She demonstrated the greatest gait deviations at the knee of any of the subjects. Apley G. Apleys system of orthopaedics and fractures. IEEE Transactions on Rehabilitation Engineering. Daniels and Worthinghams Muscle Testing: Techniques of Manual Examination. Here's why: If you have weak hip flexors, your body isn't comfortable lifting in/out of hip flexion. [17][18], Trendelenburg gait is also seen after hip replacement surgery and femoral fixation with intramedullary nail. The results from this case series have clinical and research implications. Level of evidence: 5, Petrofsky J. An instrumented gait analysis was performed of 3 females diagnosed with idiopathic inflammatory myopathies and compared to a healthy unimpaired subject. This type of gait is usually observed in children with clubfoot deformity (equinovarus). These strategies were identified through an induced acceleration analysis, but not with traditional gait analysis techniques. 2004a) and extensor (Slavin et al. Bring both your knees to your chest. Scientists concluded that muscle strength does play a moderate role in improving gait. The affected upper limb is flexed, adducted, internally rotated and placed against or across the trunk as a way of improving balance. In her case, the right leg was analyzed because it was weak only proximally and only due to the myositis. Microprocessor-based gait analysis system to retrain Trendelenburg gait. Definition: The period of gait from heel strike through to toe-off. London:Mac Keith Press, 1991. Loudon JK, Goist HL, Loudon KL. This article will discuss the anatomy, function and commonly used terminology of the gait cycle. There are many different possible causes of weak hip flexors. During the stance phase of gait, the primary role of the hip musculature is to provide stabilization of the superimposed trunk (Perry 1992; Winter 1991). Kepple TM, Siegel KL, Stanhope SJ. For example, in the case of knee stiffness, the person may not be able to flex the knee enough to clear the toes from the ground. The hip joint flexes during the swing phase and extends during the stance phase of gait. There was much more variability across subjects in the strategy used to generate forward acceleration of the body center of mass (Figure 2) than that used to generate vertical support. 1515 NW 18th Ave, 3rd Floor Muscle contraction and joint mobility are considered to be key elements in the functioning of gait. Gait analyses were performed on all subjects walking barefoot independently without assistive devices at a self-selected speed. Verywell Fit uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. European Journal of Applied Physiology. Saleh M, Milne A. Weight-bearing parallel-beam scanography for the measurement of leg length and joint alignment. Bethesda, MD 20894, Web Policies Bend knees and bend at hips to swing the kettlebell between your legs (like passing a football), and then stand tall, swinging the kettlebell up in front of the chest as you squeeze your backside and press hip forward. [17] This resolves as wound healing improves[14]. But when these muscles are weak or tight, you may experience low back pain or tightness through the front of your hip. 2002. p. 118. Reviewer: These complex and interesting relationships that appear to govern the ways in which an individual with impairment can compensate for hip flexor weakness were not identified with the traditional gait analysis and have not been described previously (Perry 1992). Circumduction gait muscle weakness Now we know that circumduction gait results due to insufficient knee and hip movement. Joint angle is in the top row and flexion angles are positive. [30] [31]. Gait Analysis: Normal and Pathological Function. Despite contributions to walking and balance, there is no consensus regarding hip strength deficits in lower limb prosthesis (LLP) users. Slavin MD, Jette DU, Andres PL, Munsat TL. Inclusion in an NLM database does not imply endorsement of, or agreement with, How to strengthen weak hip flexors Past studies that have correlated muscle weakness with walking speed have found that muscle strength only explains some of the variability in ambulatory status (Siegel et al. (6th ed.). Balance on the other foot and hold for 30 seconds. Hip flexor weakness made it difficult to flex the hip joint. While there was consistency across subjects concerning the source of hip extension acceleration, each subject used a different strategy to generate hip flexion acceleration to oppose the hip extension effect of the ankle plantar flexors (Figure 2). Due to the distribution of muscle weakness caused by IIM, this diagnosis provides an opportunity to study how hip muscle weakness and its compensations in the sagittal plane can impact gait. The use of an Electromyogram (EMG) biofeedback reduces the trendelenburg gait by an average of 29 degrees. Bring the knees up to the chest one by one, moving the slider along the floor. These features are more commonly known as limping. