Tuesday, February 1, 2011

Gait Analysis Primer, or, The Way She Wiggle and the Way She Walk

The word gait refers to the act and action of walking, running, and other forms of upright ambulation, particularly how each body segment interacts and affects the other parts of the body, giving each individual their own unique "walk." From issues such as alignment, speed, and hip/pelvic travel (side-to-side), we can begin to understand where pathology may be hindering effective ambulation, from mere performance-related concerns, to significant pain and impairment.

When we put one foot in front of the other, a whole complex of muscles, nerves, ligaments, tendons, and bones and joints must work in some kind of harmony in order to move that foot ahead of the other foot, then repeat, over and over, thousands of times a day. The fact that we do ambulate in an upright manner makes it far more complex - bi-pedal stance is far more impacted by gravity than quadripedal is. Some have described human gait as the act of constantly falling forward, but always (mostly) catching ourselves in time, then repeating the process. There is some truth to this, but its actually quite a bit more complex than that. Gait analysis is the art and science of studying and refining this complex process with the aim of improving the outcome for the given individual.

In order to get a taste for how this works, try this the next time you are in a public place where many people are walking around. Select any other person at random, and position yourself to walk behind them for a block or so. And no, I am not promoting stalking! Stay back a minimum of twenty feet. Now, watch the way the person walks. Start at the level of their feet - what kind of shoes are they wearing? Shoes always influence our gait. High heels have the most significant impact, so you need to realize from the start that any gait analysis is usually done with the subject in their bare feet. Watch to see whether one foot appears to strike the ground or leave the ground in a manner different from the opposite side. This takes practice, but that's what we're doing, isn't it?

Watch to see if the heels of each foot "bounce" a little after the heel strikes the ground - this is often, though not always, a sign of a tight Achilles tendon. Observe how the feet are pointed in stance - are the toes pointed in, or out, or fairly straight ahead? Each of these possibilities impacts the over-all gait in different ways.

Now, go up to the hips. Does one side appear to move further to the side than the other during the same phase of gait? Does it rise more? Again, each of these may be indicative of some type of pathomechanical issue.

Move your gaze up to the shoulders - does one appear higher than the other? Do the arms swing the same amount, or even the same angles? Then the head. Does the upward movement that occurs as the heel of each side leaves the ground appear even, that is, the same for each side? Or does there appear to be a difference, and even a head tilt to one side?

OK. Now, try the same thing for people walking towards you. Make the same observations. Are you beginning to see the scope of this art, even a little? It takes a lot of training, and a lot of practice. The high tech tools that are often used for gait analysis offer deeper insight, but the core knowledge of gait analysis remains the training and skill of the clinician.

Next time, I'll expand this topic by looking at some of the specifics as they may apply to us post-clubbies. Until then, just explain to your significant other that when you are watching someone's hip motion, it's in the cause of science. Bet they've never gotten that excuse before!



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