When an individual is running or walking, muscles in the low back and pelvis region need to work in a highly coordinated and integrated way to ‘stabilise’ the pelvis, in particular when the body weight is supported on a single limb such as at heel strike and soon after heel strike.

When this muscle system fails to act accordingly loss of stability of the pelvis occurs and commonly manifests as a Trendelenburg sign, and/or excessive anterior tilting of the pelvis.

This loss of pelvis stability directly stresses the lumbar spine, pelvis, and hip joints in particular, but also leads to increases in rotational stresses further down the lower limb thereby increasing strain on the knee, ankle, and foot.

Correction of these faulty movement patterns involves specific exercises to improve function of the gluteal (buttock) muscles in particular. Often the problem is not just due to lack of muscle strength, key muscles can fail to activate with the correct timing and as such exercises to improve ‘brain to muscle’ activation, progressing to exercises specifically re-teaching the muscles to activate as the heel lands are required.

Other contributing factors may include a leg length discrepancy, and tight/short muscles on the front and outside of the thigh which also need to be identified and managed accordingly.