The document discusses normal and abnormal human gait, emphasizing waddling gait as a specific abnormality often resulting from bilateral weakness of the gluteus medius muscles. It details the mechanics of waddling gait, its association with various conditions such as myopathies and pregnancy, and the role of hip abductors in maintaining stability during walking. Treatment strategies, including physiotherapy aimed at strengthening key muscle groups and gait training, are also outlined.

1. WADDLING GAIT

2. INTRODUCTION
NORMAL GAIT
 Human gait refers to locomotion achieved through the
movement of human limbs.
 Gait is a series of rhythmical & alternating movements of trunk &
limbs which result in forward progression of center of gravity &
the body.
ABNORMAL GAIT
 Abnormal gait is when a person is unable to walk in the
usual way. This may be due to injuries, underlying conditions, or
problems with the legs and feet.

3. In general gait deviation fall under following
headings.
1. Neurological gait :- Parkinson gait, Hemiplegic gait, Ataxic gait,
Scissoring gait(crossed-leg gait)
2. Muscular weakness gait:- Gluteus medius gait, Trendelenburg’s gait,
Waddling gait, Gluteus maximus gait ,
Quadriceps (hand to knee gait) ,
High stepping gait
Genu Recurvatum gait,
3. Joint or muscular limitation gait:-Toe tip gait, Calcaneal gait,
Hip flexor contracture gait,
Stiff knee gait
4. Leg length discrepancy gait:- Equines gait
5. Painful gait:- Limping gait.

4. WADDLING GAIT
 It is an abnormal gait pattern ,the patient walk like a
duck
 Usually found in the people with bilateral weakness of
gluteus medius muscles.
which is the primary hip abductor.
Role of hip abductors in gait
The hip abductor muscles stabilize the hip within the
frontal plane during the single-limb support phase of
walking. ( i.e. when a given limb enters mid stance , the
opposite leg is in it’s swing phase –not in contact with the
ground)

5.  The tilting of pelvis is
controlled by the hip abductor
muscle of the stance extremity
 For example, pelvis drop on
the side of the right swing is
controlled by the isometric
and eccentric contraction of
the left hip abductor muscle

6. Role of hip abductors – in waddling gait
The gluteus medius originates from the ilium (between ant. and post.
gluteal lines), and it inserts on the lateral surface of the greater trochanter.
Its contraction pulls the two insertion sites toward one another, thus
elevating the opposite side of the pelvis.
 Its weakness causes contralateral sagging of the pelvis (Trendelenburg
Sign)

7.  Trendelenburg described it as a pelvic drop on the side
of the swinging leg and compensatory lateral trunk
bending towards the side of the standing leg
 If the weakness of gluteus medius is only in one
side (contralateral) the gait will be
Trendelenburg gait
 Bilateral weakness of gluteus medius leads to dropping
of the pelvis on both sides during walking leading to
waddling

8.  When the patient walks, he / she can't stabilize the
pelvis, When one side of the pelvis drop , in order to
avoid fall the patient will laterally bend the trunk to
opposite side
 This gait is also called “DUCK GAIT” – because the
patient is walk like a duck
 while walking the patient’s body sways from side to
side on a wide base. Therefore the patient lurches on
both sides while walking

9.  There will be increased lumbar lordosis with shoulder
thrust backward and abdomen being protuberant
 Waddling gaits are commonly seen in pregnant women,
especially during the third trimester.
 Therefore it also called pregnancy gait

10. Gait analysis
 During the mid-stance, the pelvis drop towards
the non weight bearing extremity, in order to
compensate the fall , person will shift the
weight in the stance extremity or to keep the
COG over the stance leg
 Then the body will swing towards the weight
bearing leg
 And trying to get hyperlordotic and lock back
over the other hip

11. Kinematic deviations
During stance phase:
 The weakness of proximal muscles of hip girdles, will
interferes with the stability of the pelvis during walking
 Excessive trunk lateral flexion occurs in frontal plane
 Posterior pelvic rotation
 Hip adduction increases
 Increase in hip flexion in sagittal plane
 Knee flexion occurs with valgus
 Dorsiflexion also increases

12. During swing phase:
 The failure to stabilize pelvis, it will produces
exaggerated rotation of the pelvis with each steps
 Pelvic tilt downward
 Anterior pelvic rotation
 Increased knee flexion in sagittal plane during
acceleration phase
 Dorsiflexion increases in sagittal plane during
acceleration and midswing phase

13. Spatio-temporal deviations
 Short steps or step length will decreases
 Stride length will become less
 step width:- will increase
 Wide base of support
 Stance duration increases
 swing duration will be less
 Cadence increases
 speed reduction
 longer double-support time

