Gait Problem ? But where is the problem ? A case of failed single leg stance in a runner during the “3 Second Gait Challenge”.
Remember, what you see is not the problem most of the time.
You have heard it from us over and over again. What you are seeing in someone’s gait or running, the thing that does not look right, is their strategy to cope with the body parts that are dysfunctional. You are quite often not seeing what is wrong.
For example, here during our “3 Second Gait Challenge” this gentleman shows a solid left stance phase of gait. At times it is so solid and calm that it looks like we still-framed the video. The right side is another matter. During right stance there is excessive “checking” of the frontal plane (side to side) at the ankle. You also clearly see him using the right arm as a ballast moving it out to the right during right stance phase to help offset and dampen the frontal plane challenges.
Now going back to our initial thesis (“Remember, what you see is not the problem most of the time.”) surely you will agree that what you are seeing that right arm doing is probably not the problem here. Correct ?
Now, this is a patient of ours, so we know what is wrong with him. But from an outsider looking in, the problem in this case is more likely in the right lower limb, but you cannot see what is wrong with it. So remember, what you see is frequently not the problem, rather it is a compensation strategy. This gentleman’s problem is coming from his right lower abdominal functional impairment (specificially the lower transverse abdominus and internal abdominal oblique functional weaknesses, we know because we clinically muscle assessed him for strength, skill, and motor patterns in our office.) These muscles were clearly neurologically inhibited and weak and the motor pattern he has laid down is many years in the making, driving a deeply seated compensation pattern. Basically, he cannot stabilize his torso on the pelvis-hip during single leg stance. This lets the pelvis drift to the right. In this case it was not gluteus medius weakness allowing for the drift, which is more common. The torso is weak on the right side making it difficult to stabilize right lateral torso movement so he cheats by moving his torso to the left (which you can see) but does so ineffectively and thus needs to use the right arm to “check” the poor strategy. His Rolling patterns were clearly disfuctional however even after correcting them he still had the gait neurologic pattern as his default, hence gait retraining is necessary in this and all cases. We do many other functional assessments, methods we have developed and they all clearly directed and confirmed the diagnosis. Just remember, if you fix a person’s movement patterns but then do not fix the repetitive gait pattern they have been using then their gait is cycling the problems right back into the person and you are wasting your, and their, time.
Additionally, It would be easy to say that this gentleman has a proprioceptive deficit and that he needs to do some balance work on a Bosu ball or tilt board. But that is “so last year” thinking. If someone is having troubles standing and balancing on a stable concrete floor why in the world would you make his stance surface training even more unstable ? This again is just not wise thinking. You don’t first learn to drive on the freeway, you start in a parking lot or back street where you can learn skills at a slow speed first. Conquer stability on a stable surface, then progress them to a more unstable surface.
Today we showed you a small diamond in our assessments. The “3 second gait challenge”. This one is a keeper for us. As we always say “Speed kills”. And in gait speed also is a disguise, it blends and blurs the deficits and challenges. Slow your clients done to 3-4 seconds and watch what jumps out at you ! (did you read our blog post on Speed and Gait deficits ? Here is the link.) Speed is the devil when it comes to gait. At a normal walking pace and running pace these deficits were not perceptible, because speed in the sagittal plane (moving forward) reduced the lateral challenges. Speed blurs, speed blends and speed kills.
We continue to ask “Of all the functional movement courses being offered out there now, why do they not get into functional gait screening?" We think we have the answer. It is likely because this stuff is difficult, it is because it takes a deep knowledge base of whole body biomechanics/functional anatomy (from arm swing to big toe function) and it is because what you see in someone’s gait is very often not the problem. A deep and broad understanding of human gait is not something you can pick up in a single weekend seminar nor can it be something done simply by a "check off” sheet. This is complicated stuff, our 700+ blog posts with 230 in the draft folder plus 90 YouTube videos proves that there is great depth to gait and proves how complex it can be. But, if you have been with us for awhile and continue to work at this stuff you are likely getting better and better at this gait stuff. Do not give up. This is a worthwhile journey.
We are The Gait Guys. Shawn and Ivo.
Providing a stable surface for your knowledge base!
