Trendelenburg gait, otherwise referred to as a hip drop or trunk lean with walking are all compensatory movement patterns that may lead to back pain, hip pain, knee pain, or SI joint pain over time. There are many reasons this may occur, some of which include pain secondary to a recent injury or surgery, poor hip strength, limited mobility, inhibited hip musculature, developed movement compensations, and much more. It is important to be aware of this movement impairment, as this can lead to problems up and down the kinetic chain. This article will demonstrate excellent exercises to fix your Trendelenburg gait starting with activation, followed by strengthening, and finally movement re-training!

 

What is a Trendelenburg Gait?

Quick History Lesson: In 1895 Freidrich Trendelenburg described the Trendelenburg sign as weakness of hip abductor muscles in reference to congenital dislocations of the hip and progressive muscular atrophy. Fast forward to today: most orthopedic and physiotherapy textbooks describe this sign as a test of hip function.

Apley’s system of orthopaedics wrote: “Normally each leg bears half the body weight. When one leg is lifted the other takes the entire weight. As a result, the trunk has to incline towards the weight-bearing leg. This is achieved by the hip abductors; their insertion is fixed and the pull is exerted on their origin. Consequently, the pelvis tilts, rising on the side not taking weight. When this mechanism fails, Trendelenburg’s sign is positive. The pelvis drops instead of rising on the unsupported side.”

What is MVIC? You will see this term “MVIC” used a couple of times throughout the article. MVIC is an acronym that represents the term “Maximal Voluntary Isometric Contraction”. This is the greatest amount of tension a muscle can generate as well as sustain for an allotted amount of time.

 

Uncompensated Versus Compensated Trendelenburg Gait

Shown here are 2 movement strategies, both of which are most commonly caused by weakness and/or poor motor control of the hip abductors (particularly the gluteal muscles):

1. The first strategy (Trendelenburg) shown here is a manifestation of a pelvic drop, in which the pelvis on the same side as the limb that is swinging forward (swing phase)  will DROP. This is because the recruitment of the hip abductors of the stance limb (the leg in contact with the ground) is less than optimal to maintain a level pelvis.

2. The second strategy (Compensated Trendelenburg) shown here is a manifestation of a trunk lean towards the stance limb. This movement strategy brings my center of mass over my base of support (the stance foot). This is a compensatory strategy to decrease the external moment (demand) that gravity will put on my hip abductors aka making it easier for the hip abductors on that side to support the pelvis!

In a normal gait pattern, the trunk and pelvis are stable meaning there will be less than 5 degrees of movement in the frontal plane (from side to side). If one begins to walk with a Trendelenburg for an extended period of time, it may lead to low back pain.

 

The Ultimate Hip Programming At Your Fingertips

Hip Prehab Program trendelenburg gait prehab guys

The Hip [P]tehab Program is a physical therapist developed, step-by-step program that teaches you how to optimize your hip health. This program will bulletproof your hips for anything life throws at you! Learn more HERE!

 

Hip Dip & Raise Exercise

Sample Hip [P]rehab Program Exercise

Why is the recruitment of the gluteal muscles so difficult? One reason is the poor representational area in the primary motor cortex for these muscles! Here is a great way to improve muscle recruitment of the hip abductors, particularly the gluteus medius! Evidence suggests that static isometric glute med toque is a poor predictor of frontal plane pelvic drop. You only need average glute med strength to prevent a Trendelenburg gait pattern yet so many people present with this movement pattern. Hence, it is not so much strengthening, but motor control training is important to prevent this compensatory movement pattern. This dynamic exercise helps with not only strength but also MOTOR CONTROL of the hip abductors.

To perform this exercise:

✅ Elevate the leg opposite to the one you want to work on. Allow a majority of your weight to be accepted through the leg that is in contact with the floor.

✅ Allow your pelvis to drop towards the leg on the elevated surface.

