Description, Causes and Risk Factors:
As the human body uses a mechanical system of muscles and bones to move around, when a person has abnormalities in this system, unusual movements can occur. One such abnormality is the Trendelenburg gait, which is an indication that a person has problems with the hip area. Conditions which can produce the sign include a dislocation of the bones of the hip, or problems with the muscles of the area.
The trendelenburg gait or gluteus medius gait is an abnormal gait who is observed in patients that have weak hip abductor muscles (muscle that causes movement away from the median plane of body, axis of middle finger, or axis of second toe, or in the case of the thumb, anterior to the plane of the palm). This condition makes it difficult to support the body's weight on the affected side. The abductor muscles themselves are normal but they have a mechanical disadvantage. During the stance phase of gait, the hip abductors function ineffectively and the pelvis tilts away from the affected side. In an attempt to lessen this effect, the child compensates by leaning over the affected hip. This brings the center of gravity over the hip and reduces the degree of pelvic drop.
Trendelenburg gait occurs when the patient has to deal with weakness of the abductors of the hip (Musculus gluteus medius). Patients who have significant shorter height and greater body mass index sustained the trendelenburg gait.
Usually the pelvis, which is the large, wide bone structure into which both the spine and the legbones connect to, moves up on the side of the body where the foot is lifted up. In a Trendelenburg gait, the person cannot lift up the side of the pelvis to help raise the foot and transfer the weight to the other leg. Instead, the person's pelvis moves downward, in the opposite manner. This reduces the efficacy of the foot-raising, and the affected person typically bends his or her leg more than usual at the knee to make up for the lack of lift. Other indicators of Trendelenburg gait include short steps on the unaffected side, and a tendency for the person to lean to the affected side while walking.
Breakages or dislocations of the pelvis are possible causes of a Trendelenburg gait. Alternatively, the muscles of the region may be involved and a variety of muscle-wasting conditions can cause the problem. Nerve damage is another possibility, as the nerves control the movement of the muscles. Polio is a nerve condition that can display Trendelenburg gait as a symptom, although this disease is very uncommon in countries with polio vaccination programs.
One of the major symptoms of a Trendelenburg gait is a condition referred to as a trendelenburg sign, which manifests itself as an abnormal gait cycle and causes a dipping of the hip that is swinging rather than the normal raising. A secondary indicator of a trendelenburg sign is the increased degrees of knee flexion as the individual attempts to clear the ground their foot. You may also feel pain or irritation in the buttocks that varies with severity of injury.
The authors describe several methods of evaluating the Trendelenburg gait. These include:
Standard manual muscle testing of hip abduction in sidelying. Because the gluteus medius also has an effect on other hip motions, researchers often recommend a full testing of hip flexion, abduction, ER (external rotation), IR (internal rotation), and extension as well.
- Double- to single-leg stance test. The patient is instructed to stand on one limb and pelvis orientation is documented. The authors also recommend adding an upper body movement to the single-leg stance test. This will further challenge the patient, specifically the athletic patient. During this, the patient is instructed to balance on one limb while reaching the arms overhead and leaning away from the stance leg. This will move the patient's center of gravity further away from the stance limb and require a greater amount of gluteus medius stabilization to avoid the dropped pelvis position.
- In addition to the above described, researcher would also recommend that patients should be observed during several functional activities, especially if a specific activity tends to exacerbate symptoms. This could include eccentric step-downs, front lunges, or even running and jumping activities for athletes. Watching the kinematics of the pelvis and lower body closely can be very beneficial.
Currently, no treatment modalities exist for patients with compensated Trendelenburg gait. What we can do is try to deal with the causes who develop Trendelenburg gait. Open reduction and Salter innominate osteotomy (SIO) without preoperative traction is effective in the management of development dysplasia of the hip in children younger than 6 years.
Pelvic support osteotomies cause a significant improvement in terms like posture, gait and walking tolerance to patients who have to deal with untreated congenital dislocations.
Osteopathic Manipulative Treatment (OMT) could result in improved gait parameters with people who have to deal with somatic dysfunctions, this can be measured due to a GaitMat II system. Further research is needed to tell more about the relationship between somatic dysfunctions and gait deviations.
There is a significant difference in the incidence of a positive Trendelenburg gait between surgical approaches, using trochanteric osteotomy or not. This shows the effectiveness of distal trochanteric transfer.
Physical Therapy: Trendelenburg gait is an abnormal gait caused by weakness of the hip abductors. Therefore the mean purpose of your physical therapy is to strengthen the abductors of the hip. The exercise most appropriate for Trendelenburg gait is by laying the patient on the other side than the affected side, bring the leg towards the ceiling. To make the exercise heavier, we can use a weight around the leg we move upwards or a teraband. Other exercises in the revalidation of Trendelenburg gait are functional closed-chain exercises, lateral step-ups and functional balance exercises. It is also important to strengthen the rest of the leg on the affected side.
The use of an Electromyogram (EMG) reduces the Trendelenburg gait by an average of 29 degrees.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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