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. Orthopedic physical assessment. [6][13] Hip abductor weakness may be caused due to neuronal injury to the superior gluteal nerve either due to nerve entrapment or by iatrogenic factors. p528-530. A research investigated the usefulness of a two-channel EMG biofeedback training device that patients could wear at home. 1997). The use of electromyogram biofeedback to reduce Trendelenburg gait. Lie down flat on the back, bringing one leg to the chest, using the hands. DOI: 10.1007/BF02345278. If youre looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today. 1996; Siegel et al. WebTwo-Joint Hip Flexor Stretch Repeat 8 to 10 times Lie flat on your back on a table or elevated surface (a bed works) with your legs just off the edge. This exercise uses sliders, which are small discs that a 2005). Levangie, P. K., & Norkin, C. C. (2005). These symptoms include: 2 Lower back pain Knee pain or instability Changes in gait 3 Stiffness or tightness in hips after being stationary Limited range of Walking in greater hip extension increases predicted anterior hip joint reaction forces. WebHip flexor weakness is caused by L2-L3 nerve compression or possibly upper motor neuron lesion. J Bone Joint Surg Br November. Participants in the study with the strongest hip abductors and hip flexors had a better gait than those with weaker muscles in that area. Authors of an earlier study did notice an association between the magnitude of the ankle plantar flexor moment and the hip flexor moment during gait of subjects with hip muscle weakness caused by Duchenne muscular dystrophy, but they proposed a different mechanism to explain this association (Armand et al. 7 Hip Flexor Exercises Straight leg raise Sliding mountain climbers Pigeon pose Jump lunge Bulgarian split squat Kettlebell swing Banded hip march 1 Straight Leg Hip flexion is created by the hip flexor muscles to produce the forward Weak Hip Flexor Gait Pattern | Common Compensations ABCs of PT 1.26K subscribers Subscribe 66 6K views 1 year ago Abnormal Gait This video is a Bend the knee and lift the leg so that it is level with the hips. Your hands will be shoulder-width apart, arms will be straight and beneath your shoulders, with your back flat and body in a straight line from shoulders to ankles.. 2003). Anatomy and human movement: Structure and function. With the knee flexed 90, the lower leg is moved medially, causing hip internal rotation. This condition makes it difficult to support the bodys weight on the affected side. Staying seated for extended periodscan cause weakness in the psoas muscle. Web2) Hip extensor weakness (Posterior lurch gait): Backward trunk lean with hyperextended hip during stance phase of affected limb. These two data sources will provide an answer to:. (3rd ed.). Its often included in a rehab program after a hip or pelvis injury, and its also an excellent exercise to add to a lower-body routine. Youll need an exercise mat to perform the straight leg raise., Modification: Decrease the distance you lift the straight leg. Philadelphia, PA: F.A. The knee is held in a stable extended position as the foot makes contact with the ground during heel strike by concentric contraction of the quadriceps muscle group and eccentric contraction of the hamstring muscles. Put a pair of slide discs or furniture sliders on the floor. Bulgarian split squats are an intermediate exercise that strengthens the hip flexors, glutes, and calves. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. This muscle group includes the psoas muscle, which helps push the top of the leg upward. S2 hyperextended the knee to generate a knee flexor moment which produced a hip flexion acceleration. Additional study is needed to determine the prevalence of these and other possible compensatory gait strategies in all subjects with weakness and which among them might be optimal for any one individual. Foot drop A person with foot drop is unable to raise their foot at the ankle. Vasudevan PN,Vaidyalingam KV,Nair PB. Raise the left arm as your right knee comes up towards the hips. Significance of the Trendelenburg sign in total hip arthroplasty. Gait is a multi-joint, multi-organ activity. FOIA It is characterized by wide step width and jerky, irregular, uncoordinated movements. The ankle is dorsiflexed as the foot swings through to make contact with the ground at heel strike. Contract your abdominal muscles, and bring your right knee up and out in front of you like you are marching. While sitting down in a chair, attach ankle weights to the ankles. Edinburgh: Elsevier Churchill Livingstone. Get instant access to this gallery, plus: Introduction to the musculoskeletal system, Nerves, vessels and lymphatics of the abdomen, Nerves, vessels and lymphatics of the pelvis, Infratemporal region and pterygopalatine fossa, Meninges, ventricular system and subarachnoid space, Joint motion and muscle activity during gait, Starts when the heel of one foot strikes the ground and ends when that same heel touches the ground again. Make sure it is knee-height and level.. