Trendelenburg Gait

It’s also called lurch gait.  This gait pattern I bet is really, really common in stroke survivors.  Trendelenburg gait happens when one side of the body has really weak hip abductor muscles.

This is what happens……when you’re walking…let’s use the right leg, I’ll describe what you’ll see with the right leg.  When you’re walking and it’s time for the right leg to leave the ground and advance forward, you need muscles to kick in so that your right foot can clear the ground.  A lot of times after a stroke your leg will have trouble clearing the ground because of weak shin muscles leading to foot drop, meaning you must strengthen your tibialis anterior muscle.

In this case, it’s weak hip muscles.  Stand on both feet, now lift up your right leg, do your hips stay level and unmoving or when you lifted your right leg off the ground did your right hip drop?  The correct answer is that your hips stayed level.

When you lift up your right leg, the hip abductor muscles on the OPPOSITE side of the body turn on to prevent your hip from dropping.  Since your left leg is stationary, the only way to ABDUCT(move away from the body) the left leg is to raise the right hip.  If the hip abductor muscles on the left side are weak, the right hip will drop when the right leg is lifted off of the ground.  So if you see a hip drop on the right side, it means that the left hip muscles are weak.

This drop of the hip is called the Trendelenburg sign.  Sometimes, the body has compensated in order to find a way to clear the foot when walking.  This compensation is by the upper body leaning to the left(in the case of right hip drop) in order to pull the right leg up and allow the foot to clear the ground.  So the body will lean to the affected side during advancement of the opposite leg.  If you’re affected on the left, the upper body will lean to the left when advancing your right foot forward during the gait cycle.  If you’re right side affected, the upper body will lean to the right when advancing the left leg forward.  So if this happens to you, you’ll want to exhaustively strengthen the hip abductor muscles.

Categories: Health, Rehab, Stroke stuff

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17 replies

  1. Why isn’t something this clear written up and publicized as a stroke protocol? With something like this I could have practiced exact muscles. Instead I got, ‘Walk this way’, I couldn’t and his lack of understanding of even how to approach telling me what was going wrong was infuriating.

  2. I agree with Dean – Leaving rehab, I got a list of daily exercises, and only one person (my physiatrist) ever told me which muscles needed to be strengthened. Why not?

    In fact, I once asked my first PT how to strengthen my hamstring. She showed me an exercise, and I responded, “If I could do that, I wouldn’t need you.”

    • Because people suck suck suck suck suck. No one is trying to genuinely help you without expecting something in return.
      That has nothing to do with crappy physical therapists. Sorry.

      • Sorry, Amy, but I disagree with you there: I think people are wonderful, and PT’s become PT’s because they want to help. The real problem is that they don’t know how. They’re taught how to rehab an arm that’s been broken in 4 places or a knee replacement. And one big issue, I think, is that they blame the patient for not recovering. So many PT’s see lack of improvement as the result of the patient not even doing the exercises. That really frustrates them.

        • Well that’s great that you have that outlook. I sure don’t. I think that the vast majority of people are extremely selfish and only out for themselves. And I totally agree with you about PTs. When a patient doesn’t get better often they blame the patient and call it non-compliance.

          • In M. Scott Peck’s book “People of the Lie,” he describes people who sincerely believe they love, but then act in ways that are distinctly not-love. Reading the book, I absolutely recognized a couple of people like that in my life, people he identifies as “evil.” In my life, I’ve met perhaps a dozen, at most. They are not everywhere, but they can contribute to a lost faith in humanity. The thing is, not everyone is like that.

    • I don’t know why things like this aren’t explained to patients, I really don’t get it. Why go to school for all that time and not let your patients know the things that could really help them? I don’t know. It’s embarrassing. It makes me embarrassed.

  3. I think the biggest problem with most people is not exactly an insanely selfish nature, but STUPIDITY is the main culprit. There are way too many stupid people in the world…the just can’t do better. Or the worst combination stupid + lazy 😦 I have encountered too many of these types. They suck at their jobs of course and I wonder how they get through life.

      • After having a stroke, I have a new respect for people who are “stupid.” Having been really very bright (IQ and common sense) pre-stroke, most things were easy for me: whenever confronted with a problem or something new to learn, my attitude was always, “how hard can it be?” And it usually turned out ok (except for learning Italian). But then the stroke walloped my cognitive abilities, and i struggled understanding even things that were extremely easy pre-stroke. I hate to actually tell anyone, but an IQ test one month post-stroke came back as a horrifying 99. As low as it sounds, that is, by definition, average. So, most people out there stumble along as baffled by a boatload of shit as I was immediately post-stroke. I am amazed at how much gets done by those average “stupid” people. Fortunately, things are back to being relatively easy again, except one damn OT told me to try again to learn Italian.

      • Exactly!! And they are usually the people “breeding”..Then the cycle continues…more idiots are born/raised.

  4. You can’t fix stupid, but laziness is learned. The whole “entitled” attitude is learned and very annoying. People are lazy at their jobs so they are not productive or helpful. It bugs me when I have to deal with lazy people when I’m paying them for a service especially.

    • Entitlement is a sign of immaturity and people that have this sense of entitlement often act and present themselves as so much more mature, more evolved and enlightened. HELL HELL HELL NO!!!!

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