Trendelenburg Gait: Why Your Pelvis Drops When You Walk and How Physiotherapy Can Help
Understanding hip weakness, walking difficulties, pelvic stability and exercises to improve your movement.
Working with a patient with a Trendelenburg gait
When working with a patient who has difficulty walking following hip surgery or a pelvic fracture, one of the things we may notice is that their pelvis drops to one side with each step. They may walk with a limp, lean their body from side to side or struggle to stand on one leg without losing their balance.
This walking pattern is known as a Trendelenburg gait. It can occur following a hip fracture, hip replacement or pelvic injury, but it can also develop gradually because of muscle weakness, hip pain or problems affecting the nerves that supply the hip muscles.
For patients, this can be frustrating. Walking may feel less stable, distances may become shorter, and activities such as climbing stairs, getting out of a chair or walking outdoors may become more difficult. Some people also experience discomfort around the hip, buttock, lower back or pelvis.
The encouraging news is that physiotherapy can often help improve walking mechanics, strength and confidence. The most appropriate treatment depends on what is causing the problem, how severe the weakness is and whether there are any restrictions following surgery or injury.
In this article, we explain what a Trendelenburg gait is, how the pelvis works during walking, why the problem can develop, how it is assessed and which exercises may help.
1. What is a Trendelenburg gait?
A Trendelenburg gait is a walking pattern in which the pelvis drops towards the side of the leg that is lifted off the ground. It usually indicates that the muscles responsible for stabilising the pelvis are not working effectively enough during walking.
Imagine standing on your right leg and lifting your left foot off the floor. Your right hip muscles need to work to keep your pelvis level. If these muscles are weak or unable to function effectively, the left side of your pelvis may drop. When this happens repeatedly during walking, it can produce the characteristic Trendelenburg gait.
The main muscles involved are the gluteus medius and gluteus minimus, which lie around the outer side of the hip and underneath the larger buttock muscles. They help move the leg out to the side and, importantly, stabilise the pelvis when you stand on one leg.
A Trendelenburg gait can affect one side or both sides. If both hips are affected, the person may develop a more pronounced side-to-side or waddling walking pattern.
It is important to understand that a pelvic drop does not automatically mean that a particular muscle is simply weak. Pain, joint problems, nerve dysfunction and changes to the hip's structure can all affect how well the pelvis is controlled.
2. How does the pelvis work when we walk?
To understand a Trendelenburg gait, it helps to understand what happens during normal walking.
Walking may look simple, but it involves a carefully coordinated sequence of movements involving the feet, ankles, knees, hips, pelvis, trunk and arms. Your muscles must continually adjust to keep your body balanced while moving forwards.
The walking cycle
Each walking cycle has two main phases: the stance phase and the swing phase.
The stance phase occurs when your foot is on the ground supporting your body weight. During this phase, your leg must support you while the other leg moves forwards.
The swing phase occurs when your foot leaves the ground and your leg moves forwards ready for the next step.
During normal walking, these phases alternate smoothly between the two legs. For much of the time, your body is supported by one leg while the other moves forwards. This is when pelvic stability becomes particularly important.
Why does the pelvis need to stay level?
When you stand on one leg, gravity creates a tendency for the opposite side of your pelvis to drop. The hip muscles on your supporting side counteract this movement, helping keep your pelvis relatively level.
For example, when you stand on your right leg, the muscles around your right hip contract to prevent your left side of the pelvis from dropping excessively. When you step forwards onto your left leg, the muscles on that side take over the task.
This is a continuous process. Your hip muscles must respond to changes in body weight and maintain control throughout each step.
The pelvis does not remain completely rigid during normal walking. A small amount of rotation, tilting and movement is natural and helps make walking efficient. The aim is not to eliminate all pelvic movement, but to maintain sufficient control for comfortable and stable walking.
The role of the gluteus medius and gluteus minimus
The gluteus medius and gluteus minimus are particularly important because they help control the position of the pelvis when the body is supported on one leg.
When these muscles are weak, painful or not receiving normal nerve signals, they may not generate enough force to stabilise the pelvis. The opposite side can then drop during the stance phase of walking.
The body may compensate by leaning the trunk towards the supporting leg. This shifts the body's centre of mass closer to the hip joint and can reduce the demand on the weakened muscles.
Although this strategy can help someone keep walking, it may produce a noticeable limp or sideways lean.
3. What does a Trendelenburg gait look like?
The most noticeable feature is often a drop of the pelvis on the side of the leg that is lifted from the ground.
For example, if the muscles around your right hip are not controlling your pelvis effectively, the left side of your pelvis may drop when you stand on your right leg. During walking, this may happen repeatedly as you transfer your weight onto the right leg.
