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