What hip and glute strengthening exercises can help prevent injuries in a healthy individual with no significant past medical history who wants to start running?

Hip and Glute Strengthening for Injury-Free Running

Begin a structured hip and glute strengthening program focusing on hip abduction exercises, core strengthening, and progressive plyometric training to prevent running injuries, as reduced lower extremity muscle strength is directly associated with higher injury risk. 1

Core Strengthening Components

Hip Abduction Exercises (Primary Focus)

The hip abduction exercise generates the highest targeted gluteus medius activation (70.1% MVIC) while minimizing compensatory muscle recruitment, making it the preferred exercise when gluteus medius strengthening is the primary goal. 2

• Perform side-lying hip abduction with 5% body weight resistance attached to the ankle 2
• Hip hitch/pelvic drop exercise variations generate high activity (>40% MVIC) in all gluteus medius segments (anterior, middle, posterior) and both gluteus minimus segments 3
• Single leg bridge exercise effectively targets the middle gluteus medius segment with high activation levels 3
• Standing isometric hip abduction generates high activity in both anterior and posterior gluteus medius segments as well as all gluteus minimus segments 3

Gluteus Maximus Strengthening

• Include resistance training as it provides protective mechanisms by attenuating shock and reducing loads on lower extremity structures 1
• The clam exercise with elastic resistance generates the highest gluteal-to-tensor fascia latae activation index, optimally activating gluteal muscles while minimizing unwanted tensor fascia latae compensation 4
• Bridge exercises with resistance effectively target gluteus maximus 4

Core and Proximal Hip Strengthening

Address core and proximal strength to optimize lower extremity biomechanics, as excessive hip adduction during running gait is a predictor of tibial bone stress injuries in female runners. 1

• Implement core strengthening exercises 2-4 times per week 1
• Focus on eccentric hip strengthening that emphasizes triplanar motions and integrated movement patterns, particularly targeting hip abduction and external rotation 5
• Proximal strengthening controls biomechanical variables including internal knee rotation and knee valgus alignment, which are associated with 2-4 times higher stress fracture rates when excessive 1

Progressive Plyometric Training

Add high-impact plyometric training (loads greater than four times body weight) during advanced training phases, as running alone does not subject the body to high enough impacts to produce optimal osteogenic effects. 1, 6

• Begin plyometric exercises only after establishing adequate base strength 1
• Perform zig-zag hopping for optimal tibial bone strengthening based on high strain and strain rates produced 1
• Focus on power generation rather than landing heavily, using only a few repetitions per session 1
• Schedule 2-4 short exercise sessions per week (30 minutes/day or less) 1
• Combine high-impact loading with resistance training for superior bone mineral density improvements at lumbar spine and femoral neck 1, 6

Training Progression Principles

Volume Progression

• Progress training volume using the 10% rule to avoid overwhelming tissue adaptation capacity 5
• Avoid sudden changes in distance, speed, terrain, surface, or footwear 5
• Perform strengthening exercises on alternate days, as bone cells regain 98% of mechanosensitivity after 24 hours of rest 6

Sex-Specific Considerations

Female runners require more conservative training progression and particular attention to hip strengthening, as they experience higher tibial bone stresses across all running speeds and excessive hip adduction is a predictor of lower extremity injuries. 7, 5

Flexibility Component

• Address calf and hamstring flexibility as part of comprehensive injury prevention 1, 5
• Identify and eliminate myofascial restrictions before beginning strengthening programs 5
• Perform calf stretching regularly 1

Common Pitfalls to Avoid

• Do not rely solely on hip abduction with external rotation (ABD-ER) or clamshell exercises without resistance, as tensor fascia latae activation (70.9% MVIC) exceeds gluteus medius activation (53.0% MVIC) in ABD-ER, and anterior hip flexor activation (54.2% MVIC) exceeds gluteus medius (32.6% MVIC) in clamshell without resistance 2, 4
• Do not perform body-weight only gluteal activation programs expecting strength gains, as 6-week body-weight gluteal activation programs show no significant improvements in EMG activity or hip extension force 8
• Do not ignore biomechanical assessment of hip strength, running gait, and lower extremity alignment before symptoms develop 5
• Do not overlook the importance of resistance training, as reduced muscle mass and strength are identified risk factors for bone stress injuries 1