What is Trendelenburg's gait?
The trendelenburg's gait is caused by a unilateral weakness of the hip abductors, mostly the gluteal musculature. This weakness could be due to superior gluteal nerve damage or due to lesion of 5th lumbar spine . This condition makes it difficult to support the body’s weight on the affected side.
During normal gait, both lower limbs bear half of the body weight in some part of the stance phase. When one lower limb is lifted in swing phase, the other takes the entire weight. During the stance phase of the gait, the pelvis tilts downwards on the weight-bearing extremity and hikes up on the non-weight bearing extremity.
But when there is a hip abductor weakness, the pelvis tilts downwards instead of upwards on the non-weight bearing extremity. In an attempt to lessen this effect, the person compensates by lateral tilt of the trunk away from the affected hip, thus center of gravity is mostly on the stance limb causing a reduction of the pelvic drop.
What does it look like?
The main symptom of Trendelenburg gait can be seen when one leg swings forward and the hip drops down and moves outward. This is because the hip abductor of the other leg is too weak to support his weight.
If glutes are too weak to support the weight as person walk, they'll walk with a noticeable side-to-side motion. It may look as though they are limping or missing a step.
These people may lean back or to the side slightly as they walk to maintain balance. They may lift their foot higher off the ground with each step to avoid losing balance or tripping over their feet as their pelvis shifts unevenly.
A trendelenburg's gait is characterized by trunk shift over the affected hip during stance and away during the swing phase of gait and it is best visualized from behind or in front of the patient.
What causes this condition and who are at risk?
️Often this gait results from straining hip abductor muscles during physical activity. Exercises aimed at strengthening glutes are common causes . In this case, the gait will likely fade as muscle inflammation fades.
️This gait can also appear after a total hip replacement surgery . During this procedure, surgeon will have to make incisions in the gluteus medius muscle. This can weaken the muscle and cause a person to walk with this gait.
️Weakness in these muscles can also be produced by:
Nerve damage or dysfunction, especially in those that run through gluteal minimus and medius muscles.
Osteoarthritis , a type of arthritis that happens when joint cartilage starts to wear away.
Poliomyelitis, a condition associated with the polio virus that weakens muscles.
Cleidocranial dysostosis, a condition present from birth that can cause bones to develop improperly.
Muscular dystrophy a condition that causes muscles and bones to become weak over time.
Hemiplegic cerebral palsy.
How to quantify the trendelenburg's gait?
In many cases, abnormal hip movement during a swing of one or both legs can give enough evidence to diagnose a Trendelenburg gait. The physiotherapist will likely watch person walk while standing directly in front of or behind them to get the most precise view of their gait.
The physiotherapist may also use the Trendelenburg test to diagnose this condition and can use this test when there is no X-ray taken but there are signs of trendelenburg. To do this, they will instruct person to lift one leg for at least 30 seconds. If they are unable to keep their hips parallel with the ground while they lift, it may be a sign of Trendelenburg gait.
Doctor/ physiotherapist may also use x-rays of their hip to identify the causes of weakness in the gluteus minimus or medius. X-ray is the best way to diagnose or confirm the trendelenburg pathology.
Physiotherapy treatment and management.
Physiotherapy helps to gain some control over gait and make the side-to-side motion less prominent. Physiotherapy for this gait often includes osteopathic manipulative treatment (OMT).
Trendelenburg gait is an abnormal gait caused by weakness of the hip abductors. Therefore, the main purpose of physiotherapy with regards to this impairment is to strengthen the abductors of the hip. An appropriate exercise to strengthen the hip abductors is to have the patient lie in side-lying on the unaffected side and abduct the upper leg towards the ceiling.
References.
https://www.healthline.com/health/trendelenburg-gait
https://www.ncbi.nlm.nih.gov/books/NBK541094/
Methni Dahanayake
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