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. If it is difficult to keep the leg up close to the chest after letting go of it, a weak hip flexor may be the culprit. Be careful not to round your shoulders. This is caused by weakness of the gluteus medius and minimus muscle of the contralateral, stance leg. Input to and results from the induced acceleration analysis for the 3 subjects with weakness (S1S3) and the unimpaired subject (NL). These structures are surrounded by soft-tissues and twenty-two muscles. Weak hip flexors are not the same as tight hip flexors. Sedentary Lifestyle: This is one of the most common causes for Weak Hip Flexors. SLACK incorporated, 2009. For example, the strategies used by S1 and NL were fairly similar apart from differences in knee flexion angle. Author: Can Trendelenburg's sign be positive if the hip is normal?J Bone Joint Surg Br.1997;79(3):462-6. Conditions such as and osteoarthritis can also cause weakness in this muscle group. There are three subphases of the swing phase: As the legs move, so does the rest of the body. Riley PO, Kerrigan DC. In this analysis, the knee flexion angle in the model was increased by 1, 5 and 10 degrees. The therapist can use this test when there is no X-ray taken but there are signs of trendelenburg. Each of these phases has subphases that are going to be described in detail in the following text. These compensatory strategies permit independent ambulation, although at a reduced speed as compared to normal gait. She then used a scaled down version of the normal gait strategy, but generated the hip flexor moment by positioning her hip at the end of its available range of motion. People may try to compensate by toe walking, foot supination, or exaggerated hip flexion of the unaffected side. Let the other leg stay out to the side, off the roller. (5th ed.). Modification: You can drop the band and just do a psoas march. The conclusion of this study was that the group that used the home training device, showed almost normal gait after two months. During gait, the pelvis tilts downwards instead of upwards on the non-weight bearing extremity. A foam roller can be useful in stretching and loosening hip muscles. Last reviewed: December 05, 2022 When refering to evidence in academic writing, you should always try to reference the primary (original) source. The therapists watches and gives advise/correction to posture, so as to facilitate proper gait re-education. Traditional gait analysis techniques using kinematic and kinetic variables have not been widely used to describe the effects of isolated muscle weakness at the hip (Armand et al. The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. Some people also find stretching useful for tight hip flexors. In addition, there is a decreased walking velocity and decreased cadence. WebJoint powers were analyzed in 10 patients with FSHD at comfortable and maximum walking speed to determine the contribution of ankle plantarflexor, hip flexor and hip extensor power to propulsion. Read more. The large tick mark on the horizontal axis is at 66% of stance phase and corresponds to the average time at which the induced acceleration analysis was performed. Many people have weak or inflexible hips due to excessive sitting and too little exercise. This was because the ankle plantar flexors were responsible for generating heel rise which raised the body against gravity and maintained vertical support. S1 generated the largest hip flexor moment of the three subjects with weakness, and it was larger than expected based on manual muscle test scores. This type of gait can be seen in neurological conditions that affect the basal ganglia. Finally, S3 used gravity to produce a hip flexion acceleration. Her hip flexor and knee extensor moments were near zero during most of stance. Joint flexion/extension angles, net internal flexor/extensor moments, and GRF components in the A/P and vertical directions are shown in Figure 1. 2010;110(2):81-6. Lower extremity joint moments obtained from the gait analysis were used to drive an induced acceleration model which determined each moments contribution to upright support, forward progression, and hip joint acceleration. The rear knee should be parallel to the floor. This can help improve side-to-side muscle imbalances. Comparison of two foot-floor interfaces in induced acceleration analysis. Nerves and Nerve Injuries: Pain, Treatment, Injury, Disease and Future Directions. 