This article is a transcribed edited summary of a video Bob and Brad recorded in July of 2021. For the original video go to https://www.youtube.com/watch?v=6LkfwXmSUwM&t=97s
Bob: Do you waddle side to side when walking? That's called the Trendelenburg gait and we're going to show you how to fix
Brad: So, we're talking about waddling or Trendelenburg gait and I'll just demonstrate it right now.
Bob: Dr. Friedrich Trendelenburg.
Brad: He was a doctor they named it after and it was quite a while ago, 1844 he was born. He died in 1924. So, people have been walking like this for centuries it sounds like. It's when you have this kind of lean, usually to one side. You walk over to one side and it's typically because of a weak muscle. And we're going to talk about that and show you.
Bob: That weak muscle may be due to pain too. Pain might have caused the weak muscle because you don't want to take weight on that side, so the muscle becomes weak.
Brad: Right. I've had people with this after total hip surgery. Yeah, and for other people, it may be for other reasons. One way or another, that's how it presents, that waddle, side-to-side, right-to-left, the muscle that helps or maintains your stability is the gluteus medius. And this purple tape just shows where it connects. It's a broad muscle, kind of like a fan and it connects down to the hip and all the way up to the top of the Iliac crest. So that's the muscle. If we strengthen that muscle, it's going to help stabilize that hip and allow you not to compensate and waddle.
Bob: Can you see if it's strong, it's going to help hold the pelvis up. If it's not strong, the pelvis could actually dip down. Causing you to waddle.
Brad: Right. Which causes the whole trunk to go down to the side. There's a test that we use and what we're going to do is simple. You can do this to yourself. Get a stopwatch, it takes 30 seconds. You look at your waist level. We have a level, but you don't need this. What's going to happen is I'm going to stand on one leg and maintain a level pelvis or belt line. So, you can look at the belt line. And then if suddenly, I'm starting to drop then you go to the other leg and it's for 30 seconds.
Bob: It stays.
Brad: Yeah, you have maintained without that pelvis dropping down, then you'll know which side is the weak side.
Bob: Well, it’s weak on the right side if it dips to the left
Brad: Right. Yeah. It's the opposite. There is another test I'll show in a minute.
Bob: So if the dip is on the right, it's weak on the left.
Brad: It's the opposite. So Bob, just lay down once on your left side, please. Can you lift that leg up and straighten it out? So this is a manual test that I would do. I'd push down just above the knee, hold it, hold it, hold it. And if you're strong and normal hip abductor, you can hold a lot of weight and it's fine. And I do one side, have the person roll over and do the other side.
Brad: But we're going to assume you found that one side drops. You have the waddling gait. Maybe you did a manual test if you had someone to do that. But the exercises we're going to start out actually the same position you just were for the test.
Bob: And I can do it with a band or without a band. I'll start without a band.
Brad: So, we've decided that this is the weak side. And what you can do is you can do these exercises on both sides, but you'll notice the weak side.
Bob: So, I'm going to work hip abduction and you can start without any weight because the weight of the leg is going to be plenty for you for the first couple of weeks probably.
Brad: Right. I would say 10 repetitions.
Bob: Keeping the toes straight forward. Don't turn your toes toward the ceiling.
Brad: You'll feel that hip abductor muscle. If you can do 10 good quality ones and it feels easy, then you may want to go to two options. You can use a loop band like this.
Bob: This is a booty band. I think we call it.
Brad: There are other ones too. The booty bands are made of elastic cloth and there are rubber ones. The cloth is a lot more comfortable.
Bob: The band is a lot of work.
Brad: That's quite a bit harder. If you move the band up towards the hips, it's easier. And so, you can adjust that. You'll get a feel for that relatively quickly.
Bob: It’s a little easier. But it's hard either way.
Brad: So, if you did this for another week or two, you're going to find that gets easier.
Bob: And yeah, if you're just starting out, you don't do it every day. And you don't go crazy the first time because your hips can get really sore, and you can actually get micro tears in the muscles.
Brad: So, don't go too crazy. Now we're showing you some other options. You do not have to do them this way. There are some strengthening exercises you can do standing, which I kind of prefer as long as you can do them safely.
Bob: It's a little more functional. Do you want me to show the side plank?
Brad: Actually, let's do that. That's another option lying down.
Bob: That's a tough one. You can start just on your knees, and you're going to go like this. Now you're working on the bottom leg and you're working on the top leg. Now you can do it with the legs straight too, and it just gets a lot harder.
Brad: Yeah. That's aggressive. It depends on how athletic or how strong you are, but probably starting out the first time on your knees.
Bob: I mean, you wouldn't do it on a wiggly mat or a cushion, do it on the floor.
Brad: And probably not in a bed. Unless you have a really firm bed, but again, 10 repetitions is a good goal with all of these. You may want to do that one on both sides. So, shall we go on to the next one?
Bob: Now, as Brad alluded to he's going to do some in a standing position, which is a lot more functional. It's closer to real life.
Brad: And you don't have to do all of these, you pick the ones out that work for you and that you feel comfortable with. You do need to have a resistance band of some sort. You don't need the handles on there, but it can be helpful. You'll see why when I demonstrate it. You stand on it and you need to have shoes on with this. I always have my patients do them with shoes. And then you pull up a little bit and give some resistance and you simply walk sideways. You don't have to go fast. You're probably better off doing it slow and controlled. This doesn't look like it's very hard. But if you just do it, I can already feel my hip abductors working and doing overtime work right now. You want to go both directions. I usually have my patients go about 10 feet but you don't have to measure out exactly. You'll get tired. I'm already getting tired.
Bob: And safety first. We want to make sure that you're not going to fall over when you're doing this.
Brad: Right. If you feel wobbly with this, it's not an option. Unless you have someone there to hold you but even then.
Bob: Well, I was going to say, if you had a loop band, you could hold on to a counter.
Brad: That's a good point.
Bob: But again, these are great functional ones, meaning that it translates to real life because you're walking already. You have strengthened your muscles while walking.
Brad: So, with this, you can hold onto a cupboard and the further down you go again, it's more resistance. And if I go up closer to above my knees, it's easier to do so you start higher and go down below the knees as tolerated and go back and forth two to three times. There's one more thing. I think this is probably something everyone should do. Pick out the exercise that we just did, and work on one or two of them. Don't do them seven days a week, do them probably five days a week with some days off.
Bob: Or maybe three times.
Brad: To get started, right. So, you don't get too sore. But if you have a full-length mirror in your house in a hallway or distance to walk, look at that mirror and observe yourself initially when you started doing it and see that Trendelenburg gait and some people just by thinking about it, they can improve without the strengthening, even.
Bob: Just the feedback of watching the mirror.
Brad: Yeah. And then when you walk, think about it as well. Spend 20 or a few minutes walking, really focusing on it. Because a lot of times when you walk, your mind goes other ways, you're talking, but actually do some walking where you're focusing on staying upright.
Bob: You might also just take your phone video and videotape yourself starting, and then videotape yourself later to see how you’ve improved.
Brad: Like three weeks later into this. And then you can say, "oh wow, I'm getting better." The good old Trendelenburg is correctable and it's going to take some work, but you can do it.
Bob: Yep. Just be careful out there.
Brad: I'm going to say that later we can fix just about anything…
Bob: Except for…
Brad: A broken heart.
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