Other features can include:
A limp or uneven walking pattern.
A side-to-side movement of the pelvis.
Leaning the upper body towards the affected hip.
Difficulty standing on one leg.
Reduced confidence when walking or turning.
Difficulty climbing stairs or stepping up onto a kerb.
A feeling of weakness or instability around the hip.
Discomfort around the outer hip, buttock or lower back.
Not everyone experiences pain. Some people have a noticeable limp but little discomfort, while others find that walking causes fatigue or pain.
A person may also develop a waddling gait if both hips are affected. This is different from a pattern caused by pain alone, although the two can occur together.
4. What causes a Trendelenburg gait?
The most common underlying problem is impaired function of the hip abductor muscles, particularly the gluteus medius and gluteus minimus. However, several conditions can contribute.
Muscle weakness and reduced activity
Hip muscle weakness can develop after a period of inactivity, illness, a fall or reduced mobility. Following a hospital admission, for example, a person may lose strength throughout the legs and trunk, including the muscles that stabilise the pelvis.
Someone who has spent several weeks walking less than usual may find that standing on one leg becomes more difficult, even if they did not have a significant hip problem before.
Hip osteoarthritis
Osteoarthritis can cause pain, stiffness and reduced movement at the hip. Pain may inhibit the muscles around the joint, while reduced activity can lead to further weakness.
A person with hip osteoarthritis may therefore develop a limp or pelvic drop because of a combination of pain, muscle weakness and altered movement.
Tendon problems around the hip
The gluteus medius and gluteus minimus muscles attach to the outer part of the upper femur. Their tendons can become irritated, damaged or torn.
These problems may cause pain over the outside of the hip, tenderness when lying on that side, difficulty climbing stairs and weakness when standing on one leg. A significant tendon tear can contribute to a Trendelenburg gait, particularly if the muscles cannot generate enough force to support the pelvis.
Nerve problems
The nerves supplying the hip muscles are also important. Damage or dysfunction affecting these nerves can reduce muscle activation and strength.
For example, injury to the superior gluteal nerve can affect the gluteus medius and gluteus minimus. Certain spinal nerve problems may also affect the muscles involved in hip stability.
When nerve dysfunction is suspected, strengthening alone may not address the underlying problem, so further assessment may be needed.
Changes following hip surgery
Trendelenburg gait can occur following hip surgery, including total hip replacement and other operations involving the hip.
Depending on the surgical approach, the surrounding muscles and soft tissues may be affected. Pain, swelling, reduced activity, muscle weakness or damage to the tendons or nerves can also influence recovery.
A pelvic drop after surgery does not necessarily mean that the operation has failed. It may reflect weakness during recovery, but persistent or worsening weakness should be assessed by the treating team.
5. The relationship between Trendelenburg gait, pelvic fractures and hip fractures
Hip and pelvic fractures can have a considerable effect on walking, particularly in older adults.
Following a fracture, a person may experience pain, reduced confidence, muscle weakness and a period of reduced mobility. Even after the bone has healed, rebuilding the strength and coordination required for normal walking can take time.
Following a hip fracture
A hip fracture often affects the upper part of the femur. Depending on the fracture, treatment may involve a hip replacement, hemiarthroplasty, dynamic hip screw or intramedullary nail.
Although these operations treat the fracture or damaged joint, they do not automatically restore the strength and function of the surrounding muscles. Rehabilitation is often needed to rebuild these abilities.
A person may initially rely heavily on a walking frame, lean towards one side or struggle to maintain their balance when transferring weight between the legs.
If the muscles around the operated hip remain weak, a Trendelenburg gait may develop or persist during recovery.
Following a pelvic fracture
The pelvis forms a strong ring of bone that connects the spine to the lower limbs. It helps transfer body weight between the trunk and legs.
A pelvic fracture can affect walking by causing pain, restricting movement and reducing the ability to load the affected side. Some fractures also involve areas close to the muscle attachments around the hip.
Following a period of reduced weight-bearing or limited mobility, the muscles around the hips and pelvis may become weaker. This can affect the person's ability to control their pelvis when standing or walking. However, not every pelvic fracture causes a Trendelenburg gait. The relationship depends on the location and severity of the fracture, whether the hip muscles or their attachments are affected, the person's pain and the recovery process.
Anyone recovering from a pelvic or hip fracture must follow their surgeon's weight-bearing instructions before progressing exercises or walking practice.
Why recovery can take time
After a significant fracture, rehabilitation involves more than allowing the bone to heal. The person
may need to rebuild muscle strength, balance, coordination, walking tolerance and confidence.