2001;85(5):491-495, McGee SR. Evidence- based physical diagnosis. Top Contributors - Uchechukwu Chukwuemeka, Scott Buxton, Glenn Demeyer, Redisha Jakibanjar, Kim Jackson, Shaimaa Eldib, Olivia Wayteck, Manisha Shrestha, Oyemi Sillo, Emma De Moerloose, Claire Knott, Lauren Lopez, Admin, Daphne Jackson, Lenaertz Kiara and WikiSysop , The trendelenburg gait is caused by a unilateral weakness of the hip abductors, mostly the gluteal musculature. During the stance phase of gait, the pelvis tilts downwards on the weight-bearing extremity and hikes up on the non-weight bearing extremity. The hip flexor moment was not observed until the hip neared the end range of extension, so it is possible that this moment was generated through passive soft tissue stretch rather than active force generation. In induced acceleration analysis, dynamical models driven by net joint moments obtained from traditional gait analysis or by muscle forces obtained from dynamical simulations allow the effect of a joint moment or muscle force on the acceleration of all body segments to be quantified directly (Zajac et al. As a service to our customers we are providing this early version of the manuscript. The musculoskeletal model allowed joint motion to occur in additional planes of movement at the ankle and hip, but results were presented in only one plane because the focus of the analysis was to study how subjects with hip muscle weakness functioned in the sagittal plane, the plane of progression during gait. Thefollowingis an example of an exercise that uses an elastic exercise band to strengthen the hip flexors: Underuse of the muscles or sitting down for extended periods can cause weak hip flexors. Starting with the right foot forward, pick up the left foot and place it on the bench behind you with the ball of your foot in contact with the bench., Keep your back straight and lower the left knee towards the floor, but dont let it touch the floor. Also, they did not appreciate the potential benefit the knee flexor moment could have played in controlling hip joint extension. Philadelphia: Saunders. Computer-assisted analysis of 153 patients with polymyositis and dermatomyositis. From this group, 3 subjects who each used a different compensatory strategy during gait were selected for presentation (S13) and compared to a healthy unimpaired subject (normal or NL). [14][15][16], Trendelenburg gait is also observed in patients with developmental dysplasia of the hip, congenital dislocation of the hip (CDH), congenital coxa vara, or coxa valga secondary to other disorders like Legg-Calv-Perthes disease or slipped capital femoral epiphysis. Portland, OR 97209, Weak Hip Flexors: Signs, Symptoms, and How to Treat Them, https://orthosportsmed.com/wp-content/uploads/2021/09/Blog-header-image-weak-hip-flexors-signs-symptoms-how-to-treat-them-OSM-Oregon.jpg, https://orthosportsmed.com/wp-content/uploads/2015/01/osm-header-vs7.png, Orthopedic & Sport Medicine Center of Oregon | 503-224-8399 |, Having Joint Pain? 1994; Perry et al. The trendelenburg gait is caused by a unilateral weakness of the hip abductors, mostly the Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. Thank you, {{form.email}}, for signing up. This strategy likely was less stressful to the joints than the patterns used by the other two subjects. [28][29]Level of evidence: B. Osteopathic Manipulative Treatment (OMT) could result in improved gait parameters for individuals with somatic dysfunctions, as measured by a GaitMat II system. Exercises can be useful to prevent or strengthen weakness in the hip flexor muscles. Slide your left leg back. HardCastle P, Nade S. The significance of the trendelenburg sign. How to strengthen weak hip flexors Return the right leg to the starting position. Weakness of muscles of the calf as a source of late pain and fatigue of muscles of the thigh after poliomyelitis. Recreational exercisers count on these muscles to propel them through a grueling run. Keep your torso upright and only lean forward as much as you can. Examples of similar success among the strategies include results such as all subjects walking at similar, yet reduced, speeds ranging from 5768% of normal, and none requiring the use of an assistive gait device. Lower your body so the forward leg is parallel to the floor. It can also can cause other muscles in the area to work and transmitted securely. Start with lifting your leg a few inches off the ground and increase each time you perform the exercise.. This would be especially important if hip muscle weakness existed in combination with other impairments that would make one of the described gait strategies impractical (e.g. 1985; 67-B (5) :741-746. The kettlebell swing is part cardio, part explosive strength, and all about working every muscle in your body. Slowly bend the knee until it reaches a 90-degree angle. The gait pattern describes the gait characteristics of each individual. The patient get visual feedback about how he/she walks. These muscles provide the stability and the force required for movement of the femur during activity. Emara K. Pelvic Support Osteotomy in the Treatment of Patients With Excision Arthroplasty. Tara