What is Trendelenburg gait?
Trendelenburg gait can happen when the way you walk — your gait — is affected by weakness in your hip abductor muscles. If your glutes are too weak to support your weight as you walk, you’ll walk with a noticeable side-to-side motion. It may look as though you’re limping or missing a step.
Walking with this gait doesn’t necessarily mean that there’s anything wrong with your hips or that there’s a serious underlying condition. In fact, it’s sometimes called painless osteogenic gait because it usually doesn’t hurt or disrupt your life. You can usually minimize its effects through targeted exercise or physical therapy.
Keep reading to find out what can cause Trendelenburg gait, how to identify it, and how it can be treated.
What causes this condition and who’s at risk?
Oftentimes, this gait results from straining your hip abductor muscles during physical activity. Exercises aimed at strengthening your glutes are a common culprit. 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, your surgeon will have to make incisions in the gluteus medius muscle. This can weaken the muscle and cause you to walk with this gait.
Weakness in these muscles can also stem from:
- nerve damage or dysfunction, especially in those that run through your 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 your muscles
- cleidocranial dysostosis, a condition present from birth that can cause your bones to develop improperly
- muscular dystrophy, a condition that causes your muscles and bones to become weak over time
What are the symptoms?
When you walk, your gait is made up of two phases: swing and stance. When one leg moves forward (swing), the other leg stays still and keeps you balanced (stance).
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 your weight.
You may lean back or to the side slightly as you walk to maintain your balance. You may lift your foot higher off the ground with each step to avoid losing your balance or tripping over your feet as your pelvis shifts unevenly.
How is this condition diagnosed?
In many cases, abnormal hip movement during a swing of one or both legs can give your doctor enough evidence to diagnose a Trendelenburg gait. Your doctor will likely watch you walk while standing directly in front of or behind you to get the most precise view of your gait.
Your doctor may also use the Trendelenburg test to diagnose this condition. To do this, your doctor will instruct you to lift one leg for at least 30 seconds. If you’re unable to keep your hips parallel with the ground while you lift, it may be a sign of Trendelenburg gait.
Your doctor may also use X-rays of your hip to identify causes of weakness in the gluteus minimus or medius.
What treatment options are available?
Your treatment options will depend on what’s causing your gait.
Medication and orthotics
If your gait is causing pain, you can take an over-the-counter nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil) or acetaminophen (Tylenol) to help ease your symptoms. In severe cases, your doctor may prescribe cortisone injections to help reduce pain.
Your doctor may also recommend using a lift in one or both of your shoes so that your hip abductor muscle weakness is compensated by the shorter distance to the ground.
Physical therapy and exercise
Physical therapy may help you gain some control over your gait and make the side-to-side motion less prominent. Physical therapy for this gait often includes osteopathic manipulative treatment (OMT).
In OMT, your doctor will use their hands to move your legs in various directions. This can help your joints become more accustomed to moving in certain directions and increase your muscle strength and resistance.
Other exercises that can strengthen your hip abductor muscles include:
- lying on your side and extending your leg straight out
- lying on the floor and moving one leg up, over the other, and back in the opposite direction
- stepping sideways and up onto an elevated surface, then back down again
- lifting your knee up with your lower leg bent, extending the lower leg out, and swinging the extended leg backward so that you lean forward
You should only use these exercises under your doctor’s supervision, so talk with them before adding anything new to your routine. They can advise you on how to exercise safely and reduce your risk for additional complications.
Biofeedback may help you increase your range of motion when you walk by training you to take conscious control over muscle movement.
Using electromyography (EMG), sensors attached to your muscles can communicate your muscles’ electrical signals to a computer, device, or app when you move. Over time, you can learn how your muscles respond to certain movements and adjust your walk accordingly.
Can this lead to any complications?
If left untreated, moderate-to-severe cases of Trendelenburg gait can be debilitating or lead to serious complications.
- having pinched nerves
- walking with pain, stiffness, or grinding in your hips
- losing significant range of motion in your hips and gait
- losing the ability to walk, which may then require you to use a walker or wheelchair
- becoming paralyzed in your lower body
- having death of bone tissue (osteonecrosis)
What’s the outlook?
Trendelenburg gait can be disruptive, but it’s often treatable with special shoes or exercises designed to strengthen your hip abductor muscles.
If an underlying condition, such as osteoarthritis or muscular dystrophy, is causing this gait, your doctor will help you develop a treatment plan. Medication and physical therapy can help limit the impact of the condition on your health and ability to walk.
Trendelenburg gait may not always be fully correctable, but treatment can help you walk more steadily and reduce your risk of complications.