Why it is crucial to correct your hip drop – for runners, athletes and even your not-so-physically active individual

Trendenlenburg sign/gait or also known commonly as hip drop is one of the body’s many imbalances that may occur due to one sided weakness of the hip stabilising muscles. The hip stabilising muscle mainly involved is the gluteus medius muscle, and its secondary support muscles the gluteus minimus and tensor fascia latae (TFL) muscles that also carry out hip stabilisation functions.

Hip drop is particularly important to be addressed and fixed in people who are highly active and participate in high impact and demanding sports, such as running, marathons, athletes, soccer players, etc. due to the nature of the high demands on the joints and muscles of their lower body. If hip drop becomes a sustained and ongoing problem, it could potentially risk the athlete’s joint integrity and predispose them to muscular strain or even tear. For most of us who aren’t highly trained athletes, correcting a hip drop will mean that we will benefit from a better gait, less foot, knee, hip and lower back pain because it will reduce the compensation that occurs in our body. We will benefit in a way such that our balance will improve, our joint mobility will improve, and our control of our lower limbs will be enhanced. These reasons become more vital as we age, and for those of us who don’t spend a lot of time exercising and being active.

 

 

 

 

Causes of weak gluteus medius/hip drop:
– Direct trauma or acute trauma to the nerves that supply the  muscle, direct damage to the muscle like a contusion or laceration, or a broken hip to name a few.

– Chronic causes: these would be the more common causes and risks of hip drop/Trendelenburg gait/weak gluteus medius. Commonly found in athletes who participate in endurance sports, distance running or triathlons, etc. Contributing factors include poor strength and flexibility of the joints and muscles, and failure to warm up properly because it sets a poor foundation for the muscles and tendons in the joints to perform optimally. In other words, poor strength and flexibility, and warm up of the joints, muscles and tendons will increase the risk of injury later on.

– Malalignment issues: joint fixations will limit full range of motion and hence the muscles that control those joints will not be working properly causing the muscle to have faulty patterns over time due to altered neuromuscular action. These malalignment issues often occur through the kinetic chain in the pelvis, the sacroiliac joints, the hip joints, lumbar spine, the knees and feet.

– Tight muscles in specific regions throughout the body will cause compensation patterns to occur through the kinetic chain. For instance, tight quadratus lumborum muscles on one side of the body will cause a pull on the ilia bone and prevent full range of movement through the joint. This inevitably will put more stress on the opposite side of the body to pull the slack and do more work, and for the same side of the body, the muscles that are suppose to be working effectively (in this case the gluteus medius) will tend to lose its muscular firing ability and function. Thus causing the gluteus medius to become the weaker muscle compared to its twin on the other side of the other hip, and this inevitably leads us to our hip drop problem if the underlying problem is not fixed soon enough.

How to diagnose hip drop:

On of the classical sign that will show up positive for hip drop is the Trendelenburg sign. To perform the Trendelenburg test, the practitioner will get the patient to stand on one leg for about 30 seconds or more, instructing the patient to try not to lean to one side. A positive Trendelenburg sign is indicated when the patient’s non-weight bearing pelvis drops down. This will show the examining practitioner that the patient does have gluteus medius muscle weakness that causes hip drop. 

However, a positive Trendelenburg sign could also indicate other few possibilities such as:
– superior gluteal nerve palsy that may have happened due to trauma or disease
– lumbar disc herniation
– Legg-Calve-Perthes disease

So it is highly advisable that you get assessed by a qualified Chiropractor, Doctor or other physical therapist to rule out any of these other more serious and complicated issues.

What you can do about hip drop

After you have been properly diagnosed, you could start your rehabilitative exercises immediately to correct the hip drop. There are many exercises and stretches that you could do at the gym, at the park or even in the comfort of your own home. The following are the best recommended exercises that you could easily do that is fast and effective, sorted from easiest to more challenging:

*Remember that the rehabilitative system works like this: 15 repetitions, 3 sets 

Lateral leg raises: Lateral leg raises are one of the most easiest exercises to warm up and get the hip joint moving and the muscles that we need to exercise working. It’s highly recommended to start your rehabilitative program with these lateral leg raises, even if your at an intermediate level. To do this exercise, all you need to do is lay down on a flat surface and focus your mental energy on the muscles that need to be activated (that is your gluteus medius) and the motion that you are about to do with fluidity and control

1. lay on your side with your hip joints directly above each other – and keep the hip joints level
2. engage and activate your core muscle. Raise your top leg up into the air, maintaining the same plane as your bottom leg (don’t let it sway to the front or the back)
3. as you bring your leg up into the air, you could intensify this exercise by adding in some hip abduction midway through and ending in about 80% hip abduction at your finished position. This additional hip abduction will get all of the fibres of your gluteus medius muscle firing and working for better neuromuscular activation.
4. bring that leg down into neutral position to where you have started. Remember that it is important to control the motion of lowering your leg down and not just letting that leg drop down

Lateral step ups: these could be done on just a step/stairway or even a little stable stool that you have at home. The idea of this exercise is activation of your gluteus medius whilst you go through the range of motion of lifting your body weight onto that weight bearing hip/leg. Remember to do these repetitions in a controlled and fluid manner.