Laferrara is a certified NASM personal trainer, yoga teacher, and fitness coach. Induced acceleration analysis additionally quantified the effect of lower extremity joint moments on upright support and forward progression which was helpful in determining the goals of the various compensatory gait strategies selected by each subject. Approximately 10 repeated gait trials were collected per subject, yielding 4 trials with adequate force plate contacts for kinetic analysis (only 3 trials on the right for S3). After midstance, the ankle plantar flexor moment normally provides upright support and forward progression while accelerating the hip into extension. [31] [33] [34], Patients with trendelenburg suffer from abnormal range of motion in hip and trunk; so, a wall mirror biofeedback could also be used. Keep bodyweight towards heels. A sensitivity analysis also was performed to examine the ability of the ankle plantar flexor moment to produce hip joint acceleration over a range of knee flexion angles. the contents by NLM or the National Institutes of Health. We gratefully acknowledge the contributions of Paul H. Plotz, MD, Chief, and the staff of the Arthritis and Rheumatism Branch of the National Institute of Arthritis Musculoskeletal and Skin Diseases, and Lisa G. Rider, MD, Deputy Chief, and the staff of the Environmental Autoimmunity Group of the National Institutes of Environmental Health Sciences, for their work on the clinical research studies in which our subjects were participating at the time of their gait analyses. The extended leg recruits the hip flexors and specifically targets the psoas muscle. The purpose of this case series was to quantify different strategies used to compensate in gait for hip muscle weakness. Follow These Tips to Finish the Summer Off Safely. Another advantage of this passive strategy is that it may be associated with less metabolic energy demands in gait. HHS Vulnerability Disclosure, Help Al, Primary care geriatrics: a case-based approach, Mosby Elsevier, 2007. [23], When pain in the hip is diagnosed, the surgeon will base the diagnose on data obtained from clinical and X-ray assessments. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle. Sara Lindberg, M.Ed., is a freelance writer focusing on health, fitness, nutrition, parenting, and mental health. Kinematic and biomechanical equations can be calculated to determine variations from known norms. Gage JR. Gait analysis in cerebral palsy. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. According to a recent article weakness in the hip flexors can make it difficult for a person to maintain a straight posture. knee flexors too weak to utilize S2s strategy). This goal is only achievable when patients are doing exercises which strengthen the hip abductors in combination with the two-channel EMG biofeedback device. Siegel KL, Kepple TM, Stanhope SJ. Between-leg mechanical differences as measured by the Bulgarian split-squat: exploring asymmetries and relationships with sprint acceleration. WebThe gluteus medius is most easily evaluated on gait assessment and, if weak, results in the classic Trendelenburg gait (i.e., weakness causes contralateral hip drop). Reading time: 14 minutes. (2nd ed.). She had suffered nerve injuries in her left leg after being struck as a pedestrian by an automobile 20 years previously. The manual muscle test revealed 4+/5 strength in the quadriceps femoris (Table 1) so muscle weakness did not explain the absent knee extensor moment. It should be straight, with toes pointed and heel pointing towards the ceiling. In addition to providing vertical support, the ankle plantar flexor moment also accelerated the hip into extension (Figure 2). The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. An increased hip extension strategy in gait increases anterior hip joint reaction forces and may lead to pain and increased risk of acetabular labral tears (Lewis et al. The scientists concluded that using exercise bands in this context can significantly strengthen the hip flexors. Move your hands forward until your forearms are on the floor, and your head is resting on your arms. Modification: The jump lunge is an advanced move. S2 & S3 used either a knee flexor moment or gravity to produce forward progression, which had the advantage of accelerating the hip into flexion rather than extension, and decreased the demand on the hip flexors. Take a diagonal step, about 2 or 3 feet long. After a 1% lidocaine diagnostic injection to the tibial nerve, his ankle plantar flexor spasticity was diminished, and the ankle plantarflexion abnormality was corrected. The move is performed unilaterally, which means that you target one leg at a time. Elsevier, 2007. p51. Engage your core and slide your right knee towards your chest. Pain in the hip flexor area may be the result of a hip flexor strain. The alterations in normal gait can be caused by different