Overview of Trendelenburg Gait

Trendelenburg gait is associated with the trunk leaning towards the same side as the leg you're standing on with contralateral pelvic drop. People with this gait step with the right, have to lean over to the right due to right hip pain or weakness, causing the pelvis to drop to the left. It is commonly seen in older adults, among anyone who recently had total hip replacement surgery and in those with hip dysplasia issues,

What is Trendelenburg Gait?

Trendelenburg gait is an abnormal movement pattern caused by weakness of the abductor muscles of your lower limbs and both your gluteus medius and gluteus minimus. With Trendelenburg gait, your body doesn’t have the ability to maintain the necessary center of gravity on your standing leg. Typically, when walking, the body shifts the weight to the stance leg. This causes the center of gravity to shift to keep your body in balance.

People with Trendelenburg can still live a healthy life, as this condition doesn’t often disrupt your daily movement. However, you can cause less stress in your walking by following the targeted exercises found below. 

Causes of Trendelenburg Gait

What can cause Trendelenburg gait? According to authors Viraj Gandbhir and Appaji Rayi, author of the book Trendelenburg Gait, failure of your hip joint and abductor mechanism can lead to a positive Trendelenburg gait. This gait occurs when you have the following conditions:

• Osteonecrosis of the hip, a disease caused by reduced blood flow to bones in the joints
• Chronic dislocated hips
• Hip dysplasia
• Legg-Calve Perthes disease, a childhood condition that occurs when your blood supply to the ball part of your hip joint is interrupted
• Severe hip bursitis, a recent total hip surgery, or significant lateral hip pain
• Muscle weakness stemming from osteoarthritis, a type of arthritis that occurs when joint cartilage wears away; muscular dystrophy, a serious condition in which muscles become weak; nerve damage; or after total hip replacement surgery

Why Your Gait Matters

In a 2016 study out of Dalhousie University and published in Human Movement Science, 15 healthy volunteers were shown how to walk like someone with Trendelenburg gait. Researchers had these participants walk with their typical gait and with a pelvic gait drop (Trendelenburg).

They found that when the participants' pelvic dropped four degrees to one side, the knee on that side shifted inward 23 percent higher than those walking with normal gait.

Determining If You Have Trendelenburg Gait

According to Gandbhir and Rayi, a person with Trendelenburg gait typically complains of a limp. This limp can either cause pain or not. For those who do experience severe pain, you will notice you often bend or lurch to the side to keep your center of gravity when you walk.

If you do have a limp, you should see a doctor. The medical professional will perform a test to determine if you might incur a positive Trendelenburg test. In this test, the doctor will ask you to lift each foot off the ground while raising up your pelvis as high as possible for at least 30 seconds.

If you don't have any issues, this should feel comfortable and you should be able to hold this position for more than 30 seconds. If you have a weak abductor mechanism or something else that is contributing to a Trendelenburg gait pattern, the doctor will view your pelvic dropping on the side of your lifted leg.

Gandbhir and Rayi say the prerequisites for the test are as follows:

• No hip abduction or adduction deformities. The presence of an adductor deformity can present as a false negative.
• Painless hips. If you experience too much pain, you won't be able to hold that position at all, even for a few seconds.

You might also need an X-ray, ultrasonography or MRI. A doctor might also perform a blood test to confirm findings, according to Gandbhir and Rayi.

Exercises

You should always keep safety as your number one priority when performing these 12 exercises to help with your Trendelenburg gait. Also, more than likely, you have been walking with this type of gait for quite a while and you're compensating. You should go slow and stop if you feel any type of pain.

If you experience chronic pain or if you recently had total hip replacement surgery, speaking with your doctor first before beginning an exercise program will assist in preventing further injuries.

Here are 12 exercises for Trendelenburg gait to build up your hip abductors. You will need a resistance band to complete all of these exercises. You can find one in any sporting goods store or anywhere workout equipment is sold.

Side Plank

How to do:
1. Layout a mat and lie down your left side.
2. Rest your right leg on top of your left leg.
3. Gently lift up your body to form a straight line. You will put your weight on your left forearm and the outside of your left foot to do this lift.
4. Rest your right hand on your right hip to help steady yourself.
5. Hold for 30 seconds.
6. Switch sides and repeat.

Modification: If you can’t hold for 30 seconds, try to hold the position for as long as possible.

How often: Do three sets of 30 seconds per side three times per week.

Squats

How to do:
1. Sit upright in a chair.
2. Stand upright and cross your arms.
3. Tighten your torso and push your hips back.
4. Lower your body until your glutes touch the chair.
5. Rise slowly back up, keeping everything tight.

Modification: If you can’t go all the way down to the chair, go as far as possible.
To make it harder, try doing a one-leg squat. When you stand upright, lift your right leg up and keep it up the entire time. Do three sets and switch legs.

How often: Three sets three times per week.

