Trendelenburg Gait

A positive Trendelenburg gait (gluteus medius gait/lurching gait ) is generally indicative

of hip abductor weakness. The classic Trendelenburg's gait pattern is seen when the
stance phase hip abductors cannot resist the pull of gravity on the unsupported swing
phase lower extremity. The therapist will observe the swing phase pelvis dip below level.
A compensated Trendelenburg's pattern is observed when the client deviates the body in
the frontal plane toward the stance leg to decrease the moment arm of gravitational
forces pulling on the swing side, decreasing load on the stance side abductors. Although
Dimattia et al. found that alone, the Trendelenburg's position was a poor predictor of
hip abduction strength, it remains a useful observational tool to clue the therapist to
core impairments affecting gait.

Trendelenburgs sign
Trendelenburgs 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 of the ground
without additional support. If the patient has adequate abductor strength, then the iliac
crest of the raised leg should remain parallel with or elevated slightly in relation to the
contralateral side. In addition, the patient should maintain an upright posture without
significant tilt of the upper trunk, which would indicate a compensatory mechanism to
help the patient maintain his or her balance.

A positive Trendelenburg sign is defined as either a compensatory tilt of the torso (vide
supra) or a drop of the contralateral iliac crest (See Fig above), indicating that the
ipsilateral hip abductors are unable to contract with adequate force to maintain a level
pelvis. Instability of the pelvis from other etiologies may also create a positive
Trendelenburgs sign resulting from increased tensile forces on the bony structures of
the hip. Therefore, diagnoses causing pelvic instability, such as LeggCalvePerthes
disease or acetabular fractures of any etiology, may be considered as alternate causes of
a positive test.
The Trendelenburg gait, often discussed by writers concerned with hip pathology, is
really only a magnification of normal movement pattern, much like the double bump
anterior pelvic motion. This gait is a response to mild weakness in the abductors as the
hip on the swing side drops more to pretension the abductor muscle until it finds the
strength to resist. Increased movement of the center of mass of the HAT segment over
the weightbearing limb is usually combined with this, thereby decreasing the force
needed to resist the drop of the pelvis. This pattern may also suggest mechanical
instability of the hip joint, such as hip subluxation, and hip radiographs should be
obtained. With severe weakness of the abductor muscles, the center of mass of the HAT
segment will move completely over the weightbearing limb, usually with elevation of the
pelvis on the swing side. This movement is called a hip lurch, in which the trunk
muscles can also be used to control the drop of the pelvis on the swing limb side.

Treatment of Trendelenburg gait

Treatment of Trendelenburg gait is by strengthening of the abductor muscles when
possible. Treatment of the lurching gait pattern is by strongly encouraging patients to
use forearm crutches, which will decrease both the energy of walking and the force on
the joints in the lower extremities, especially the knee joint. Some of these movement
patterns may also occur secondary to pain in the hip joint. Therefore, a good history
should be available with the gait analysis.