Massage therapy · Kitchener–WaterlooTrendelenburg Sign

The Trendelenburg sign is a finding on a simple test, not a condition in itself. It shows weakness in the hip abductors – the muscles on the outside of the hip, such as gluteus medius, that move the leg out to the side and help keep the pelvis level (McCarney et al., 2020; AAOS, n.d.). Weak abductors make it difficult for the hip to support the body's weight on the affected side.

When you stand on one leg, the abductor muscles on the standing side normally keep the pelvis level, or slightly raised on the side of the lifted leg. If these muscles are weak, the pelvis drops on the unsupported side instead – a positive Trendelenburg sign (McCarney et al., 2020). To lessen this, many people lean over the affected hip, moving their centre of gravity over the hip to reduce the drop.

Causes of a Trendelenburg Sign

Trendelenburg Sign Anatomy

The hip is a ball-and-socket joint connecting the thighbone (femur) to the socket in the pelvis. It allows the leg to rotate, bend, straighten, and move inward (adduct) and outward (abduct). Near the top of the femur are two bony bumps: the greater trochanter, where buttock muscles that move the leg out to the side attach, and the lesser trochanter, where the iliopsoas muscle attaches to lift the leg forward (hip flexion).

How to Treat a Trendelenburg Sign

Tips

• Physical therapy aims to strengthen the hip muscles and improve movement in the joint.
• A waddling walk can be a sign of this problem, so get it assessed and follow a proper treatment programme.
• Avoid sitting still for long periods. Staying active and doing your exercises helps strengthen the muscles.

A Trendelenburg sign means the muscles on the outside of your hip aren't holding your pelvis level when you stand on one leg. My aim is to build those muscles back up, ease the areas that have been working overtime, and help you walk more evenly and comfortably.

I start by assessing how you stand on one leg and walk, the strength and flexibility of your hip, thigh and trunk muscles, and how your back, hips and knees move. If something points to another cause, such as uneven leg length or nerve weakness, I'll point you to your family doctor or nurse practitioner. After recent hip surgery, I need your surgeon's okay before we start, and I follow your precautions.

Hands-On Treatment

• Easing the areas that work overtime: the low back, outer thigh, front of the hip and the other leg
• Gentle stretches for tight hip flexors, hamstrings and outer thigh
• Scar work around a hip replacement scar once it has fully healed
• Work around the buttock and hip is only with your informed consent and a written consent form

Strength and Balance

• Starting with buttock squeezes, clams, bridges and side-lying leg lifts, done slowly so the right muscles do the work
• Building to standing work: single-leg balance, step-ups, side step-ups and mini-squats, keeping your pelvis level
• Gym-based progressions when you're ready, such as split squats, hip thrusts, Romanian deadlifts and carrying a weight in one hand
• A short home programme to do between visits

Walking

• Practising walking with a level pelvis and even steps
• Setting up a cane, used in the hand opposite the weak hip, if you need one for now
• Helping you work out whether a shoe lift or insole might help and how to get one, and pointing you to a chiropodist or podiatrist for a custom one

1. McCarney, L. et al. (2020) 'Determining Trendelenburg test validity and reliability using 3-dimensional motion analysis and muscle dynamometry', Chiropractic & Manual Therapies, 28(1), 53. doi: 10.1186/s12998-020-00344-3
2. Ugland, T.O. et al. (2019) 'High risk of positive Trendelenburg test after using the direct lateral approach to the hip compared with the anterolateral approach: a single-centre, randomized trial in patients with femoral neck fracture', The Bone & Joint Journal, 101-B(7), pp. 793–799. doi: 10.1302/0301-620X.101B7.BJJ-2019-0035.R1
3. Bianco Prevot, L. et al. (2025) 'Leg length discrepancy after total hip arthroplasty: a review of clinical assessments, imaging diagnostics, and medico-legal implications', Healthcare, 13(12), 1358. doi: 10.3390/healthcare13121358
4. American Academy of Orthopaedic Surgeons (n.d.) Hip conditioning program. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/recovery/hip-conditioning-program/ (Accessed: 7 October 2026).