These abilities do not necessarily recover at the same rate. Someone may be allowed to put weight through their leg but still lack the strength to walk without a frame.
This is one reason why ongoing physiotherapy can be valuable following hospital discharge.
6. Can a Trendelenburg gait contribute to back pain or sacroiliac joint pain?
Some people with a Trendelenburg gait also experience pain around the lower back, buttock or sacroiliac region. The sacroiliac joints are located where the sacrum, at the base of the spine, meets the pelvis on either side.
It is important to be cautious here: a Trendelenburg gait does not automatically cause back pain or sacroiliac joint pain. However, changes in walking mechanics can influence how loads are distributed through the hips, pelvis and trunk, and may contribute to symptoms in some people.
Changes in pelvic movement
When the hip muscles cannot stabilise the pelvis effectively, the pelvis may drop more than usual on one side. The trunk may lean to compensate, and the body may use different movement strategies to maintain balance.
These changes alter the way forces are transferred through the lower back and pelvis during walking. In some people, repeated compensatory movements may contribute to discomfort or aggravate an existing back problem.
Increased demand on other muscles
If the hip abductors are not working effectively, other muscles may work harder to help maintain stability. These can include muscles around the lower back, trunk and opposite hip.
Over time, this increased demand may contribute to fatigue or discomfort, particularly if someone walks long distances or has limited strength and endurance.
What about the sacroiliac joints?
The sacroiliac joints transfer forces between the spine and pelvis. Walking naturally involves small movements and changing loads through this region.
A Trendelenburg gait can change how these loads are distributed, but it is not possible to conclude from a pelvic drop alone that the sacroiliac joint is the source of pain.
Lower back and buttock pain can have many causes, including spinal conditions, hip problems, muscle and tendon disorders and other pelvic conditions. A proper assessment is needed to identify the most likely source.
The important message: if you have both a limp and back or pelvic pain, it is worth assessing the whole movement pattern rather than treating the painful area in isolation.
7. How is a Trendelenburg gait assessed?
A physiotherapist will usually begin by asking about your symptoms, medical history, previous falls, any hip or pelvic surgery and how your walking has changed. They may then observe you walking, standing up from a chair, turning and transferring your weight between your legs. They will look at pelvic movement, trunk position, step length, balance and the use of any walking aid.
The Trendelenburg test
The Trendelenburg test is a clinical assessment used to examine how well the hip muscles control the pelvis during single-leg standing.
During the test, the person stands upright and lifts one foot off the floor, ideally while the examiner observes the pelvis from behind. The test is then repeated on the other side if appropriate.
If the pelvis remains relatively level, this suggests that the supporting hip muscles are controlling the movement effectively. If the pelvis drops towards the side of the lifted leg, this may indicate impaired hip abductor function.
The person may also lean their trunk towards the supporting hip to compensate for weakness.
Important: this test is not suitable for everyone. If you have recently undergone hip surgery, sustained a fracture, have significant pain or are at risk of falling, do not attempt it independently. It should only be performed when safe and appropriate, with support if needed.
The test also has limitations. A positive result does not identify the exact cause of the problem, and a normal result does not rule out every hip muscle or tendon condition.
Other assessments
The physiotherapist may assess hip strength, range of movement, pain, balance, walking speed and the ability to perform everyday tasks. They may also look at the lower back, neurological function and the suitability of the walking aid.
If there are concerns about a fracture, tendon injury, nerve problem or other underlying condition, the person may need medical review and investigations such as X-rays or other imaging.
The aim is to understand why the pelvic drop is occurring, rather than simply identifying the walking pattern.
8. Exercises to improve hip strength and reduce a Trendelenburg gait
Exercise can help improve hip strength, pelvic control and walking function when weakness is contributing to the problem. However, the right exercises depend on the cause of the gait abnormality and the person's current abilities.
The following are examples of exercises that may be used in rehabilitation. They are not a personalised programme, and they may not be suitable immediately after a fracture or hip operation. If you are recovering from surgery, follow your rehabilitation team's advice before starting or progressing them.
Exercise 1: Seated hip abduction
Sit upright on a firm chair with your feet flat on the floor and your knees bent comfortably. Keeping your feet in place, gently move your knees apart, hold briefly and then return to the starting position with control. A resistance band around the thighs may be introduced when appropriate.
This exercise helps activate the muscles around the outer hips without requiring you to balance on one leg. Start with a small number of comfortable repetitions and build gradually.
Exercise 2: Standing hip abduction
Stand upright beside a sturdy worktop and hold it securely for support. Keeping your trunk upright and your toes pointing forwards, move one leg out to the side without leaning your body. Return slowly to the starting position and repeat as advised.
