Is this a gluteus medius foot targeting problem in swing phase or is this a loss of internal hip rotation? Or . . . .

Is this a gluteus medius foot targeting problem in swing phase or is this a loss of internal hip rotation? Or . . . .

You have to examine your client to know what to treat, a gait analysis or a series of screens is not enough. The saying "an exercise is a test and a test is an exercise" has some sharp edges around it. A screen doesn't tell you what exercise a client necessarily needs or should be prescribed.
This stuff really does matter.
What you see is not the problem , it is their compensatory strategy in coping with a problem. When someone has a pebble in their shoe and they walk on the outside edge of their shoe to avoid the pebble the solution is not to tell them to stop walking on the outside of the shoe, the solution is the de-pebble the shoe. Corrective exercises can be a similar path to this pebble analogy. One must look deeper and beyond what we see in our clients, we merely see how they have adapted, not the problem. A Trendelenburg leaning gait is not met with a solution to prescribe a corrective exercise to correct the lean, the solution is to see why the client is reducing the compressive loading across the hip. Stop giving corrective exercises if you are not examining your client. Yes, that means you need to have hands on diagnostic skills. Sorry.

Loading the wrong pattern drives a compensation, and maybe another problem or a compensation to the compensation deeper.

Loading the pattern that is corrective, the one that solves the deficit leading to the gait you see should be your target. Corrective exercises are supposed to be corrective to the problem, not to the gait aberation you see. Without the exam to solidify proper path, corrective exercises often are directed at the things we see, not the aberation that drove what we see. Be part of your clients solution.
If you aren't examining your client, you don't know for certain what you are actually doing.

This is me, Dr. Allen, i am walking in a matter to prove my point.
Do i have a loss of right internal hip rotation (thus the externally rotated limb?). Do i have a swing leg gluteus medius weakness that is allowing me to adduct the limb rendering a mere foot targeting problem? Do i have weak peronei ? A weak glute max ? A right frontal plane drift that i am avoiding by turning my leg out so i can use my quads to help the deficient glutes better block the frontal plane drift ? I could go on an on as to possible causes.
Or do i merely have a pebble in my shoe?
Mic drop.

To give a corrective exercise you have to know what is wrong. That means you have to have the knowledge and the hands on skills to diagnose the "why". So you can prescribe the correct "how".

Shawn Allen, one of the gait guys

A return to "the Kickstand Effect". So your foot is turned out, externally rotated ?

Amputee War Veteran Sergeant Christopher Melendez Became a Pro WrestlerRead more at http://www.craveonline.com/mandatory/1053779-standing-tall-how-amputee-war-veteran-christopher-melendez-beca#XeD2LrZ2xmtXQ6um.99

Amputee War Veteran Sergeant Christopher Melendez Became a Pro Wrestler
Read more at http://www.craveonline.com/mandatory/1053779-standing-tall-how-amputee-war-veteran-christopher-melendez-beca#XeD2LrZ2xmtXQ6um.99

Why is my foot turned out ?  A 3rd return to the solitary externally rotated foot.

Below you will find our 2 prior articles on this topic, but this is a relatable concept to other thing which we have embedded in many of our blog posts and podcasts over the last decade of sharing what we know.

In the photo above the brave Army Veteran Sergeant Melendez one can see the concept brilliantly as he only has one limb.  One can see the concept in full play, he must balance his body mass over one point, not two like the rest of us lucky folk.  In trying to balance over one point, if the foot is straight forward (if one is blessed with close to neutral torsional bone alignment) one will have good stability in the sagittal plane (forward /back) but will be at risk to fall, drift or sway into the frontal plane. Here Sergeant Melendez displays the foot and limb turn out into the frontal plane so that he can use the quadriceps to help him protect into that frontal plane, plus, by situating his base posture in more of an externally rotated position (likely losing internal rotation capability over time, unless forcibly maintained through specific exercises) he can more fully and skillfully engage all 3 divisions of the gluteus maximus and medius, and perhaps hamstrings and adductors and who knows what else, to maintain a more stable and likely less fatiguable posture. Go ahead, try it for yourself, this is easier to balance and maintain that a straight sagittal foot posturing. The one trouble he might have, is not deviating too much, or too often, into a frontal plane drift hip-pelvis posture. This will put much aberrant compressive load onto the roof of the femoral head-acetabular interval, where most of us begin a degenerative hip arthritis journey, unfortunately. 

Side note:   So you might think your client has FAI ?  Maybe start here, our thinking might lead you done a helpful path to get started. Search our blog for FAI as well.

here are the 2 prior articles on the topic, with video.  Watch for this one, it is everywhere out in the world, walking amongst us.  
Thank you for your service Sergeant Melendez.  Here is the article written by K. Thor Jensen, on Crave Online.  

https://thegaitguys.tumblr.com/post/14262793786/gait-problem-the-solitary-externally-rotated

https://thegaitguys.tumblr.com/post/40617674450/a-return-to-the-solitary-externally-rotated-foot

Shawn & Ivo, The Gait Guys

External Tibial Torsion as expressed during gait.

So, last week we watched this young lad doing some static ankle and knee bends, essentially some mini squats.  Here was what we found (LINK). It is IMPERATIVE that you watch this LINK first before watching today’s video above.

Now that you have watched that link here is what you should be seeing today.

You should see that the left foot is extremely turned out. We talked about why in the linked post from last week. It is because of the degree of external tibial torsion.  When it is present the knee rides inside the foot progression line (the knee bends into the forward / sagittal plane when the ankle bends into its more lateral /coronal / frontal plane (they all mean the same thing) ie. when the foot points outwards.

Remember, the knee has only one choice of motion, to hinge forward and backward. When the knee is asked to hinge in any other direction once the foot is locked to the ground there is torque placed upon the knee joint and thus shear forces.  Menisci do not like shear forces, nor does articular joint cartilage.

So, once again we see the rule of “you cannot beat the brain” playing out. The brain took the joint with the least amount of tolerance, the knee, and gave it the easy job.  The foot was asked to entertain another plane of motion as evidenced here in this video with significant increased foot progression angle. 

When the foot progression angle is increased but the knee still must follow the forward body progression (instead of following the foot direction) the motion through the foot will be directly through the medial longitudinal foot arch.  And as seen here, over time this arch will fail and collapse. 

Essentially this lad is hinging the ankle sagittally / forward through the subtalar and midtarsal joints, instead of through the ankle mortise joint where ankle hinging normally should occur.

This is a recipe for disaster. As you can see here.  You MUST also know and see here that there is an obvious limp down onto that left limb. It appears the left limb is shorter. And with this degree of external tibial torsion and the excessive degree of foot pronation, the limb will be shorter. You need to know that internal limb spin and pronation both functionally shorten the limb length.  This fella amongst other functional things is going to need a full length sole lift. We will start with 3mm rubber infused cork to do so. And let him accomodate to that to start.

We will attempt to correct as much foot tripod (anti-pronation) control as possible to help reduce leg shortness as well as to help reduce long term damage to the foot from this excessive pronation. We will also strengthen the left gluteus medius (it was very weak) to help him engage the frontal/lateral/coronal plane better. This may bring that foot in a little. But remember, the foot cannot come in so far that it drives the knee medially. Remember who is ruling the roost here !…… the knee.  It only has one free range, the hip and foot have 3 ! 

Shawn and Ivo