TRENDELENBURG GAIT

INTRO
One of the most common types of gait deviations
-> It is caused by an abnormality in the abductors of the hip

This gait causes the “drop” of the opposite side from where the abnormality is present
-> A weak R side hip will cause the left side to drop during R side (weak) stance phase

DETAIL
The hip is a class 3 lever, where the acetabulofemoral joint (hip joint) acts as the fulcrum, the
hip abductors act as the effort, and the weight of the LE acts as the load. This means that
movement of the lever mechanism requires more effort, but the distance that the load is able to
travel in a short amount of time is greater. The forearm is another example of class 3 lever.

A trendelenburg gait may be caused by any individual failure in any of the components of the
mechanism:
→ Fulcrum: Dysplasia or dislocation (trauma or infections, aka tuberculosis)
→ Lever: Coxa vara (less 110 to 120) (this may also cause genu valgum)
→ Effort: Any abnormality in the hip abd (nerve damage, weakness, tendinitis)

In most cases, when the deviation is noticed during physical therapy it will be due to paralysis or
paresis, in other words, pathology is in the effort element.

TEST
Preferably barefoot, pt w/ both feet in ground, bends one knee and alternates (30sec hold); hip
in the unsupported side should stay at similar height as supported side.
If hip drops in the unsupported side or pt compensates by shifting the torso over the supported
side, the test is positive.

The reasoning behind the test is the way in which our body weight is supported by our LE. Our
center of gravity is in the middle of the body, passing right by the middle of the pubic symphysis.
When one foot is lifted off the ground, the hip will drop in the unsupported side unless there is a
counter mechanism to support the now unsupported side of the hip. This mechanism is provided
by the hip ABD of the opposite side.

The best way to understand how does this work, it is to analyze hip ABD and ADD in both open
and closed chain.

Weakness can be unilateral or bilateral

→ if one side LURCHING (compensatory)
→ if both sides WADDLING
TREATMENT
In the case of paresis, the most effective treatment will be muscle strengthening of the hip ABD.
→ tx ex
→ tx act (side stepping)
→ Balance activities may also improve status due to gluteus minimus being a stabilizer (better in an
advanced pt)

Weight bearing activities generally have a better outcome in getting the pt back to a functional
status (proprioception?)

OTHER SIMILAR
Caution must be exercised to not confuse this gait pattern w/ other similar gait abnormalities,
such as:
→ short limb gait (literal, result is the same, but origin is different)
→ Antalgic gait (cause is pain)
→ Posterior lurching gait (sounds similar, but lurching is to back and due to hip ext weakness)