00:04 - 00:07This is Brent of the Brookbush Institute in this video we're going over
00:07 - 00:10two very similar tests, we're going to go over the
00:10 - 00:14Trendelenburg sign for gluteus medius weakness and we're also going to go over
00:14 - 00:20the single leg balance test for lateral hip pain, and I guess we could say
00:20 - 00:23abductor pathology. I'm going to have my friend Melissa come out she's going to help
00:23 - 00:26me demonstrate these two tests, and the first thing you'll notice is that she
00:26 - 00:30has her shirt tucked in and tank tops into yoga pants is probably not a great
00:30 - 00:35fashion statement, but we do need to be able to see if somebody's iliac crest
00:35 - 00:39are level. So having somebody with their shirt out over their pants is going to make
00:39 - 00:44it very hard for you to determine whether their pelvis stays level as we
00:44 - 00:49have them stand on one leg. Now once we get their pants in line with their
00:49 - 00:53pelvis and we have a good visual marker with their belt line, all we have to do
00:53 - 00:57is get a posterior view, so I'm going to have Melissa face that way. It is easier
00:57 - 01:01to see pelvis level from a posterior view. I'm then going to get down on one knee
01:01 - 01:05and kneel so that my eyes are level with her pelvis, because if I go from
01:05 - 01:09here and I have her lift one leg and let's say this side dropped a little bit
01:09 - 01:13I probably wouldn't notice right, we keep create a little bit of an optical
01:13 - 01:19illusion here when we're not perfectly level and have a good line-of-sight. So
01:19 - 01:23I'm going to have her lift this leg and a positive Trendelenburg test is
01:23 - 01:27actually really easy to see, what would happen is either as she lifted her
01:27 - 01:31leg or shortly after she lifted her leg, her pelvis would drop and I would get
01:31 - 01:36some drooping to this side, that means this side the leg she's standing on her
01:36 - 01:42gluteus medius isn't strong enough to keep her pelvis level. Now the single leg
01:42 - 01:47balance test is essentially the same test but we're looking for slightly
01:47 - 01:52different signs. I'm going to have her go ahead and lift one leg, we're going to hold
01:52 - 01:57this for 30 seconds and now what I'm really looking for is her concordant
01:57 - 02:02sign that is what was the symptoms she came in to see me for. I would be using
02:02 - 02:08this particular test for something like maybe I think gluteus medius tendonitis,
02:08 - 02:13piriformis tendonitis, greater trochanteric bursitis could be an issue.
02:13 - 02:17If as she's holding this I go hey Melissa how you feeling?
02:17 - 02:21A little bit of pain, and then I ask that follow-up question is this is the pain
02:21 - 02:24you were talking about when you came in? Yeah
02:24 - 02:31then this is a positive single leg balance test. Now keep in mind if Melissa
02:31 - 02:36was let's say an older, you can put your leg down, if Melissa was an older
02:36 - 02:40individual maybe somebody who's a little deconditioned, just standing on one leg
02:40 - 02:44could cause some burning right like that exercise burn like you're working your
02:44 - 02:48gluteus medius. So it is very important that you ask the right follow-up
02:48 - 02:52questions right, were these the symptoms you were talking about when you came in
02:52 - 02:55to see me, we want that concordant sign. The
02:55 - 02:59other thing important to mention is although it's called the single-leg
02:59 - 03:02balance test, Melissa could hold on to something.
03:02 - 03:07Melissa could could put her hand on the table that's right next to you here
03:07 - 03:12maybe if you're in an office, you could give them a foam roll to hold on to if
03:12 - 03:16they needed like the back of a chair, because we're not actually testing
03:16 - 03:20balance we're testing either gluteus medius strength in the case of the
03:20 - 03:29Trendelenburg sign, or whether the work of the hip abductors starts provoking
03:29 - 03:37pain by pulling on a very sensitive gluteus medius tendon. So
03:37 - 03:41it's not actually balance that we're testing in this test, although you could
03:41 - 03:46add I guess a third test to this of do they have a positive Trendelenburg, does
03:46 - 03:51this bring on pain and can they hold it without assistance, that might be a good
03:51 - 03:56functional goal. I'm going to go ahead and have you turn and face the wall. Now just
03:56 - 04:00so you guys can see what I was looking for, I would get level with her pelvis so
04:00 - 04:07I have a good line of sight here. I then would ask her to lift one leg, so
04:07 - 04:11if she all of a sudden were to do this that would be a positive Trendelenburg,
04:11 - 04:15and what you are probably going to see is go ahead and put this leg down, is her
04:15 - 04:20pelvis is going to drop as she lifts her leg. I hope you see how this
04:20 - 04:24is not level and I hope this makes a little bit of sense from a functional
04:24 - 04:29anatomy standpoint. So if she lifts her leg and drops that's pelvis on femur
04:29 - 04:32adduction, which definitely means her gluteus
04:32 - 04:36medius isn't strong enough. Now as far as the single leg balance test of
04:36 - 04:41course I just have her pick up this leg I can hit my stopwatch or look at my
04:41 - 04:44clock on the back wall, have her hold it for 30 seconds be
04:44 - 04:49talking to her, how does this feel? She says it feels fine okay good we're just
04:49 - 04:53going to hold this a little longer, if she needed to hold on to something that's
04:53 - 04:59okay because we're just testing abductor strength. Does she have
04:59 - 05:04piriformis tendonitis, does she have greater trochanteric bursitis, this would
05:04 - 05:09be one positive test that would start getting me to think in that direction.
05:09 - 05:13Thank you Melissa. So there you have it two very similar
05:13 - 05:18tests that tell us slightly different things, but essentially we're looking for
05:18 - 05:24is the gluteus medius weak, is the gluteus medius or abductors contributing
05:24 - 05:31to our hip pathology symptoms. Start practicing these tests, grab a partner,
05:31 - 05:35grab a colleague just go through the motions a couple times before you start
05:35 - 05:38trying it out on patients. If you have any questions leave those in the
05:38 - 05:41comments box below.