Trendelenberg gait
It 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 in 5th lumbar spine lesion.
What exactly happens with this gait?
During normal gait, both lower limbs bear half of the body weight in some part of stance phase. When one lower limb is lifted in swing phase, the other takes the entire weight.
During the stance phase of gait, the pelvis tilts downwards on the weight-bearing extremity and hikes up on the non-weight bearing extremity.
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.
The gluteus medius and gluteus minimus are the two main hip abductors. They support the opposition of the pelvis and prevents the pelvis from dropping.
They are supplied by the superior gluteal nerve, which arises from L4- S1 nerve roots.
Causes
Neuronal injury to the superior gluteal nerve either due to nerve entrapment or by iatrogenic factors
Developmental dysplasia of the hip,
Congenital dislocation of the hip (CDH),
Congenital coxa vara
Coxa valga secondary to other disorders like Legg-Calvé-Perthes disease or slipped capital femoral epiphysis.
Replacement surgery and femoral fixation with intramedullary nail
Muscular Dystrophy
Hemiplegic cerebral palsy.
Presentation
Ttrunk shift over the affected hip during stance and away during the swing phase of gait
Assessment
The modified McKay criteria is useful to assess if a patient has Trendelenburg gait. These criteria measure pain symptoms, gait pattern, Trendelenburg sign status, and the range of hip joint movement.
Surgical management
Surgical correction of hip dysplasia
Pelvic support osteotomies
Osteopathic Manipulative Treatment (OMT)
Physical therapy management
The main purpose of physical therapy with regards to this impairment is to strengthen the abductors of the hip. PT includes:
Strengthening exercises
Resisted Strengthening exercises
Lateral step-ups and
Functional balance exercises.
Electromyogram (EMG) biofeedback
Visual feedback to facilitate proper gait re-education.
At Valley Healing Hands, we provide the best Physical Therapy treatment for Trendelenburg gait. We have highly skilled therapists who will assess your complaints and provide you with the best exercises to help you with your concerns. Our patients are completely satisfied with our services and you may learn about what they have to say about us here. You may also get connected to us here. Our patients love us, you too will.