1. with your knee resting on the platform, concentrate on activating your gluteus medius muscle, hoist your body weight on this hip so that your standing up right.
2. keeping your body weight propped up on the supported leg, let your unsupported hip dip down whilst still maintaining the contraction of the gluteus medius on the weight bearing hip.
3. With your gluteus medius still activated on the weight bearing hip, tip your dipped hip back to neutral position
4. Step down. Repeat 15 times, 3 sets.

Lateral band walks: you will need an exercise band for this. You could easily purchase one from your sports retailer, eBay, or gymnastics/pilates studios. These lateral band walks will challenge your mobility and coordination aswell as your gluteus medius strength.

1. with your hips slightly bent, but the top of your collarbone not passing your knees. Engage in the first position as the image suggests
2. Consciously activate your gluteus medius muscle and start side stepping, keeping your movements controlled and fluid
3. Follow the hind leg to the leg you used to step out first.
4. Repeat 15 times, 3 sets.

Single leg squats: once you have been able to regain the proprioception and the muscular control of your gluteus medius muscles and its supporting muscles, you can try these killer single leg squats. Hang onto some support for balance if you are a little bit off balance at first. Not only does this single exercise work on strengthening up the gluteus medius muscle, it also improves your proprioceptive neuromuscular pathways to – in other words, improve your balance.

1. Start off in standing position – activating your gluteus medius muscle
2. Squat down on the one leg slowly – maintaining contraction and activation of the gluteus muscle. Remember knees do not go past toes.
3. stay down as low as you can (try to go lower everytime into the squat position) for a 3 second hold.
4. Stand up from this position, still engaging the gluteus medius muscle
5. Repeat 15 repetitions, 3 sets

Remember, this article is to serve you an introductory insight into what may be causing hip drop. If you are concerned and want to gain further insight, it is highly advisable that you seek a registered Chiropractor or physical physician to evaluate, assess and conduct you with your concerns.

Levator Scapular Syndrome – 1 reason you may be experiencing headaches, neck pain or shoulder pain

The levator scapular muscle is one little nasty muscle that may cause us problems from time to time, especially for those who spend a lot of time at a desk, looking down at their tablets or phones, or laying on pillows that are too high for their bodies – just to name a few common activities.

When the levator scapular muscle becomes shortened and tight, it can develop little contractures in between the muscle fibres, called trigger points. The result of these trigger points forming will create pain in the location of the little contractures or may refer pain to certain areas of the body.

The trigger points of the levator scapular muscle are shown, and its associated referral pattern:

So if you have ever wondered why parts of your body may feel heavy, achy or it has a strange sensation but you just don’t know where the source of the problem is coming from, you may want to know some common trigger point locations and its pain referral pattern.

As the above image suggests, the referral pattern of the levator scapular trigger points is to the back of the shoulder and along the edge of the scapular bone near our spine, the medial spine of the scapula. Another association with levator scapular syndrome is mechanical dysfunction of the upper cervical spine at either C1, C2, C3 or C4 where the muscle inserts. What is meant by mechanical dysfunction is the inability of the joint to move freely in its full range of motion without any hindrances from muscular pain, tightness or joint restrictions.

Hence, we could either view the mechanical dysfunction in two ways: 

1. the joints of C1, C2, C3 or C4 is not moving properly causing the levator scapular muscle to spasm, tighten or shorten 

2. The spasming of levator scapular muscle causes the joints of C1, C2, C3 or C4 to be dysfunctional 

How to treat levator scapular syndrome:

– trigger point therapy: you can use a lacrosse ball/massage ball/tennis ball (a ball that is rather firm so you can apply pressure against it) and place the ball onto the location of the trigger point and roll the ball around the area; or apply static pressure to the point until the tenderness/referral pain completely dims down 

 – muscle stretches: to stretch the levator scapular muscle, follow the image below. The proper way to stretch is to hold the muscle in its stretch position until you don’t feel the stretching sensation anymore. Holding the muscle in a stretch position is a static stretch. You could also do an active stretch where you take the muscle to its stretching position and then go through the range of motion of the muscle, whilst maintaining the stretch tension, until you feel the stretching sensation diminish.

 

– cervical adjustments by a Chiropractor: having your chiropractor assess your posture, your daily activities and your compensation patterns will enable a clear diagnosis of the causes and effects of what is happening with your body. Your chiropractor will be able to determine the level of mechanical joint dysfunction in your cervical spine and then adjust the dysfunctional segment to restore proper range of motion, thus eliminating one cause of levator scapular syndrome. 

 – eliminating contributing factors/postures: shoulder shrugging regularly recruits the levator scapular muscle. So, it is very important to have your desk height at a level where your shoulders are dropped down and backwards in a relaxed state to prevent shoulder shrugging. Eliminating stress is also a very important factor to eliminate when treating levator scapular syndrome because when we stress, we automatically assume a position where our shoulders are elevated and held there to hold in our tension. 

 – strengthening exercises of the antagonist muscles: antagonist muscles are muscles that act to oppose the function of another muscle. The antagonist muscle of the levator scapular muscle are the serratus anterior and middle trapezius muscles.

Strengthening the antagonist muscles will be able to counteract the force of the problem muscle, in this case the levator scapular, by balancing out the power of the muscle and its associated pull on its bony attachments  

strengthen the middle trapezius:

Rehabilitation exercises to Rehabilitation exercises to strengthen the serratus anterior:

 

If you are still unsure, please get a consultation from your Chiropractor to get properly assessed and treated.