✅ Focus on using your hip abductors to bring the pelvis back to a neutral alignment. Use a mirror to allow yourself to perform this with optimal form and progress to the point where you no longer require visual cues.

✅ If strength and endurance are the goal then repeat until fatigue!

✅ If Motor Control is the goal: REPEAT REPEAT REPEAT for numerous repetitions to make those neuroplastic changes in the brain! This is the only way to increase representation in your primary motor cortex!

 

Watch This Video To Fix That Pelvic Drop

Teaching a movement is divided into 3 parts: Activation, Strengthening, & Movement Training. This exercise would be categorized as an activation drill. Note: Bolga et al did a study on Pelvic Drop determining a 57-59% MVIC- That’s Great activation folks!

LISTEN: HOW TO BEGIN STRENGTH TRAINING

begin strength training exercises to fix trendelenburg gait hip strength prehab guys podcast

 

Strengthen the Hips!

Gluteus medius strength is important in an applied sports setting, evidence suggests that unilateral hip abduction weakness has been associated with an increased risk of injuries in sports such as soccer, ice hockey, and running. The weakness here has also been associated as the cause of knee, hip, and low back pathologies. In support of this, it has been shown that athletes with stronger hip abduction strength are less likely to be injured compared with athletes with weaker hip abduction strength.

Here are 3 great exercises to improve strength here:

✅ Supine to Side Plank (AKA Side Plank w/ Hip Abduction): 89–103 % MVIC (Maximal Voluntary Isometric Contraction) -NR Boren et al.

✅ Side-Lying Hip Abduction: 56% MVIC – NR Boren et al.

✅ Clams: 62–77% MVIC -NR Boren et al.

There is evidence to suggest that strengthening on its own will not help with poor movement patterns such as Trendelenburg or dynamic knee valgus. You need to also train the muscles to activate at the right time which we call “Motor Control.”

Side Plank With Hip Abduction

Sample Hip [P]rerhab Program Exercise

Get set-up on your side with your elbow directly under your shoulder and your forearm supported on the ground. Have your feet stacked and supported on the ground with the knees straight. To begin the exercise, push your hips up and forward as high as you can and hold this position. Then lift your top leg up towards the ceiling while keeping it straight and in line with your body, lower, and repeat.

This exercise has actually shown in studies to have the highest EMG activity for the gluteus medius, which is an important muscle to train in order to fix your Trendelenburg gait. Check out the infographic below!

 

Best Exercises For The Glute Med

best exercises for the glute med trendelenburg gait the prehab guys

 

Clamshells

Begin by lying on your side with your leg together. Slightly bring your knees up towards your chest. Loop a band around both knees. From here, use the top knee to push against the resistance while your feet stay together. Bring that knee up as far as you can until you start to open up your hips and rotate back.

READ: HOW TO MANAGE LOW BACK TIGHTNESS

low back tightness causes routines fixes the prehab guys

 

 

Strengthening + Movement Re-Training

Once you begin to strengthen a particular area, you also want to move into more functional movement patterns that are translatable to the activities you perform on a daily basis. This progression is essential to ensure that quality movement patterns stick long-term!

 

Captain Morgan

Sample Hip [P]rehab Program Exercise

Get set-up near a wall, while standing on one leg, place the other leg against the wall. While maintaining this, let your hip/pelvis sink on the side further away from the wall followed by lifting your hip back up to push harder into the wall, and repeat.

 

Prehab Membership The Prehab Guys

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Standing Fire hydrants

It is recommended to first activate the weakened area (to increase corticomotor excitability) -> strengthen -> then you can movement train. Because all the glute med strength in the world doesn’t matter if doesn’t activate at the appropriate time (AKA Motor Control). Here are 2 great exercises to challenge the muscle function of the hip abductors- primarily the gluteus medius. Remember- Keep your pelvis level, after all this is the Trendelenburg article!

