Uncle Gimpy's Story Time

Limping, as I've touched on before, is nature's way of accounting for pain, pathomechanics, and trauma, affecting the body in an asymmetrical manner. Again, the body has two primary goals in the face of any of these causes: to maintain as level a visual horizon line as possible, and to keep the inner ear balanced. All else is secondary to these two central requirements. This is mainly because it is easier to limp than to alter one's inner equilibrium or the alignment of the eyes with the horizon. Thus, the body works to compensate by other mechanisms: bending the knee, abducting the foot, lifting the heel on one side early in the gait cycle, externally rotating the leg. Each of these actions in turn produce effects further up the body: hip raise on one side, shoulder drop on the other; slow changes to the sacral level toward imbalance, that eventually results in scoliotic and lordotic changes; even going as far in some individuals as causing a primary head tilt. I have even met individuals whose multi-level compensation has led to an observable change in the levels of the eye orbits, this last being found only, in my experience, in individuals with pronounced ligamentous laxity.

The most interesting aspect of limping is how it varies from person to person. Some of us manage to compensate without limping, especially if the compensation has occurred throughout one's life. But when the trauma is new, the body has not had time yet to compensate, so it is left only with the option of limping, unless a lift, or the appropriate orthotic device is introduced, reducing or eliminating the need to compensate, and thereby stopping a limp from developing. This series of observations, over many years, has led me to an understanding of compensatory function and the secondary purpose of limping.

The primary purpose, in my view, is to offset changes to one's biomechanics in gait, that result first in pain, and soon after by challenging the inner ear and the visual horizon. Limping is thus initially an accommodation to a rude new reality. But as time goes on without any intervention, either mechanically or surgically, limping begins a chain of actions referred to as compensatory. That is, they permit the body to rearrange itself to account for the pathomechanical changes not otherwise addressed. So, an early heel-off limp might slowly be absorbed by the development of a change in the sacral-pelvic angle, which in turn may eventually lead to a shoulder drop on the opposite side. And each type of limp, combined with the ligamentous tonality in that particular person, will eventually reshape and realign the biomechanics presented originally into a new format, so to speak. Thus, we can see limps where the leg externally rotates (usually an effort to "shorten" a long limb - effectively reducing the length of the "lever arm" of the forefoot during the propulsive phase of gait); limps where the knee bends (long side) or hyperextends (short side, and usually accompanied by other levels of compensation); limps where the pelvic girdle rotates more than normal (where there may be some muscular weakness, often to the short side.) And of course, limps caused by acute trauma that dramatically or subtly alter the nerve, muscle, and tendo-ligamentous structures and functions.

The downside of non-intervention is obvious - the longer the limping is allowed to continue, the deeper and more problematic the resultant compensatory changes become. And time, along with severity of the pathomechanics, are factors in how to (eventually) intervene, and at what speed such intervention might reduce or eliminate the compensations. Someone who is twelve years of age when their trauma initiates the compensatory chain of events will allow for rapid response once intervention is initiated, whereas someone in their fifty's whose trauma has been interfering with their bodies for years may well take several years of graduated intervention before real counter-compensation can take shape.

We are complex creatures, physically (I am unqualified to speak to our other complexities, except to admit to their existence.) And the fact our bodies are capable of changing structurally in response to trauma, whether abrupt, or of a congenital nature, is for me an amazing challenge, and will continue to be something I study, because there is nothing I like better than solving mysteries. And believe me, humans are nothing if not full of mysteries.