Trendelenburg Gait: Causes, Test and Exercises That Help

Maybe someone told you that you walk with a limp. Maybe your hip feels like it gives way when you stand on one leg. Maybe your walking still feels unsteady after hip surgery. Trendelenburg gait is the pattern behind all three, and it points to weakness in the muscles that stabilise your pelvis when you walk.

01 · The fundamentals

What Trendelenburg gait is

Trendelenburg gait is an abnormal walking pattern caused by weakness in the hip abductor muscles, most commonly the gluteus medius. During a normal step, the hip muscles on the leg you are standing on hold your pelvis level. When those muscles are weak, the pelvis dips on the other side each time you take a step, and that shows up as a limp or a side-to-side waddle.

The name comes from Friedrich Trendelenburg, a German surgeon who first described the sign in 1895. More than a century later, it remains one of the most recognisable gait patterns assessed by physiotherapists and rehabilitation professionals.

Trendelenburg gait is a signal. It is your body flagging that the strength or control of your hip muscles has changed, and the cause might be muscular, neurological, or structural. Finding that cause comes first, because the right treatment depends on it.

Trendelenburg gait is a signal worth listening to.

02 · The causes

What causes hip abductor weakness

The hip abductors can weaken for many reasons. Some are sudden. Some build over years. Understanding which one applies to you matters, because the treatment path depends on the cause.

Gluteus medius weakness

The gluteus medius is the primary muscle that keeps your pelvis stable when you walk. Disuse weakens it. So does injury. So does prolonged bed rest. People who sit for long periods, have had a lower limb injury, or have been immobile after surgery are at higher risk. It is the most common cause of Trendelenburg gait.

Hip replacement surgery

Trendelenburg gait is common after total hip replacement, particularly procedures using a lateral or posterior approach. The surgery can temporarily damage or stretch the gluteus medius and its nerve supply. With targeted rehabilitation, most people see their walking pattern improve. For some, the weakness lingers. If you are preparing for surgery, our guide on preparing for a total hip replacement walks through what to expect.

Hip dysplasia

Developmental dysplasia changes the angle at which the gluteus medius works. The muscle is not necessarily weak in the traditional sense. It is working at a mechanical disadvantage, and that reduces its ability to stabilise the pelvis during walking.

Hip osteoarthritis

Chronic hip pain changes how you move. You offload the sore side without thinking about it. The hip abductors weaken from reduced use, and the gait pattern develops so gradually that it can be present for months before you notice. Our explainer on hip osteoarthritis covers why this happens and what helps.

Muscular dystrophy

Progressive muscle-wasting conditions can weaken the hip abductors on both sides. When both are affected, the gait becomes a bilateral Trendelenburg pattern, often described as a waddling gait.

Cerebral palsy

Children and adults with cerebral palsy may have Trendelenburg gait from muscle weakness, spasticity, or both. The pattern is common in diplegic and hemiplegic presentations.

Stroke

A stroke affecting the motor cortex or descending motor pathways can weaken the hip abductors on one side, producing a unilateral Trendelenburg gait as part of a broader hemiparetic gait pattern.

Neurological conditions

Any condition affecting the superior gluteal nerve can impair gluteus medius function. This includes:

• Nerve damage during hip surgery
• Lumbar radiculopathy (L4 to S1 nerve root compression, particularly L5)
• Poliomyelitis
• Peripheral neuropathy

03 · The signs

How to spot Trendelenburg gait

The hallmark sign is a pelvic drop. One side dips when it should stay level.

Picture this. You stand on your right leg. The left side of your pelvis should hold steady, maybe even rise slightly. But if your right hip abductors are weak, the left side drops. Your body notices before you do, and it compensates: your trunk leans toward the weak side to shift your centre of gravity and keep you upright.

Four signs to watch for

• Pelvic drop: the pelvis tilts downward on the swinging-leg side with each step.
• Trunk lean: the upper body shifts toward the stance leg to compensate.
• Shortened stride: the swinging leg has to clear the ground despite the dropped pelvis, which shortens each step.
• Waddling pattern: when both sides are affected, the alternating drop and lean creates a side-to-side motion.