Note: Feel free to hold these positions statically- this will facilitate “encoding” for cognitive processes which are thought to play an important role in helping the learner create a motor memory. Static holds require prolonged focus and concentration, thus strengthening the corticomotor pathway to create motor learning.

Note 2: research has shown the importance of strengthening not only the gluteus medius but also the quadriceps and the hamstrings. Increases in the strength of the muscles will result in a reduction of the degree of Trendelenburg gait.

 

Single Leg Squat

While the weakness of the hip abductors is a potential cause for medial knee collapse, a lack of motor control can also be the culprit of this poor movement pattern. This is especially prevalent among higher-end athletes who demonstrate medial knee collapse with functional activities. In this case, the athlete more times than not has more than adequate strength, yet they fail to utilize and demonstrate the neuromuscular control necessary to engage the hip abductors during tasks. To see if this is the case, give the athlete visual, verbal, or manual cues to facilitate hip abductor activation.

Single leg squat has shown to fire 52-82% MVIC of the Gluteus Medius‼️
-82%, BW Boren et al.
-64% +/-24, BW Distefano et al.
-52% +/- 22, BW Ayotte et al.

Note: This can also be used as a strengthening exercise once the athlete demonstrates good neuromuscular control…

Gluteus medius strength may be even more important in sports when the center of mass changes direction unexpectedly, requiring strength and stabilization during unilateral stance. Because of the nature of contact sports and the role of pelvic stability to maintain the summation of forces of movements that begin in the lower extremity, Gmed strengthening should be included in sports that require unilateral support, especially during body-to-body contact.

In these sports, unilateral gluteus medius strengthening while standing can be considered as sport-specific. For example, single-leg squats with external resistance can be included during the preseason or in-season for ice-hockey players but should not be a staple of an ice-hockey player’s general strength development. Some may take this idea further and prescribe such exercises on an unstable surface in an attempt to mimic the instability experienced during competition.

 

Closing Thoughts

The cause of both Trendelenburg and Compensated Trendelenburg is oftentimes due to inadequate gluteal function. There are a plethora of ways to strengthen the hip muscles, and there are always ways to make obtainable progressions. It is important to know what level of exercise you should start with, and to progress appropriately from there! This article demonstrated excellent exercises to fix your Trendelenburg gait initiating with activation, followed by strengthening, and finally movement re-training!

 

Take Control of Your Hip Health

Hip Prehab Program exercises to fix trendelenburg gait prehab guys

To go from stepping to sitting we can thank the 27 muscles that cross the hip joint for their work. After thanking them, we should also thank your core, knees, feet, and really the rest of your movement system as they work together on a team to create movement. Perhaps, the best way to thank them is by giving them what they desire: strength and power!

 

REFERENCES

1.Cichanowski et al. Hip Strength in Collegiate female athelte’s with patellofemoral pain. 2007.
2.Fredericson et al. Hip Abductor Weakness in distance runners with iliotibial band syndrome. 2000.
3.Thorborg et al. Eccentric Hip Adduction and Abduction strength in elite soccer players and matched control. 2011.
4.Tyler et al. The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. 2001.
5.Leetun et al. Core Stability measures as risk factors for lower extremity injury in athletes. 2004.
6. Burnet et al. Isometric Gluteus Medius Muscle Torque and Frontal Plane Pelvic Motion During Running
7. Macadam et al. An Examination of the Gluteal Muscle Activity Associated with Dynamic Hip Abduction and Hip External Rotation Exercise: A Systematic Review. 2015.

 

About The Author

Arash Maghsoodi, PT, DPT, CSCS

[P]rehab Co-Founder & Chief Marketing Officer

arash maghsoodi the prehab guysArash Maghsoodi received his Doctorate in Physical Therapy from the University of Southern California. For his undergraduate studies, he attended San Diego State University and studied Kinesiology. After sustaining a career-ending ankle sprain while playing collegiate soccer, he realized how disabling and life-altering injuries can be. Arash currently resides in beautiful Santa Monica, California. His clinical experience is primarily in the orthopedic and sports setting. He has treated a wide variety of conditions ranging from the post-operative individual to the professional athlete. Arash is keeping the family legacy of becoming a physical therapist, as his mother is a practicing clinician of 30 years in the Orange County area.

