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Trendelenberg and Single Leg Balance Tests

Improve your balance and posture with the Trendelenberg and Single Leg Balance Tests. Learn practical exercises you can use in your regular fitness routine to improve your stability, coordination and body control.

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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.

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