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0:00 today we are going to go over how to fix a Trendelenburg gate pattern if you're not familiar with what that is it's basically just when one hip drops in most cases it's when you're standing on your weak leg and your opposite hip drops now there's a few reasons why this happens so in this video we're going to go through what some of those reasons are that might be causing this to happen as well as some exercises to help you address some of the most common root causes that can create what we call this Trendelenburg gate pattern if you're new to this channel I'm Tara I'm neurologic physical therapist and on this channel we talk about anything and everything related to Mobility Health Fitness and
0:45 mindset in the context of neurologic injury with the end goal of empowering you with as many tools as possible to take ownership of your rehab and your health and living overall more active pain-free happier healthier life and with all that said let's talk about a Trendelenburg gate pattern so as I mentioned it's when you're standing on in most cases your involved like if you have an involved leg or in this case when we get to the exercise it's going to be the working leg but it's when you're standing on that leg the opposite hip drops so why does this happen well if you are someone that hasn't had a stroke or hasn't had a brain injury the most common reason this happens is
1:32 because there is weakness in the muscles that hold that the hips level when you're standing on one leg so picture something with two pillars underneath it you remove one column you need something on the outside of this column to help hold those hips level those would be your hip abductors if those are weak then the opposite side of the roof drops so that is the most common reason that most people will end up up with this trendelenberg gate pattern now if you're someone that has a neurologic injury it gets a little bit more complicated and it sometimes can be multifactorial so the next most common reason that this might happen is if your hip adductors
2:21 are either tight or they are so the muscles that pull your legs together so when you're standing on this leg you can see this leg is coming to the middle so those are the muscles on the inside of the that hip so now why does this happen for some of you if you have spasticity or if you have an abnormal Synergy pattern which I talk about a ton on this channel an abnormal Synergy pattern in this case it would be an extensor Synergy pattern is when muscles link up abnormally together one such pattern are the muscles that straighten the leg out link up with the muscles that pull the legs together and so therefore when you're trying to stand on this leg that Synergy pattern or those muscles will couple up and so that
3:07 pulling of your leg in will cause that opposite hip to drop so that'll create two problems and we'll go into them into the exercises but because that leg is always pulling in you're going to end up with some tightness or shortening sometimes on the muscles that bring those legs together so some of the stretches are going to be important that I'm going to show here in a minute so make sure you really emphasize those stretches if this is you or you know that you have this abnormal Synergy pattern and then of course like isolating how to straighten that knee out and move those legs apart which we're also going to go over today so those would be the things you'd want to focus on if you do think that it's due to an abnormal Synergy pattern so pay special attention to those exercises when we get to those exercises and then the other reason I see this and I'm just
3:53 bringing this up because it's something to be aware of but probably not really the intent of this video or I'm not going to show you any exercises for this is for those of you who keep your weight to the inside of um an involved leg or a leg that you don't feel confident on so if I don't feel comfortable getting my weight directly over the top of like a weaker leg and I keep my weight here when you go to pick this leg up you just don't you're not going to be balanced and so you're constantly going to kind of be falling that way so just something to be aware of pay attention to that video you're walking when you lift this leg
4:39 your weight should be centered or your hips should be centered over that foot if that foot is to the outside of your hips then that might also give the appearance that that hip is dropping and then you would want to work on many videos that I have on this channel where we work on improving single leg standing balance but that's just so you're aware so that you can work on that if you are someone that has weakness of course you want to strengthen that leg so we're going to go through some strengthening hip exercises to isolate those hip abductors we're going to go through some stretches to stretch the inner thigh muscles and then we're going to go through a few
5:24 exercises to address some of those abnormal Synergy patterns that I talked about so let's go ahead and dive into the exercises this first set of exercises is going to be focused on increasing the tolerance for lengthening of all the muscles that are on the inside of the thigh that like to pull that leg inward so basically we're just going to go through a bunch of different ways to move that leg out to the side depending on whether or not you have weakness spasticity contractures or an abnormal Synergy pattern you're not going to be able to get into certain positions so that's why I'm going to give you a whole variety of different ways to again work on increasing the tolerance of these muscles on the inside
6:11 of the leg kind of relaxing and letting that leg move out to the side I will say if you are someone you know you have contractures meaning the muscles have adaptively shortened I recommend that you hold these stretches for a minute and you get very consistent doing them either once or twice a day if you're someone that you know has like involuntary contractions of the muscles that are pulling that leg in or you have an abnormal Synergy pattern meaning the leg does some crazy things involuntarily that you don't necessarily want it to do I recommend that you approach not just these exercises but all stretches with kind of more of like a slow rhythmic movement because in your