 

 

 

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.

About the author : Arash Maghsoodi PT, DPT, CSCS

26 Comments

  1. Suhail October 24, 2019 at 12:54 am

    I have been looking for articles/materials that address this very topic for a long time looking for possible solutions and clear explanations and i’m glad to have come across this! Thank you! It has been very frustrating dealing with this problem and how it affects my big 3 lifts (powerlifting). Even affects my bench press due to the hip rotation making it very hard to retract my shoulder blades evenly.

  2. sarah November 8, 2019 at 11:23 am

    These exercises are so great and the detail to which the gait is explained was super helpful! I don’t have a super obvious trendelenburg gait, but make similar compensations as described above when under load or fatigue, and haven’t been progressing much on my weak side as a result of the compensation. Gonna get back to the basics now!

  3. Ali W February 23, 2020 at 1:58 pm

    Hi. So I have a very bad Trendelenburg
    Gait. When I do the first exercise repeatedly and them stand and walk, the gait is wayyy worse. And the hip is even more twisted. Any thoughts? Thanks!!

    • Michael Lau February 29, 2020 at 7:28 pm

      If walking worse, then don’t do it! Try the other exercises in the article instead!

  4. Jason Hewett March 13, 2020 at 11:17 am

    Hi there. Thank you.

    So I have L5-S1 nerve damage and a consequent trendelenberg gait on one side and greatly reduced glutes maximus mass.

    What are the best activation exercises please?

  5. Alexandrew Hintzen September 30, 2020 at 3:49 am

    This is the most complete rehab process out there. Thanks.

  6. Mark Lewis November 16, 2020 at 1:35 pm

    Hey guys. I had hip surgery last year and the recovery has been awful. I now have severe ankle pain because of it. I find I can’t activate my right glute medius (same side as the ankle pain) and so all of the leg raises in the world seem to get me nowhere. I’m going to try your activation exercise and I’m really hoping this will do the job, so Thanks in advance! Also, I love the “captain morgan” Chuck reference, big props on that!

    • arash maghsoodi November 22, 2020 at 11:35 am

      Hi Mark. Yes, hopefully this will help out! If you are looking for a more specific program to follow, the hip prehab program would be a great place to start. Keep us updated Mark!

  7. Rayann Bungay December 1, 2020 at 1:23 pm

    Which side do I do the hip hikes? right now it’s my right hip that is lower by about 1 inch.

  8. Nancy Kumble Fenn December 3, 2020 at 1:35 pm

    I’m psyched to learn about the Trendelenburg, as I believe it’s what’s been my issue (glute inactivation) for so long. am going to work on your 3 exercise that are awesome. I also tried the single leg box squat and cannot even do ONE on the left. what’s a good way to work up to being able to do it? (I’m not an inactive person so this was hard to accept!!) thank you!

  9. Karl Proksch November 7, 2021 at 3:35 am

    Very interesting explanation of the Trendelenburg gait. I was told I have this gait by my Physio.

    I was in a motor vehicle accident where I ended up with a tibial plateau fracture and a nail going through my femur (to hold 3 pieces together). This occurred all on my right leg. My other half told me my right backside cheek is not as big as my left.

    Using the information here it explains why I have this gait and some of the exercises I have done. I do exercise physiology 2 times a week and I was looking what I could back up my work in the gym and pool with my EP.

    I will be trying some of these exercises and see how I go.

