When someone experiences weakness in the hip abductor muscles and walks with a noticeable side-to-side motion, it might be Trendelenburg gait.
So what is Trendelenburg gait? Well, under normal gait conditions, both legs bear half of the body’s weight. As the left leg is lifted, the right leg takes the bulk of the weight. When a person walks, the pelvis tilts, rising on the side not taking the weight. However, when there is abductor weakness, the pelvis drops and doesn’t rise on the unsupported side.
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Having Trendelenburg gait is not considered a serious health problem. Many people with this condition don’t even have pain or other noticeable symptoms but it might look like they are limping or missing a step when they walk.
The hip joint is made up of the acetabulum and the femur head. Soft tissues and multiple muscles surround these structures. The muscles are what provide stability and allow for movement during active times. You can read on to find out what causes Trendelenburg gait.
Also read: 12 reasons for pain above right hip
What are the causes, risk factors, and complications of Trendelenburg gait?
Some people may be familiar with Trendelenburg gait due to straining their hip abductor muscles during physical activities. Any exercise that strengthens the glutes, which are a group of three muscles making up the buttocks, can lead to this gait problem. The good news is that the Trendelenburg gait usually disappears as muscle inflammation decreases. Trendelenburg gait causes have also been linked to surgery. For instance, it is possible to get this gait after a total hip replacement operation. This is due to the fact that a surgeon has to make incisions in the gluteus medius muscle, which has been known to weaken it.
As we have established, causes of Trendelenburg gait are largely associated with fragile muscles. The list below outlines some circumstances under which this muscle can become weak.
- Nerve damage or dysfunction in the gluteal minimus and medius muscles.
- Osteoarthritis, which is a form of arthritis characterized by the wearing away of joint cartilage.
- Poliomyelitis, a condition that is linked to the poliovirus.
- Cleidocranial dysostosis, which is a condition that people can have from birth. It causes improper bone development.
- Muscular dystrophy, a condition that causes muscles and bones to become weak over time.
While many people who get Trendelenburg gait recover quickly, there are some individuals with moderate-to-severe symptoms that experience serious complications. This is usually when they don’t receive treatment for the condition. A pinched nerve, pain, stiffness, grinding in the hips, problems with range of motion in the hips, losing the ability to walk, having bone tissue die, osteoarthritis, and even becoming paralyzed are some of the potential complications.
What are the symptoms of Trendelenburg gait?
You might be wondering about Trendelenburg gait symptoms. It’s important to know how humans walk in order to fully understand the symptoms. When we walk, our gait is made up of two elements – the swing and the stance. When one leg moves forward or swings, the other leg stays still to keep us balanced, which is called a stance. When one leg swings forward and the hip drops down and moves forward, this is a symptom of Trendelenburg gait. If you have Trendelenburg gate, you may lean back or slightly to the side in order to try to maintain your balance. You may also lift your foot higher off the ground than you normally would to avoid losing your balance, as your pelvis shifts in an uneven fashion.
How to diagnose Trendelenburg gait
There is a Trendelenburg gait test. It can determine the condition of the hip abductor muscle and its function. This test is used in cases where an X-ray has not been taken but there are signs of this gait.
For the test, a person simply has to stand on one leg and tilt the other one up. If the hip of the leg that is pulled up can also go up, it means there is no Trendelenburg. If the hip from the leg is pulled up and will become lower than the other one, this could be a positive sign for Trendelenburg gait. If a gait issue is suspected, a doctor will likely want to see the person walk. The doctor usually stands in front of the patient or behind to make their assessment. In most situations, an X-ray is done to confirm the diagnosis.
Both the Trendelenburg test and X-ray assessment can tell health care professionals if there is any deformity in the hip area and to what degree.
Also read: Hip effusion: Causes, symptoms, treatment, and exercises
How to treat Trendelenburg gait
Once someone has been diagnosed with Trendelenburg gait, they should start treatment immediately. When considering how to fix Trendelenburg gait, you have to keep in mind the underlying cause. Trendelenburg gait treatment will be focused on that cause. For instance, if osteoarthritis or skeletal problems are the underlying cause, osteopathic manipulation may improve the gait.
Here are some other options in terms of treatment:
- Anti-inflammatory medications to help lower inflammation and ease pain
- Orthodics, such as using a lift in one or both of your shoes to help with the muscle weakness.
- Surgery, including the pelvic support osteotomy, which is a hip bypass procedure to stabilize the pelvis and allow for walking with less of a limp. Trochanteric osteotomy is a type of hip replacement procedure that can also be done, but it is usually carried out under very specific circumstances.
- Physical therapy is used for some people who are suffering from the effects of Trendelenburg gait. It should only be used as a treatment when recommended by a doctor.
Physical therapy and exercises for Trendelenburg gait
When you look at how to fix Trendelenburg gait, you have to keep in mind that gait issues can lead to other ailments in the bones of the hip and knee, such as arthritis and wear in the joints. This means that it is important to do Trendelenburg gait treatment exercises.
The point of physical therapy is to strengthen the abductors of the hip. Working with a therapist is the best option, but we can tell you that some of the most appropriate exercises have the patient lay down with the side less affected facing the surface while they abduct the upper active limb. These exercises can help reduce the degree of Trendelenburg gait. The list below covers some specific exercises to do:
Single Leg Squat Exercise: Standing on a single leg on a box, start the squat motion sticking your butt out. This should cause the hip to hinge and the knee to bend. Bend the knee until you are maintaining a proper form.
Leg Life Exercise: In order to prepare you for future running, it is a good idea to do leg lift after single leg squats. With this exercise, you lift the non-weight bearing legs out to the side to practice balance. This not only helps with balance but also strengthens muscles. Performing 10–15 repetitions can be beneficial.
Single Leg Balance: This is simply accomplished by standing on one leg
Yoga Tree Pose: Standing in a mountain pose with your arms at your sides, shift your weight to your left foot, bend your right knee, then bend down and clasp your right inner ankle. Use your hand to draw the right foot alongside the inner left thigh and rest the foot against the knee. Make sure your right hip and left hip are aligned. Press your palms together in a prayer position. Extend your arms overhead, reaching to the sky. Hold for one minute.
What is the use of electromyogram biofeedback to reduce Trendelenburg gait?
In recent years, Trendelenburg gait exercises have included electromyogram biofeedback. Electromyogram biofeedback or EMG uses electrodes to detect changes in skeletal muscle activity, which is fed back to the user via a visual or audible signal. It can be used to increase activity in weak muscles or reduce tone in spastic muscles.
There have been numerous studies involving EMG biofeedback. In one study published by the National Institutes of Health, ten people with Trendelenburg gait underwent a therapy program that involved muscle strengthening and half wore a two-channel electromyogram biofeedback-training device. The difference between the five subjects that used the EMG and the five that only did muscle exercises was that they had continuous biofeedback every time they walked.
The weakness of gluteus medius muscles is the main factor of Trendelenburg gait, so the device provided a warning signal giving feedback of improper gait through assessment of the gluteus medius muscles. When the gluteus medius activity was detected on the affected side or the step was too short in duration, the microprocessor provided an audio cue to alert people to correct the problem. Those participating in this therapy showed a 50 percent reduction in hip drop.
As mentioned earlier, Trendelenburg gait is not normally a serious health issue, but it can slow people down. Getting a quick diagnosis and following up with good treatment can bring comfort both physically and emotionally to those suffering.
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