National Physical Therapy Examination (NPTE) Practice Exam

While performing gait training, a physical therapist assistant notes that the patient walks with a significant posterior trunk lean. Which intervention would be best to recommend?

1. Core strengthening

2. Stretching of the lumbar extensors

3. Strengthening of the hip extensors

4. Balance training

The correct answer is: Strengthening of the hip extensors

The recommendation to focus on strengthening the hip extensors is particularly relevant in the context of a patient presenting with a significant posterior trunk lean during gait. This abnormal gait pattern often indicates weakness in the hip extensors, which play a crucial role in maintaining an upright posture and stabilizing the pelvis during walking. When the hip extensors, including muscles such as the gluteus maximus and hamstrings, are weak, the body may compensate by leaning the trunk backward to engage passive structures for stability, thus resulting in the observed posterior lean. Strengthening these muscles can improve pelvic stability and encourage a more aligned and efficient walking pattern, reducing the posterior lean and enhancing overall gait mechanics. While core strengthening could contribute to overall stability, if the primary issue is weakness in the hip extensors, directly targeting this muscle group is essential for resolving the specific gait deviation observed. Similarly, stretching of the lumbar extensors may not address the root cause of the trunk lean and could potentially lead to further instability. Finally, while balance training is important in the overall rehabilitation process, it would be more beneficial after strengthening the hip extensors, as this could provide a more stable base from which to improve balance and dynamic control during gait.