The Trendelenburg gait pattern (or gluteus medius lurch) is an abnormal gait caused by weakness of the abductor muscles* of the lower limb, gluteus medius and gluteus minimus which are supplied by the superior gluteal nerve. What this article will describe is how to identify the signs of the gait pattern and how you can treat this abnormality to improve function.
Trendelenburg’s Sign is a test used to determine whether the patient has adequate hip abductor strength, particularly of the gluteus medius. To perform this test the patient is instructed to stand on both feet and slowly raise one foot off the ground without additional support. If the patient has adequate abductor strength then the both hips should remain level or slightly elevated to the standing side. They should also be able to maintain an upright posture without a lateral tilt, which would indicate compensation to aid in balance.
A Positive Trendelenburg Sign as seen in the picture will result in lateral tilting of the torso or hip drop on the leg being raised (posterior view), indicating that the ipsilateral hip abductors are unable to contract with adequate force to maintain a level pelvis.
During the stance phase of the gait cycle, the gluteus medius works to maintain both hips at the same level. The stance phase accounts for 60% of the gait cycle, with 3x the body weight being transmitted through the hip joint during this phase. With the hip abductor muscles actioning 2/3 of that body weight you can start to realise the detrimental effect of having ineffective hip abductors. An abnormal gait associated with a weakness of the gluteus medius is characterized by the dropping of the pelvis on the unaffected side of the body at the moment of heel strike on the affected side.
However, weakness can also occur in patients the L5 radiculopathy or avulsion of the abductor muscle tendon which occurs with increasing frequency after hip replacement surgery.
As you can understand now for those with this abnormal gait or stance there is a weakness in the action of the gluteus medius and gluteus minimus. So there are numerous isolation exercises to target these abductors for example clams, glute walk. What we want to see however is an improvement in hip stability through the functional movements of hip extension and flexion, so utilising a Pilates Reformer will allow safe progressive improvements in these movements.
So if have noticed yourself, a friend or family member who has started to show any positive Trendelenburg Signs, book them in with one of our Physiotherapists or Exercise Physiologists so we can assess and develop a long term management program to not only improve function, but improve quality of life.
*Abductor muscles take a limb ‘away’ from the body