Other signs that often travel with Trendelenburg gait:

• Difficulty standing on one leg (putting on shoes, for example)
• Hip pain or fatigue during walking, worse over longer distances
• Low back pain from the compensatory trunk lean
• Knee or ankle pain from altered mechanics further down the chain
• A feeling of the hip “giving way” or buckling under load

What a positive Trendelenburg sign means

The Trendelenburg sign and the Trendelenburg test sound alike, but they are not the same thing. The sign is what a Physiotherapist sees when they watch someone stand on one leg. If the hip on the unsupported side drops instead of staying level, that is a positive Trendelenburg sign.

A positive sign usually points to weakness in the hip abductor muscles, mainly the gluteus medius, on the standing leg. It can also point to a nerve issue affecting those muscles. It sometimes shows up after a hip injury or hip replacement surgery.

Many people with a mild pattern never realise it. The body adapts. The compensation becomes your normal. That is exactly why a clinical eye matters. A Physiotherapist can identify the pattern through observation and specific testing, often in the first few minutes of an assessment.

04 · The test

The Trendelenburg test

The Trendelenburg test is a clinical assessment that evaluates one thing: can the hip abductors on your standing leg hold the pelvis level? It is one of the most commonly used tests in Physiotherapy and orthopaedic assessment, and it takes less than two minutes.

How the Trendelenburg test is performed

1. The person stands facing the examiner with their weight evenly distributed on both feet.
2. The examiner asks the person to lift one foot off the ground by bending the knee, so they are standing on one leg.
3. The examiner observes the pelvis from behind. The key observation point is the position of the pelvis on the non-standing side.
4. The person holds the single-leg stance for 30 seconds (or as long as they can maintain balance).
5. The test is repeated on the other side.

Interpreting the results

• Negative Trendelenburg test (normal): the pelvis stays level or rises slightly on the non-standing side. The hip abductors on the standing leg are doing their job.
• Positive Trendelenburg test: the pelvis drops on the non-standing side. The hip abductors on the standing leg are weak or not functioning properly.

A positive result tells you one thing. It does not tell you another. The test confirms that weakness is present. It does not explain why. Further assessment, which may include imaging, neurological testing, or a detailed clinical examination, is needed to identify the underlying cause. The test on its own is not enough. In practice, a Physiotherapist will combine the Trendelenburg test with gait analysis, hip range of motion testing, and muscle strength grading. No single test gives the full picture. Together, they build one.

05 · What works

Treatment and exercises that help

The treatment depends on three things: what caused the weakness, how severe the gait pattern is, and what you need to get back to doing. Most people start with the same first step, and that step is Physiotherapy.

Physiotherapy

Physiotherapy is the first-line treatment for Trendelenburg gait. Your Physiotherapist will assess hip abductor strength, map any compensatory patterns, and build an exercise program designed to restore pelvic stability.

Treatment typically includes:

• Hip abductor strengthening exercises, progressed from non-weight-bearing to functional positions
• Gait retraining using verbal and visual cues
• Balance and proprioception work
• Manual therapy to address joint stiffness or soft tissue restrictions

After hip replacement surgery, Physiotherapy begins in the early post-operative period and continues for months. Hip abductor strengthening is a standard part of that rehabilitation. For many people it helps the walking pattern become more even over time, though how much and how fast depends on the surgical approach, how weak the muscle was beforehand, and how consistent the rehab is.

Exercise Physiology

Some people need longer-term, progressive loading that extends beyond the acute Physiotherapy phase. That is where an Exercise Physiologist comes in. They design structured programs that build hip abductor strength over weeks and months, particularly for:

• Chronic conditions requiring ongoing strengthening (osteoarthritis, muscular dystrophy)
• Post-surgical rehabilitation once the acute phase is complete
• Neurological conditions requiring carefully graded exercise progression

Hydrotherapy

Warm water changes the equation. Buoyancy reduces the load through the hip joint, which means you can practise single-leg standing, walking, and strengthening with less pain. For early-stage post-surgical rehabilitation, or for anyone with significant discomfort during weight-bearing exercise, hydrotherapy can be the thing that makes progress possible. Optimum Health Solutions has hydrotherapy pools at our Blacktown, Croydon Park, and Campbelltown clinics in NSW, and at our Mornington clinic in Tasmania.

