Types of Gait Abnormalities and what it reveals about your musculoskeletal health?

 

Next time you get a chance to people watch, see if you can note how differently every one walks. You will see that some lift their hips on every step while others waddle.

The common notion to deal with gait abnormality is to simply ignore it as if it is a quirky character trait. This societal notion of dismissal of bio mechanical abnormalities until there is an injury really cooks my passion.

Oh and while I am mentioning my favorite trends of dismissal, let me not forget to note the way anyone with the ages of 25+ blames aging for their injuries. Then, how do you explain the elderly grandfather who is pain free and is training climbing mount Kilimanjaro?

It is true that age plays a role in degeneration and as we get older it is definitely more work to stay healthy. Keeping that in consideration, I still would like to remind everyone, hell to the no, pain is not OK and it is definitely not a part of healthy aging. We live in a society where we are taught to ignore bodies signals for injury and live with pain until we can't deal with it anymore.

It is true that as we age it requires effort to keep functional and pain free, but it is definitely attainable. The goal is to make health a priority by going in for wellness checks and work on muscular and postural imbalances and towards our optimal health instead of stop chasing pain. (That wraps up my rant for the day).

Healthy mechanics do start with the feet. How we step and walk is an immense tool to prevent injuries or identify the root of an injury. Always, ask why? Why is my back hurting? Why do I limp? You can find a mechanical explanation for most musculoskeletal pain.

So what is a pathological gait and what does it say about your bio mechanics?

pathological gait is an abnormal gait pattern caused by deformities, weakness or loss of motor control or pain. It is usually divided into three categories of etiology: neurological, musculoskeletal(MSK) or structural. This blog will tackle common musculoskeletal causes of abnormal gait.

MSK means abnormality due to muscle imbalances, dysfunction or changes in joint alignment that deviate one from an optimal gait and lead to compensations and other changes in the lower kinetic chain.

Hip Dysfunction and Gait

There can be different mechanisms for hip dysfunction that result in gait abnormality.

Here are some examples of how hip pathology can lead to changes in the gait:

  • Hip osteoarthritis can lead to a hip hiking.

Hip hiking is a functional phenomenon described as exaggerated motion of the opposite limb caused by reduced range of motion.

  • Hip flexion contractures/spasticity, compensation for excessive knee flexion or ankle dorsiflexion can cause excessive hip flexion on the affected limb.

Excessive hip flexion accompanies forward tilt of the trunk, anterior pelvic tilt, which alters patients center of gravity and leads to increased demand on hip extensors. Therefore, increasing lordosis of the spine, reducing the spinal mobility and eventually may lead to back pain due to facet irritation.

  • Hip abductor weakness can cause the infamous tendelenburg gate.

The trendelenburg gate is a specific gait abnormality described as a hip drop towards the leg swinging forward where hip abductors should stabilize the pelvis to allow the opposite leg to lift.

  • Hip adductor contracture may result in a scissor gait.

The scissor gait looks exactly what it sounds like where the leg crosses mid line during swing phase due to weak adductors.

  • Weak hip extensors may result in small and slow steps.

In individuals with weak hip extensors, to lessen the force from extensors the smaller steps are taken and slower gait is initiated to aid with limb stabilization.

  • Hip flexor weakness leads to a foot drag.

Smaller step length seen due to weakness of the hip flexors, induce forward motion that leads to a slower gait and decreased floor clearance of the toes, creates a foot drag.

Knee Dysfunction and gait

  • Weak Quadriceps shifts the line of gravity anterior to medial lateral axis of the knee which causes anterior trunk bending.

This is caused because quadriceps eccentrically control knee during flexion, so with weak quadriceps hip extensors compensate by bringing limb back into extension and reducing the knee flexion. This results in an early heel strike, increased ankle plantar flexion which prevents forward tibial motion to help stabilize the knee joint.

If the quadriceps weakness is severe enough to create a functional instability, this will prevent hyperextension of knee during initial contact causing the knee joint to “snap” back into hyperextension as the body's weight moves forward over the limbs.

  • Knee flexion contracture can explain toe walk and a limping gait pattern.

If knee flexors are in spasm or shortened, the knee will be restricted in extension, heel strike will be limited and step length will be reduced which will lead to a compensatory toe walk during stance phase.

Ankle and Foot dysfunction and Gait

  • Ankle dorsiflexion weakness causes a steppage gait.

Ankle dorsiflexion weakness is followed by lack of heel strike, decreased floor clearance, increased step height and prolonged swing phase which leads to an exaggerated hip and knee flexion.

  • Calf tightening or contractions cause a tip-toe gait.

Calf tightening causes limitations in dorsiflexion and reduction in heel strike which is compensated by "toe waling", smaller steps, excessive knee and hip flexion. This can be caused by Achilles tendinitis, prolonged immobilization or trauma to the ankle. In this gait most of the weight is on metatarsals and weight is not distributed evenly.

Don't Just Treat the Pain, Prevent It

Chasing pain is not fun and it is definitely not the only way. Strive for optimal function as we use and overuse our musculoskeletal system every day. Gait analysis is one area that must be assessed in order to re-occurence of musculoskeletal pain or prevent future dysfunction, live with optimal mobility and improve performance or ease of function. This article discussed some more common causes of gait abnormality that is caused by functional musculoskeletal dysfunctions. There is a whole another topic to investigate about neurological dysfunctions or structural abnormalities that can significantly affect gait.

Leave a comment to drop some knowledge or feel free to share a personal experience of a case where working on optimal function rather than pain introduced you to a better way to live.


References

1. Gait - Physiopedia, universal access to physiotherapy knowledge. [Internet]. Physio-pedia.com. 2017 [cited 10 April 2017]. Available from: http://www.physio-pedia.com/Gait

2. Gait Abnormalities | Stanford Medicine 25 | Stanford Medicine [Internet]. Stanfordmedicine25.stanford.edu. 2017 [cited 10 April 2017]. Available from: https:// stanfordmedicine25.stanford.edu/the25/gait.html



 
Laleh Maroufi