Single Leg Step

How to do:
1. Stand upright with your hands on your hips.
2. Tap one leg directly behind you.
3. Bring that same leg and tap it directly in front of you.
4. Keep this tapping up for 30 seconds.
5. Switch feet. Repeat on the other foot for 30 seconds.

You should be able to hold this stance on each foot for 30 seconds. If you aren’t about to do this, you should skip this exercise entirely.

How often: Do this every day for 30 seconds per foot.

Bridge

How to do:
1. Lie down, face up.
2. Bend your knees.
3. Keep your arms resting on the floor and push your heels into the floor.
4. Raise your torso and glutes so that your body essentially creates a bridge with the floor.
5. Lower your hips to the floor.

Modification: If you find this too hard on your back, place a box or stair under your feet, so that you start from an elevated position.

How often: Do three sets of 12 three times per week.

Monster Walk

How to do:
1. Get a resistance band and loop it around both of your ankles.
2. Stand with your feet a little more than hip-width apart to allow the resistance band to have tension.
3. Step forward in a slightly diagonal direction to keep tension on the resistance band.
4. Step forward with the other leg, keeping tension in the band.
5. Continue to take 10 steps forward and then 10 steps backward. You are walking like a bit of a “monster.”

Modification: Skip going backward if you find this too difficult for your coordination level or put the band above your knees as it may be easier

How often: Do three sets three times a week.

Butterfly Stretch

How to do:
1. Sit on the ground with your legs bent beside you.
2. Bring the soles of your feet together until they touch.
3. Bring your heels close to your body.
4. Use your elbows and push your knees to the ground.
5. Hold this pose for 30 seconds.
6. Release.

Modification: Put your heels out farther if you find this painful to your inner thighs.

How often: Do this pose five times three times per week.

Hip Flexor Stretch

How to do:
1. Get into a lunge, placing your right foot flat in front of you with your right leg bent. 2. Lower your left knee to the ground with your hips aligned.
3. Put your hands on your hips.
4. Move your pelvis and torso forward slightly.
5. Gently move your pelvis and torso back.
6. Keep up this movement back and forth for 20 times.

How often: Do this movement 20 times three times a week.

Hip Flexion

How to do:
1. Lie on your back with your legs straight out in front of you.
2. Keep your hands at your sides with palms facing down.
3. Slowly move your right knee into your chest using your hands.
4. Pull your leg as close to your chest as possible without feeling uncomfortable.
5. Lower your leg back down.
6. Switch legs.

To make this movement harder: try straightening the leg rather than keeping the leg bent the entire time. You will reach behind your knee instead of wrapping your hands around the front of your knee.

How often: Perform this movement 10 times per leg three times per week.

Hip Adduction

How to do:
1. Loop a resistance band around a solid object, like the leg of a couch.
2. Slip your another leg through the other side of the resistance band. You don’t need to have tension here with the band.
3. Move your free leg about shoulder-width apart.
4. Pull your leg that is wrapped in the resistance band until your leg touches your ankle of your free leg.
5. Move back.
6. Repeat 10 times and then switch legs. You can switch legs by simply standing backward.

Modification: Try placing the band around the knees as it may be easier.

How often: Do this movement 10 times per leg three times per week.

Hip Abduction

How to do:
1. Stand with your feet shoulder-width apart.
2. Loop a resistance band around both of your ankles.
3. Raise one leg and move it out away from your body as far as you can.
4. Return your leg back to shoulder-width apart.
5. Switch legs.

Modification: If you find you can’t move your leg, don’t use a resistance band. Simply move your leg out away from your body as far as you can. Use a chair for balance if necessary.

How often: Do this stretch five times per leg three times per week. 

Leg Lifts

How to do:
1. Lie on your left side.
2. Keep your right side directly over your left side.
3. Put your arm down in front of you with your right elbow resting on the ground.
4. Put your left hand underneath your head to keep you steady.
5. Raise your right leg until you feel a squeeze in your thigh.
6. Lower your leg down.
7. Repeat this lift 10 times.
8. Switch legs.

Modification: If you find this too painful due to hip dysplasia, use a chair. Stand on the side of the chair, keeping a hand on it for balance. Lift your left to the side.

How often: Do each lift 10 times per side three times per week.

Standing Kick

How to do:
1. Stand with your body facing forward, hips shoulder-length apart.
2. Put your hands into boxer stance, like you're ready to fight.
3. Lift your right leg out to the side throughout the count of three, lifting higher on every count.
4. Bring your leg back to the ground.
5. Switch legs.

Modification: Move your leg right out in front of you instead rather than to the side.
How often: Repeat this move 15 times on each leg three times per week.

Although this might seem like a number of exercises, maintaining such a routine three times per week can build back up your hip abductor muscles and help you achieve a proper gait. This can get you back walking and running without pain and avoiding future expensive health issues as best as possible.