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Trendelenberg and Single Leg Balance Tests

The Trendelenberg Test is an assessment used to assess lower extremity muscle strength by having the patient stand on one leg in an unsupported way. The single leg balance test is an assessment used to assess postural balance and lateral stability, by having the patient stand on one leg behind a line while maintaining a successful balance. Both tests are used to evaluate stability and strength in the hips and lower extremity, with potential pathology or injury of the supporting structures being identified through instability and poor balance.

Transcript

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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