Surgical intervention

In some cases, the underlying cause needs surgical correction: hip replacement for severe osteoarthritis, repair of a torn gluteus medius tendon, or nerve decompression for superior gluteal nerve entrapment. Even after surgery, Physiotherapy remains essential to rebuild strength and restore normal gait.

Six exercises that build hip abductor strength

These six exercises are commonly prescribed by physiotherapists to strengthen the hip abductors and improve pelvic stability. A Physiotherapist will select and progress them based on your specific assessment. If you are recovering from surgery or managing a neurological condition, get professional guidance before starting.

Side-lying hip abduction

1. Lie on your side with your legs straight and your hips stacked.
2. Slowly lift the top leg toward the ceiling.
3. Lower it back down.

That is one rep. This exercise isolates the gluteus medius without any weight-bearing load, which makes it the go-to starting point for most people. Your Physiotherapist will add an ankle weight as you get stronger.

Single-leg stance

1. Stand on one leg near a wall or bench for balance.
2. Hold for 10 to 30 seconds.
3. Focus on one thing: keeping your pelvis level.

This is both an exercise and a functional version of the Trendelenburg test itself. As your strength improves, your Physiotherapist will add challenges: moving the free leg, closing your eyes, standing on an unstable surface.

Clamshells

1. Lie on your side with your hips and knees bent to about 45 degrees.
2. Keep your feet together and open your top knee like a clamshell, then close it.

You will feel this in two places: the gluteus medius and the deeper external rotators of the hip. A resistance band around the knees makes it harder. A slow tempo makes it harder still.

Banded lateral walks (band walks)

1. Place a resistance band around your ankles or just above your knees.
2. Stand with feet hip-width apart and step sideways, keeping tension in the band throughout.
3. Walk 10 to 15 steps in one direction, then return.

This strengthens the hip abductors in a functional, weight-bearing position.

Step-ups with pelvic control

1. Stand beside a step or low platform.
2. Step up with one foot, focusing on keeping your pelvis level as you rise.
3. Step back down with control.

The exercise combines three things: hip abductor activation, balance, and single-leg loading under gravity.

Single-leg bridge

1. Lie on your back with your knees bent.
2. Lift one foot off the ground and push through the other foot to raise your hips.

The focus, as always, is on a level pelvis. This strengthens the gluteus medius alongside the gluteus maximus and hamstrings.

These are starting points, not a fixed program. A Physiotherapist will adjust the selection, the intensity, and the progression based on what they find in your assessment, what caused your Trendelenburg gait, and what you need to get back to.

06 · Your next step

When to see a Physiotherapist

Not every gait variation needs treatment. Some people have mild asymmetry that causes no pain and no functional limitation. That is fine.

But there are patterns worth having assessed.

See a Physiotherapist if you notice:

• A visible limp or trunk lean that was not there before
• Hip pain or fatigue during walking that is getting worse, not better
• Difficulty with stairs, uneven ground, or standing on one leg
• New low back pain or knee pain that you cannot explain
• A pelvic drop that someone else has pointed out
• You are recovering from hip surgery and your walking still feels unsteady

There is a good reason to get this checked early. When the hip muscles are weak, the body finds workarounds. The trunk leans. The lower back works harder. The knee and ankle take on forces they were not built for. These problems are real. They are the flow-on issues physiotherapists see in people who waited, and they are harder to address than the original weakness.

The good news: a Physiotherapist can usually identify whether the pattern is caused by muscle weakness that responds well to exercise, or something more complex that needs further investigation. For many people, a structured strengthening program produces noticeable improvements in walking pattern within 6 to 12 weeks of consistent practice, though the timeline depends on the underlying cause and the level of consistency over that window. For more on falls and balance work that often goes hand-in-hand with hip abductor rehab, see our blog on balance, falls and Physiotherapy.