This exercise targets the hip muscles that help stabilise the pelvis. Avoid swinging the leg or leaning sideways to create the movement. Start with a small range and only progress when you can perform it safely.
Exercise 3: Side-lying hip abduction
Lie on your side with your hips stacked and your lower leg comfortably bent if needed. Keep the upper leg straight and lift it slowly towards the ceiling, keeping the toes pointing forwards rather than turning the leg upwards. Lower it with control.
This exercise targets the hip abductor muscles, including the gluteus medius. It can be challenging, so begin with a small range and only use it if lying on your side is comfortable and permitted following any surgery.
Exercise 4: Sit-to-stand
Sit on a stable chair with your feet placed comfortably beneath your knees. Lean forwards from your hips and push through your feet to stand up, using your hands for assistance if needed. Stand tall, then reach back for the chair and lower yourself slowly.
Sit-to-stand practice helps develop the strength and coordination needed for everyday transfers. It also encourages both legs to contribute to the movement. Use a higher chair or your hands for support if necessary, and avoid practising without assistance if you are at risk of falling.
Exercise 5: Supported weight shifting
Stand at a sturdy worktop with both hands available for support. Gently shift your weight from one leg to the other while keeping your trunk controlled. Begin with small movements and return to the middle between each shift.
This exercise helps you practise transferring weight between your legs, an essential part of walking. It can be useful when progressing towards more demanding balance activities, provided it is safe for your current stage of recovery.
Exercise 6: Low step-ups
Once you have sufficient strength and your clinician has confirmed that step practice is appropriate, use a low step with a secure handrail or other suitable support. Step up carefully, bringing the other foot onto the step as instructed, and step down slowly.
Step-ups help develop the strength and control needed for stairs and kerbs. They are more demanding than the other exercises, so they should be introduced gradually and only when you can complete them safely.
Exercise 7: Clam exercise
Lie on your side with your hips and knees bent, keeping your feet together and your hips, knees and ankles stacked. Rest your head comfortably on a pillow if needed. Keeping your feet together, slowly lift your top knee upwards without rolling your pelvis backwards or allowing your hips to move out of alignment. Hold briefly, then lower your knee with control. Repeat as advised before changing sides.
This exercise works the muscles around the outer hip, including the gluteus medius and the hip external rotators, which help control the position of the hip and pelvis. Focus on a small, controlled movement rather than lifting the knee as high as possible. Keep your pelvis still throughout the exercise.
Exercise 8: Gluteal bridge
Lie on your back with your knees bent and your feet flat on the bed or exercise mat, approximately hip-width apart. Keep your arms relaxed by your sides. Gently tighten your buttock muscles and lift your pelvis until your shoulders, hips and knees form a comfortable, roughly straight line. Hold briefly, then lower your pelvis slowly back to the starting position.
Bridging strengthens the gluteal muscles, particularly the gluteus maximus, and also recruits the hamstrings and trunk muscles. These muscles contribute to hip extension and pelvic control during everyday activities such as standing up, climbing stairs and walking. Keep the movement controlled and avoid arching your lower back or lifting higher than is comfortable.
How often should you exercise?
There is no single programme that suits everyone. The starting level, number of repetitions and frequency should reflect your strength, pain, fatigue and stage of recovery.
It is generally better to perform an appropriate exercise with good control than to complete many repetitions using compensatory movements. Progress gradually as your strength and confidence improve.
Mild muscle effort can be expected, but stop if an exercise causes sharp or increasing pain, new instability or a significant deterioration in your walking. If you have recently had surgery or sustained a fracture, seek advice from your rehabilitation team before continuing.
9. Why walking practice matters as much as strengthening
Strengthening the hip muscles is important, but improved strength does not always translate automatically into a better walking pattern.
Walking requires the muscles to work at the right time, coordinate with the rest of the body and respond to changing loads. This is why rehabilitation often combines strengthening exercises with functional practice.
Depending on the person's needs, a physiotherapist may work on controlled weight transfer, standing balance, stepping, turning and walking with an appropriate aid. They may also help the person recognise when they are leaning their trunk or allowing the pelvis to drop.
A walking frame, crutches or stick may be useful while strength and control improve. The most appropriate aid depends on balance, pain, the person's ability to use it safely and any restrictions following surgery.
The goal is not necessarily to walk without an aid as quickly as possible. It is to walk safely, comfortably and as independently as circumstances allow.
How can a walking aid help reduce a Trendelenburg gait?