deformities, injuries, weakness, disease, or pain in any part of the body. J Bone Joint Surg Br. The banded hip march (aka the psoas march) is an excellent move to strengthen the hip flexors. S1 generated a hip flexor moment, probably passively, by positioning the hip at the end range of extension. Throughout the first half of stance phase, she positioned her knee in hyperextension. She showed increased flexion angles and decreased total joint excursions at both the hip and knee joints (Figure 1). This could be especially troubling for patients diagnosed with IIMs who may also suffer from arthralgias and arthritis in addition to muscle weakness (Amato & Barohn 1997). Level of evidence: 4. The symptoms of weak hip flexors can affect a range of different areas in the body. Read more. Pediatr Clin North Am 1986; 33:1355. Relative contributions of the lower extremity joint moments to forward progression and support during gait. Also, try resting your head on a yoga block or placing a yoga block under your hip to decrease the distance between your body and the floor.. These symptoms occur because the joints try to compensate for weak hip flexors, which leads to them overworking. Symptoms and causes of weak hip flexors and how to treat th Federal government websites often end in .gov or .mil. Symptoms that come with tight hip flexors include lower back pain and hip pain. Siegel KL, Hicks JE, Koziol DE, Gerber LH, Rider LG. The hip joint and its abductor mechanism behave like a class 3 lever with the effort and the load on the same side of the fulcrum. Tyler T, Fukunaga T, Gellert J. Then immediate plantarflexion occurs, controlled by eccentric contraction of the ankle dorsiflexor muscles (tibialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius), as the foot rolls forward into the foot flat position. As a library, NLM provides access to scientific literature. Repeat the lunge jump movement for 30 seconds or 10 jumps on each side., Set a bench or box behind you. 1st edn. Zajac FE, Neptune RR, Kautz SA. When muscle weakness becomes moderate to severe, some individuals continue to ambulate independently, while others do not, resulting in substantial disability. Observation of the patients gait from the side enables the examiner to detect stride and step length deficiencies as well as motion of the trunk and lower extremity in the sagittal plane, including the extensor or gluteus maximus lurch in which the patient thrusts the trunk posteriorly to compensate for weak hip extensors (gluteus maximus muscle). All subjects with impairment were female, diagnosed with probable or definite IIM (Bohan et al. Ground reaction forces were sampled at 360 Hz from 2 force platforms (AMTI, Watertown, MA, USA) mounted in series along the middle of a 6 m walkway and low pass filtered at 25 Hz. Contributions of the individual ankle plantar flexors to support, forward progression and swing initiation during walking. To remedy weak hip flexors, a person can try a range of strengthening exercises that target the hip flexors. For each additional degree of knee flexion, the ankle plantar flexor moment produced 10 rad/s2 less hip extension acceleration. 2023 Dotdash Media, Inc. All rights reserved. 2004a). S2s compensation relied on knee hyperextension so the knee flexors could generate forward progression and hip flexion acceleration. Address Gray's Anatomy (41st ed.). Means and 1 standard deviation were plotted for each variable to assess intrasubject repeatability. Subject Hemiplegia/Paraplegia/Quadriplegia Stroke (Neurology) Stroke (Geriatrics) Adaptive/Assistive Devices Gait and Locomotion Training Issue Section: You can pump your arms in the air while you jump. Background Hip muscles play a prominent role in compensating for the loss of ankle and/or knee muscle function after lower limb amputation. The person has to stand on one leg. Accessibility ( 2002). Consider hiring a personal trainer or physical therapist to walk you through each step and watch as you perform the move. Causes include scoliosis, contractures, and deformity of one or more of the leg bones. It is also important to strengthen the rest of the hip muscles on the affected side. Computed gait variables (Visual 3D, C-Motion, Inc., Rockville, MD, USA) included temporal-spatial variables, joint angular displacements, and net internal joint moments. WebWeak hip flexors Impaired ability to flex hip rapidly Tools to help slide the feet May not clear ankle due to decreased hip flexion and knee flexion Open chain exercises Knee/Hip Inadequate hip flexion/knee extension Motor control problem Resistance applied to increase proprioception Increased inversion Weak dorsiflexion Increased tone Trendelenburg sign is when, whilst standing on one leg, the free side of the pelvis drops towards the floor. (2018).. The site is secure. Weakness in the hip flexors can lead to a stiff knee gait. Gait disorders often show up as altered distance and time variables.