OK, quiz time. The Powers of Observation.
Perhaps you have been following us for a while, perhaps you are just finding us for the 1st time. Here is some back ground on this footage. Let’s test you observation skills.
Watch this gait clip a few times and come back here to read on.
This triathlete presented with low chronic low back pain of about 1 years duration. The pain gets worse as the day goes on; it is best in the early am. Running and biking do not alter its intensity or character and swimming makes it worse. Rest and analgesics provide only temporary relief.
Physical exam findings include limited internal rotation of both hips (zero); a left anatomical short leg (tibial and femoral, 5mm total); diminished proprioception with 1 leg standing (<30 seconds). MRI reveals fatty infiltration of the lumbar spinal paraspinals and fibrotic changes within the musculature; degenerative changes in the L4 and L5 lumbar facet joints, degeneration of the L5-S1, L3-L4 and L2-L3 lumbar discs.
Now watch his gait again and come back here for more.
Did you see the following?
- torso lean to left during stance phase on L?
- increased progression angle of both feet?
- decreased arm swing on L?
- circumduction of right leg?
- clenched fist on L?(esp when standing on either leg)
- body lean to R during L leg standing?
How did you do? If you didn’t see all those things, then you are missing pieces of the puzzle. Remember, often what you see is not what is wrong, but the compensation
The powers of observation of the subtle make the difference between good results and great ones.
Try some of these tips.
- break down the gait into smaller parts by watching one body part at a time: right leg, left leg, right arm, left arm, etc
- watch for shifts in body weight in the coronal plane (laterally) and saggital plane (forward/backward) as weight transfers from one leg to another
- watch for torso rotation (watch his shoulders. Did you notice he brings his torso more forward on the left than right when walking toward us?)
We are (and have been) here to help you be a better observer and a better clinician, coach, athlete, sales person, etc. If you haven’t already, join us here for some insightful posts each week; for our weekly (almost) PODcast on iTunes; follow us on Twitteror on Facebook: The Gait Guys