14. CAUSES OF WADDLING GAIT
 Myopathies, such as muscular dystrophy.
 developmental dysplasia of the hip (DDH; formerly
called ‘congenital’ dislocation)
 Superior gluteal nerve injury
 Pregnancy
 trauma to the pelvic musculature like a slip and fall or a
motor vehicle accident that may be causing the
weakness of the pelvic muscles resulting in a Waddling
Gait.
 Osteomalacia
 L5 Radiculopathy
 OA of hip
 Avulsion of gluteus medius tendon following hip surgery

15. Waddling during pregnancy
 During the second trimester, body starts producing
relaxin, a hormone that relaxes the joints and
ligaments in pelvis, allowing it to widen. it can
affect the way of walking.
 In the later stages of pregnancy, the belly starts to jut
out significantly, which can throw off the center of
gravity and make it harder to balance, especially while
walking. The spine and pelvis may also start to curve ,
to support the growing belly , causing to lean back
slightly while standing or walking. Both of these
factors can also cause a waddling gait.

16.  Having a waddling gait while pregnant is normal and
nothing to be concerned about.
 In fact, it can even reduce the risk of falling.
 Waddling gaits tend to go away after delivery
characteristics
 wide base of support
 increased lumbar lordosis
 lateral shift of the trunk

17. Physiotherapy management
 Main purpose of physical therapy is to
strengthen the abductors of the hip.
 To improve balance
 To correct the posture
 Improve the gait
The management include :-
1. Strengthening programs
2. Gait training
3. Functional balance exercises

18. Strengthening programs
 Primarily target the muscle that are responsible for gait
(gluteus medius muscle)
 The muscle to be strengthened while walking is gluteus
maximus and hamstring for hip extension, quadriceps
for knee extension, soleus & gastrocnemius for ankle
planterflexion and dorsiflexion to step forward.
 Progressive resisted exercise using weight cuff,
theraband, resistance tube
 Active ROM to the hip joint: the movement involves hip
flexion, hip extension, hip adduction, hip abduction and
rotation

19. Strengthening exercises are starts with supine hip
abduction
Hip Abduction in supine lying
Repeat this on both sides
Side lying Hip abduction
Repeat this on both sides

20. Resisted supine abduction with theraband
Side lying Hip abduction with theraband

21. Resisted abduction with theraband
Sitting abduction with theraband

22. Abduction – using weight cuff
Resistance exercise using resistance tube

23. clamshell exercise
1. Lie on one side, with legs stacked
and knees bent at a 45-degree angle.
2. Rest the head on lower arm, and
use top arm to steady your frame.
Be sure that your hipbones are
stacked on top of one another, as
there is a tendency for the top hip to
rock backward.
3. Engage your abdominals by pulling
your belly button in, as this will
help to stabilize your spine and
pelvis.
4. Keeping your feet touching, raise
your upper knee as high as you can
without shifting your hips or pelvis.
Don’t move your lower leg off the
floor.
5. Pause, and then return your upper
leg to the starting position on the
ground.

24. Clamshell exercise with theraband
1. Place the band around both legs, just
above the knees.
2. Lie on one side with knees at a 45-degree
angle, legs and hips stacked.
3. Contract your abdominal muscles to
stabilize your core.
4. Keep your feet in contact with one
another as you raise your upper knee as
high as you can, without moving the hips
or pelvis. Don’t allow your lower leg to
move off of the floor.
5. Pause at the top for a few seconds before
returning the top knee to the starting
position. Do 20 reps on each side.

25. Isometric Single-leg Wall Lean

Standing parallel to a wall, flex the hip closest to the wall to 90
degrees, with the knee bent. Press the foot of the stance leg into
the floor while driving the bent leg into the wall.
Do it on both side
The gluteus medius of the standing leg will fire to stabilize the
pelvis.

26. Swiss ball exercises
Single Leg Squat with Isometric Hip
Abduction

27. Gait training
 Patients with waddling suffer from abnormal range of
motion in hip and trunk
 Parallel bar walking by placing a mirror in front of the
patient this will provide a biofeedback to increase the
hip and trunk range of motion
 therapists watches and gives advise/correction to
posture, so as to facilitate proper gait re-education
 Make patient to walk without support
 During walk promote heel strike at initial contact with
the floor
 Prevent hip dropping and stabilize the pelvis

28. Walking with cane
 Tilting of pelvis can be
avoided by pushing
down through walking
aids on the swing side.
 when the arms exert a
force on the cane to
help minimize pelvic
drop on the side
opposite the weight-
bearing leg.

29. Pelvic brace
 Using a pelvic
brace will
reduce the
pain occurs
during
waddling gait

30. Functional balance training
 Static exercises :-
 sit to stand
 Tandem standing(stand on both legs) with or without
support
 stand with eye open and close
 Dynamic exercises :-
 Straight walking
 Tandem walking
 Side walking

31. THANK YOU