6:57 case what you're trying to do is focus on getting those muscles to relax when you're moving it so different from an Adaptive shortening where we're trying to actually lengthen that muscle you would want to hold it in the case of spasticity or an abnormal Synergy pattern we are trying to minimize how much those muscles contract when we're trying to get them to do something else so I hope all that made sense so the first one we're going to do is you're going to come up on the mat and if you can some of you are going to be able to do this but if you can't don't worry because I'm going to show a few different ways that you can do these stretches I'm just trying to kind of get creative for those of you that live alone and maybe don't have any help but you can just strap some kind of an elastic band to the end of your bed
7:43 and then if you can you know some of you can kind of get your leg up in this position because I've seen you do it when you get your afo on maybe you have to grab it with this hand but somehow if you can and don't discount these before you try them I've seen some people come up with some really creative ways of getting their leg to move um you're just going to kind of use your other stronger arm to just kind of move away and then you're just gonna rotate away as much as you can the band is just going to kind of hold your leg back so it doesn't fall off the bed and hold it straight so some of you your leg might like to bend up on you so the band will
8:28 just kind of hold it straight and then you just move as far as you can until you feel a good stretch on that inner thigh and then if that goes okay you can do a little forward lean now you'll see I have a pillowcase um wrapped around my foot that really is just to help the foot slide so I know a lot of times with the strengthening exercises the foot is moving too much or sliding too much but in this case we kind of want it to be able to slide so that it can really deepen that stretch and as I mentioned if you're someone that you know you have like contractures on the inside of the leg again I recommend you hold it for a minute if you're someone that you feel like you
9:16 have spasticity or an abnormal Synergy pattern I would rotate towards the leg and then rotate away towards nice and smooth and when you're rotating away the goal is that that leg isn't trying to pull in okay so that's why we kind of do this rhythmic movement kind of getting that hip to feel like what it what it should feel like of those muscles staying relaxed as you just perform other movements all right so that's the first one yeah if you're someone who can get down to a floor or get into kind of this low squat position but you still don't have like really good movement in this leg or you can't
10:02 move it on your own um in this case I just kind of strapped the foot and then wrapped the strap um you can really use any kind of a strap around the leg of the bed and then you're just going to kind of slowly pull it out now go slow especially if you're someone that has spasticity the faster you go the more that leg is going to try and fight it so again this is really just for those of you who can't get that leg out on your own if you can put your leg out on your own then definitely just kind of put it out there you know without using the strap but again the pillowcase around the foot will help that foot to slide and then again you're just going to lean forward and again I'm going to repeat it if
10:48 you're someone that has spasticity you want to kind of maybe bring that leg back in and then let it slide out and lean forward bring it back in and let it slide out and lean forward again adding a movement while also kind of trying to train those muscles to stay relaxed if you have a contracture I would lean forward and hold it for a minute we're going to get into some for those of you that are just a little bit higher level and what you're going to do is you're just going to try and get your legs as far apart as you can in standing and again if this is for those of you that probably have a little bit better balance and then you're just going to lean to one side by bending one knee so this is the leg we're stretching you're
11:36 just gonna bend the opposite knee moving your body away from your foot I would definitely hold on especially if you're someone that has fallen in the past or you know that you have some balance problems then you're just gonna hold it if again you have that spasticity I would do kind of more of like a rhythmic movement and again we're going to get to strengthening so this is really just kind of staying in that category of stretches or again just increasing the tolerance of those muscles on the inside of that leg to lengthen As you move foreign
12:26 higher level and you can get all the way down to the floor you're gonna do kind of like a full straddle and then just hook some kind of a strap in like a doorway and then just pull yourself forward I like this strap that has like these multiple holes on it because I'm going to get my fingers in the holes and pull forward and again hold it for a minute if if you're someone who has shortening if you're someone that has your involuntary contractions I would just move around a little bit kind of put your hands in all different kinds of positions
13:12 moving around and just not allowing that leg to pull in and then one final stretch and again I'm giving you a bunch of different positions because I know that some of you aren't going to be able to get in some of these positions so I'm giving you lots of options is with that pillowcase on your foot just letting that leg slide out if you have two hands you can put your hand on the ground stretching this thigh if all you can do is this that's fine I mean you'll get a good stretch with just
13:58 staying upright but if you're not feeling a good stretch just kind of lean forward and let that leg slide out a little bit further oh and this is just a little hack for those of you that um want to use a pillowcase and can't get it to stay on your foot you just put your foot in the pillowcase and if you're from the 90s you remember Peg rolling your jeans this is kind of reverse Peg rolling so you just kind of wrap it around and then you just fold it down and that keeps it on your foot without having to like strap it on or uh use any duct tape or anything like that and again just slide it out
