femur) in the deep pelvic socket (acetabulum cup), to prevent non optimal forward or upward translation of this big head of femur bone. This should take pressure off the hip fibrocartilage ‘labrum’ and tendons which pass over the hip joint eg. The hip flexor tendon (iliopsoas).
Other Hip External Rotators
There are other muscles that assist in hip joint and leg turn out. Lower parts of Gluteus maximus are important for back, hip and leg support , especially during single leg push off and landing for jumps, getting up off the floor and holding the leg back during arabesque. While it is not good to GRIP using this muscle, it is not useful to recommend not using gluts at all during turn out. The big Adductor Magnus is another important thigh turn out and pelvic stability muscle, but discussing that muscle’s job will have to wait for another day.
At the other end of this ‘argument’ is not to over engage the small hip external rotators so much, that the sciatic nerve is irritated as it travels behind the hip. Some people with low back and sacroiliac joint (back pelvis) pain may need to avoid clam exercises until their sciatic nerve pain settles.
Best hip external Rotator
Physiotherapists teach that specific activation of deep hip external rotators, without overactivity of superficial front thigh muscles, accelerates rehabilitation. This is especially the case following pinching and clicking pain at the hip and post hip arthroscopic surgery.
‘Relax’ front muscle over activity. Activate Back hip rotators.
I commonly see overactivity of front hip muscles and dancer’s ‘sitting into their hips’. Poor timing of contraction in parts of the upper quadriceps (rectus femoris, vastus lateralis ), tensor fascia lata (TFL) and adductor brevis/ longus, with poor activation of side and back gluteal muscles and quadratus femoris can contribute to many types of dancer lower limb and back problems. I see this pattern more commonly on the right side of the pelvis. During the single leg stance or ‘stork’ test, dancers sit laterally and anteriorly into the pelvis. This can cause the whole leg to roll inwards, during shift to single leg balance.
So it is good to practise and train good dance specific muscle patterns around the pelvis and hip.
Some poor patterns seen whilst doing the ‘clam’ exercise:
- Front hip muscles like top of the quad and TFL switch on first, prior to Posterior hip external rotators unfortunately. This may reinforce the poor front hip joint position and limit hip turnout. Tight quads, ‘floppy’ bottom!
- Pelvis rolled too far back, rather than rolling forward so the pelvis is square to the front, to feel the back hip muscles working
- Pelvis tucked under, not in ‘ neutral’ position in line with the rest of the body. Again, this can limit turn out and push the front hip bone forward
Careful positioning and thoughtful cues to focus attention on required muscle patterning is needed to calm overactive front longitudinally aligned superficial muscles and activate posterior gluteus medius and deep hip external rotators.
Your physiotherapist or teacher may have to find other ways for you to train turn out muscles. I never recommend doing hundreds of repetitions of these exercises. I prefer dancers to find the activation pattern while doing the clam, then get up and integrate the feeling of those muscles working in real life functional dance moves.
Alternative way to activate and strengthen Quadratus femoris:
Neutral low back and pelvis, Slight drawing in of lower abdominal ‘pull up’ muscles; Relaxed front of hip, hamstrings and adductors; activation of deep hip external rotator .. add light theraband resistance when muscle patterning is optimal. (Tip: Best to get assistance from your dance physio with this exercise. Feedback needed!)
Turn out from the hip standing on Rotator Discs
Susie Bond is the founder of Activate Dance Physio. Susie Bond is the practice director of Activate Physiotherapy, Evolution Pilates and MG Pilates. She has been a physiotherapist for 30 years, a Pilates instructor since 1996 and a dancer since she was 5 years old.