    • Team [P]Rehab November 7, 2021 at 11:16 am

      Hello Karl! Sorry to hear about your accident. We hope that you are having a speedy, healthy recovery! We are glad that you have found this article, and if you are looking for more content to help you recover, or have more questions for us, feel free to contact us at theprehabguys@gmail.com! We also have various lower body rehab programs designed by Doctors of Physical Therapy to help with recovery as well.

      All The Best,

      Team [P]Rehab

  10. Amy Westcott January 2, 2022 at 5:20 pm

    Hi, I developed Trendelenberg gait immediately after having a baby two years ago. Now I have all sorts of muscular problems such as a sports hernia. I honestly cannot walk very far without difficulty. Are the steps outlined above a comprehensive plan to fixing Trendelenberg? If I can’t fix it soon, I feel like I’ll have to be in a wheelchair, and I’m only 32.

    Thank you.

    • Team [P]rehab February 7, 2022 at 3:49 am

      Hi Amy!

      We are sorry to hear about your current difficulties you are working through. Although these exercises are a great first step to help with trendelenburg gait, there is more that goes into treatment than just these exercises. If you are looking for more guidance on how to manage what you are currently experience, please email us at info@theprehabguys.com, as we would be more than willing to help lead you towards what you need the most at this time.

      All The Best,

      Team [P]rehab

  11. Frances Christie March 3, 2022 at 10:18 am

    The article is interesting but I needed some. more information. When you do the hip hike, which leg is being strengthened? The supporting leg or the other leg? How many reps should you do to really make an impact? My physical therapist has me doing this exercise for my Trendelenburg gait which is on my right side. She said to stand on my right leg, and the work should be done by the leg that is the weaker. She is also having me do 10 reps 3 times, 30 in all, every day. Should I be doing more? I think your article is good but it’s not helping me figure out my own home program.

    • Team [P]rehab April 4, 2022 at 8:58 am

      Hi Frances!

      Excellent question. The leg you are putting weight on (so the opposite leg of the one that is actually doing the hiking movement_ is the one you are strengthening. Repetition schemes will change based on goal, but starting off trying to hit higher rep ranges with longer hold times will fatigue out the glutes.

      If you are looking for more guidance of a full program from home, I would look into our hip prehab program, as it gives you step-by-step guidance of how to string exercises together, while taking out the guessing game of questions such as the ones you have! The link is here below, and if you have more questions, please email us directly at info@theprehabguys.com

      Hip Program: https://theprehabguys.com/product/the-hip-prehab-program/

      Best,

      Team [P]rehab

  12. Phyllis Mikels May 17, 2022 at 3:59 pm

    Hate to tell you guys, but there’s no way a person with a broken femur and Trendelenburg gait can do planks! Let’s get real here!

    • Lauren Lynass September 29, 2022 at 10:34 am

      Hey Phyllis! Appreciate you mentioning something here. There are lots of modifications that can be done for planks to assist with whatever level you are at in the rehab process. Trying a side plank on an elevated surface with your hand resting on a counter, edge of the couch, table may be a good way to start! Finding ways that work for YOU is key here to give you the necessary tools to tackle this!

  13. jackie b June 30, 2022 at 2:53 pm

    i had achilles tendon lenghthening on right let….which seemed to make right let functionally longer also causing valgus in right knee……just had knee replacement on right leg….improved stability and straight let extension but left leg still dips down and seems shorter when doing a heel strike therefore left hip tilts down. QUESTION … which left is on higher platform to let the opposing leg go up and down..thanks

    • Team [P]rehab July 18, 2022 at 5:39 pm

      Hi Jackie!!

      Great question. In your case, would be great to work on proximal hip stability exercises for BOTH legs, as this will positively influence both lower legs from your achilles tendon lengthening as well as knee replacement. All the best to you!

      Best,

      Team [P]rehab

  14. Roddick May 11, 2023 at 8:14 am

    test

    • Roddick May 11, 2023 at 8:16 am

      lauren should be notified of this comment

  15. Roddick May 11, 2023 at 8:17 am

    Testing email comments

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