14:43 and let it come back in now we're going to move on to some of the strengthening exercises to strengthen those muscles on the outside of the hip we're going to just start with just a seated hip abduction exercise with a theraband I always recommend you start in this position we are going to do it in standing and I do recommend that you do it with the hips straight as well and we'll get to that in a minute but just to kind of get a feel and make sure that you can actually engage those muscles I recommend just starting and just doing a few in sitting I will put a link for these bands in the description below they are great for
15:30 like ten dollars you get a pack of five different resistance levels try and keep your feet flat on the ground when you do this and then just press those legs out so for this exercise we're doing a hip abduction with the resistance band we're going to start laying down we're also going to do it standing but I do recommend that you start doing this one laying down you can just maintain better form and you don't have to really worry about losing your balance but I do recommend doing this exercise with your hips straight so not just in sitting but also doing it laying down with a resistance band if you can't do it with
16:15 a resistance band then just don't use it you're still going to get plenty out of this exercise just by trying working on lifting the weight of your leg but if you feel like you do pretty good with that add that band and lift that leg up now one thing you want to pay special attention to is that you're not pointing your knee towards the ceiling that's um a pretty normal compensation of using your hip flexors instead of the muscles on the outside of the hip so make sure you're staying on your hip and almost feel like you're leading with your heel so again most people will kind of lead with their toe really focus and pace special attention that you're leading with your heel and that you're not rolling backwards and then you're just going to lift
17:07 and then from there you're going to go to standing same thing if you can't do it with the band start without the band once you get good with the without the band then you want to progress to doing this with the band two things about this exercise you do want to do it lifting both legs believe it or not you're working both legs when you're doing it so that's number one thing to to do is make sure you're doing it on both legs the other thing is really make sure that you're centering your belly button over the leg that you're standing on otherwise you're just not going to get a lot out of this exercise if you need to hold on or even lean against a wall initially go ahead and do that so that you can get the feel of it or hold on to
17:54 something I do recommend you hold on to something like a PVC pipe instead of your cane where you might lean a little bit too heavily on the cake or like I just showed you leaning against a wall and just moving that leg out to the side so for this exercise we're doing is we're starting standing up on a step it doesn't have to be a very high step a two inch or a four inch step is fine and then what you're doing is you're reaching this is the leg the working leg or the leg that the opposite hip drops so again working leg you're just tapping
18:40 the opposite heel down to the ground you can see my hip drops kind of almost automatically a little bit so then when you step back up you're also going to try and do like a little lift so that this hip almost gets a little bit higher so this is the hip that normally drops you just want to lift it just a little bit higher on the way up so down and then back up now I did mention at the beginning that I would be talking about those abnormal Synergy patterns a little bit this is one exercise that would be good if you're someone where you know you have an abnormal extensor Synergy pattern because remember as I said at the beginning that is when the muscles that straighten the knee out also want
19:27 to bring those legs together so in most cases this leg will want to shoot across or it'll want to do something crazy you want to keep it out to the side and you can see you're extending that hip but by lifting the hip you're moving that leg out instead of allowing those two movements to couple up where the knee straight and the legs want to squeeze together at the same time so I know that's a little bit confusing but for those of you that have been around for a little bit you kind of have heard me explain that Synergy pattern a little bit and you'll know if you kind of fall into this category so again heel goes down and then press almost lifting that hip up just a little bit higher
20:13 and then of course we're going to finish up with some kind of a functional activity I like doing kind of gate training on your knees if you have a Trendelenburg walking pattern because we can simulate walking but it almost makes it a little bit harder to bring this leg through so you can't really drop this hip so if this is the hip that normally drops in standing then or walking this is the leg you want to bring through you almost have to lift this leg up a little bit higher in order to clear the ground so you're just gonna bring that leg forward and then back down forward and back down really working to keep this hip up
20:58 and then that is it for this video if you liked this video and you want to see more videos like this definitely hit that subscribe button and turn on that notification Bell so that you'll get notified every time I upload new videos if you want exercises throughout the week you can head on over to Instagram where we post one to two videos every single week just to help kind of add a little variety to your home exercise routine if you want to go a little bit deeper and you want to get your specific questions answered we do offer a monthly live link for that is in the description below if you wanted even more value you could join our gold membership program where you get access to the monthly lives as well as access to an entire Vault of over
21:43 350 about 400 exercises at this point of actual exercises that I use to create programs for my patients that I see in person so information for that is also in the description below I enjoyed spending time with you all today and I'll see you in the next video have a good foreign [Music]
