In the strength systems review for spina bifida, which pattern is described?

• A. Crouch with decreased gluteus maximus and hamstring strength limiting hip extension
• B. Hyperlordosis without muscle weakness
• C. Normal strength in all lower-extremity muscles
• D. Predominant upper-extremity weakness only

Answer: (A)

In spina bifida, a crouch gait pattern often reflects weakness in the hip extensor muscles and the posterior chain, especially the gluteus maximus and hamstrings. The gluteus maximus is the main muscle that extends the hip during stance and helps decelerate hip flexion as you rise to step. When it’s weak, the hip tends to stay in a more flexed position during stance because there isn’t enough power to achieve full hip extension. The hamstrings contribute to controlling hip and knee movement; if they’re also weakened, there’s less ability to stabilize the knee and control hip extension, which further promotes a flexed hip and knee posture as a compensatory strategy. Together, these weaknesses produce the crouched alignment seen during walking, with reduced efficiency and greater energy cost.

Other patterns don’t fit as well because they imply preserved hip extension and overall normal leg strength or a disparity that doesn’t match the common posterior-chain weakness seen in many individuals with spina bifida.