Why Your Hip Drops When You Walk : How to Regain Stability
Trendelenburg gait can lead to imbalance, discomfort, and difficulty walking efficiently. However, the good news is that it can be improved with the right exercises and treatment.
What is Trendelenburg Gait?
Trendelenburg gait happens when the opposite hip drops during walking.
What Does Trendelenburg Gait Look Like?
✔ The opposite hip drops when stepping forward.
✔ To compensate, the person may lean their body to one side to balance.
✔ Walking may feel unstable, unbalanced, or awkward.
Root Causes of Trendelenburg Gait
1. Weakness in the Hip Flexors
Although Trendelenburg gait is often associated with hip abductor weakness, weakness in the hip flexors can also contribute. Hip flexors help lift the leg when stepping forward. If they are weak, the body may shift in an attempt to compensate, which can worsen hip drop.
Non-Structural Causes of Trendelenburg Gait
AFO (Ankle-Foot Orthosis) Issues
Wearing a brace (AFO) can affect how weight is distributed, leading to compensations that cause the hip to drop.
✔ If the foot is rotated inside the brace, it can shift body weight incorrectly.
✔ An AFO with a heel wedge in a pointed position can make it harder to walk properly.
Treatment:
✔ Consult your orthotist to adjust the brace.
✔ Get a strap placed in front of the ankle to keep the heel in place.
✔ Use an SMO (supramalleolar orthosis) for better foot support and alignment.
Structural Causes of Trendelenburg Gait
2. Spasticity (Involuntary Muscle Tightness)
Spasticity is when muscles stay tight and contracted involuntarily due to damage in the brain or spinal cord.
✔ If the quadriceps (front of the thigh) or calf muscles become overly tight, they can force the foot into an unnatural position, making it appear as if the opposite hip is dropping.
Treatment:
✔ Stretching exercises for the quadriceps and plantarflexors (muscles that point the foot down) can help reduce tightness and improve mobility.
3. Extensor Synergy Pattern
An extensor synergy pattern happens when muscles work together abnormally, making it difficult to bend the hip or knee separately. This can contribute to poor movement coordination and worsen hip drop.
Additionally, excessive hip adduction (where the leg moves too far inward) can also contribute to hip drop, making balance and walking more challenging.
Treatment:
✔ Break the pattern by practicing hip extension with abduction (moving the leg outward).
4. Spasticity in the Upper Body
Spasticity can also affect the shoulders and trunk, causing a person to lean too far to one side when walking. This improper weight shift can worsen Trendelenburg gait.
5. Poor Coordination of the Hip, Knee, and Ankle
Some people struggle with coordinating movement when stepping forward, leading to unnecessary shifts in weight that contribute to hip dropping.
Treatment:
✔ Practice forward weight shifting to improve movement coordination.
Effective Exercises
Breaking Abnormal Movement Patterns: Best Done in Kneeling Position
✅ Focus: Hip extension + hip abduction
How to Get Into a Kneeling Position
1️⃣ Start in a Side-Sitting Position – Sit with your legs to one side.
2️⃣ Tuck Your Strong Leg Underneath – Bring your stronger leg underneath you while keeping your affected leg in front.
3️⃣ Lower Yourself Onto One Knee – Slowly shift your weight down onto one knee.
4️⃣ Bring Both Knees to the Ground – Once stable, position yourself so both knees are on the floor, facing a chair or sturdy surface for support.
🔹 Tip: If you’re trying this for the first time, have someone assist you or use a stable object for balance. Safety comes first!
1. Tall Kneeling Clamshell Exercise – 1st Variation (With Support)
1️⃣ Start in a tall kneeling position with one hand on a chair or another stable object for support.
2️⃣ Shift your weight over your affected leg, ensuring your hip stays aligned and does not drop.
3️⃣ Lift your stronger leg out to the side in a controlled motion.
🔹 Tip: Focus on keeping your hips level and avoid leaning too much to one side.
Tall Kneeling Clamshell Exercise – 2nd Variation (Without Support)
1️⃣ Start in a tall kneeling position without holding onto any support.
2️⃣ Shift your weight over your affected leg, keeping your hips level and preventing them from dropping.
3️⃣ Lift your stronger leg out to the side in a slow, controlled motion.
Tall Kneeling Clamshell Exercise – 3rd Variation
1️⃣ Start in a tall kneeling position, placing one hand on a chair or another stable object for support.
2️⃣ Shift your weight over your affected leg, keeping your hips aligned.
3️⃣ Move your stronger leg forward, then bring it back to the starting position in a controlled motion.
➡️ Progression: Try performing this exercise without any support to further challenge your balance and stability.
2. Advanced Standing Balance Exercise
1️⃣ Stand with one hand on a stable surface (like a chair) for support.
2️⃣ Lift your stronger leg out to the side and lightly tap your toes on a chair or another higher surface.
3️⃣ Hold the position to build balance and control.
🔹 For those who can’t use their affected hand: Place support directly in front of you to hold onto instead.
3. Forward and Backward Stepping with a Yoga Block
1️⃣ Stand with a yoga block placed in front of you.
2️⃣ Step your stronger leg forward over the block while keeping your hips level and preventing them from dropping.
3️⃣ Step backward to return to the starting position.
4. Breaking the Extensor Synergy Pattern
1️⃣ Stand with your affected leg on a step, keeping the knee bent.
2️⃣ Shift your weight onto your stronger leg while keeping your posture upright.
3️⃣ Relax your affected leg and hold the position until the urge to straighten it decreases.
➡️ Progression: Use a higher step for an increased challenge.
5. Learning to Dissociate, Address Weakness, and Spasticity
1️⃣ Stand safely next to a sturdy surface (such as a step stool with a handle) for support.
2️⃣ Place your affected leg on a mini skateboard or any object with wheels (like a furniture slider).
3️⃣ For weakness: Keep your leg slightly bent and move it forward slowly, focusing on controlled movement.
4️⃣ For spasticity: Hold your leg in a slightly bent position and relax for a few seconds to help reduce stiffness.
Final Thoughts
These exercises help improve movement coordination, balance, and strength while addressing abnormal movement patterns and underlying causes of Trendelenburg gait. Starting with support when needed and gradually progressing as stability improves is key to long-term success.
Always prioritize safety and listen to your body throughout the process. For the best results, consult with a therapist or orthotist to tailor your approach and ensure you’re on the right path to better mobility. 💪🚶♂️
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