A walking aid, such as a four-wheeled walker (rollator), can make a noticeable difference to someone with a Trendelenburg gait. You may notice that a person walks with a more level pelvis and less of a limp when using a walker compared with walking unaided. This is because the walker provides additional support and allows some body weight to be transferred through the arms, reducing the demand on the muscles around the hip that help stabilise the pelvis. It also provides a wider base of support, helping the person feel more balanced and confident as they move between their legs. With less effort required to maintain balance, they may be able to walk with a more upright posture and less sideways leaning of the trunk. A walking aid does not necessarily correct the underlying muscle weakness, but it can compensate for reduced strength or control and make walking safer and more efficient while rehabilitation progresses. The most appropriate walking aid depends on the individual's balance, strength, coordination and ability to use it safely, so a physiotherapist can help assess which aid is most suitable.
10. When should you seek professional advice?
If you notice a new limp, increasing pelvic drop, difficulty standing on one leg or a deterioration in your walking, it is worth arranging an assessment. This is particularly important if the problem has developed after hip surgery, a pelvic fracture or a fall.
Seek urgent medical assessment if you develop severe hip pain after a fall, cannot stand or put weight through your leg, or have a sudden and significant deterioration in mobility. These can be signs of a serious injury.
Following surgery, contact your surgical or medical team promptly if you develop worsening pain, new weakness, wound redness or discharge, fever, or other concerning symptoms. Sudden chest pain, shortness of breath or collapse requires emergency help.
A Trendelenburg gait is a description of a movement pattern, not a diagnosis. Identifying the cause is important because some problems respond well to strengthening, while others require further investigation or specific treatment.
11. How Physio at Home can help
At Physio at Home, we understand how frustrating it can be when walking becomes difficult or less confident, particularly after a fall, fracture, operation or period of illness.
Our private home-visit physiotherapy service supports people across Mid Cornwall, covering the Truro to Falmouth area. We assess mobility in the person's own environment and develop rehabilitation plans around their abilities, goals and everyday activities.
For someone with a Trendelenburg gait, physiotherapy may include assessing walking and balance, identifying weakness or movement difficulties, selecting appropriate strengthening exercises, practising safe transfers and stepping, and helping the person use their walking aid effectively.
Where the problem has developed after a hip replacement or fracture, rehabilitation must take account of the surgical procedure, healing stage and any weight-bearing or movement restrictions. We work within the guidance provided by the treating team and recommend further medical review when needed.
Our aim is to help people improve their strength, stability, confidence and independence, with rehabilitation that is practical and relevant to daily life at home.
If you or a family member is struggling with walking following hip surgery, a pelvic fracture or a period of reduced mobility, Physio at Home may be able to help.
Find out more about our home-visit physiotherapy service: https://www.physioathome.uk/
Physio at Home — private physiotherapy in Mid Cornwall, from Truro to Falmouth.
Important information
This article is for general educational purposes and is not a substitute for individual assessment or medical advice. The cause of a Trendelenburg gait and the most appropriate treatment vary between individuals. Exercises should be adapted to your needs, particularly following a hip or pelvic fracture or surgery. Follow the instructions provided by your treating healthcare team.
References and further reading
Cleveland Clinic — Trendelenburg Gait. An overview of symptoms, causes, assessment and treatment.https://my.clevelandclinic.org/health/symptoms/trendelenburg-gait
StatPearls / National Library of Medicine — Trendelenburg Gait. A clinical overview of the hip abductor mechanism, causes, assessment and rehabilitation.https://www.ncbi.nlm.nih.gov/books/NBK541094/
StatPearls / National Library of Medicine — Trendelenburg Sign. Explains the clinical test and the role of the gluteus medius and minimus in pelvic stability.https://www.ncbi.nlm.nih.gov/books/NBK555987/
British Journal of Sports Medicine — Physical examination tests for hip dysfunction and injury. Reviews clinical assessment methods, including the Trendelenburg sign, and discusses their diagnostic limitations.https://bjsm.bmj.com/content/49/6/357
NHS — Broken hip. Information about hip fractures, treatment, recovery and rehabilitation.https://www.nhs.uk/conditions/broken-hip/
Physio at Home. Home-visit physiotherapy and rehabilitation in Mid Cornwall.https://www.physioathome.uk/
Useful links for patients and families
Cleveland Clinic: Learn more about Trendelenburg gait, its causes and treatment.https://my.clevelandclinic.org/health/symptoms/trendelenburg-gait
NHS: Information about broken hips and recovery following a fracture.https://www.nhs.uk/conditions/broken-hip/
Physio at Home: Find out about home-visit physiotherapy in Mid Cornwall.https://www.physioathome.uk/
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