Exercise 4: Clamshells

Exercise: Clamshells

(Called “Clamshell” in video walk-through)

Instructions: Lie on your side with knees bent and feet together. Keeping feet touching, lift the top knee without moving your hips. Lower slowly.

Provider Tips

• Keep hips stacked, avoid rolling backward.

• Progress with resistance bands.

Clinical Rationale

• Strengthens key hip stabilizers: clamshells target the gluteus medius and minimus which play a crucial role in pelvic and trunk stability. Weakness in these muscles can lead to poor pelvic control, contributing to abnormal lumbar loading and contributing to low back pain.
  

• Promotes lumbo-pelvic stability: improved hip abductor strength supports better control of the pelvis during gait, standing and dynamic activities reducing compensatory stress of the lumbar spine. Clamshells also encourage proper movement mechanics in the kinetic chain, reducing lumbar shear forces and excessive rotation when done correctly.
  

• Facilitates neuromuscular re-education: reteaches proper motor recruitment patterns, especially in patients who have become reliant on compensatory strategies (e.g. overusing lumbar extensors or hip flexors). Clamshells also help patients regain control over hip and trunk musculature in a low load environment.
  

• Addresses common muscle imbalances: many patients with low back pain present with gluteal weakness and lateral hip instability, often paired with overactive TFL or lumbar paraspinals. Clamshells help correct these imbalances by isolating the hip external rotators and abductors.
  

• Low impact and easily tolerated by most: performed in a side-lying position that minimizes lumbar stress and is typically well tolerated by those in the sub acute phase. Easily modified as well with resistance bands or increasing/decreasing reps based on pain levels and strength.