SIGNS TO CHECK DURING GAIT ASSESSMENT

We talked about gait analysis in our previous post in two parts. In this post we write compansation during gait pattern .

We routinely do different joint examination depending on patients problem of course gait examination should be the standard aspect of every examination process.

The information gathered during functional assessment will allow the clinician to quickly make a proper treatment plan and know the patient’s overall presentation. For instance , if the patient has a compensated Trendelenburg during the stance phase of gait. We assume the strength or motor control of the Gluteus Medius is insufficient. If you Find out these patterns will ultimately differentiate a novice physio from an expert.

GAIT ANALYSIS CONSIDERATIONS:

The human gait cycle is a very complicated, coordinated series of movements. Focusing on single muscles and areas of weakness will do little to improve the ability to walk.

The human body is a kinetic chain. There is also a compensation at the knee, ankle or foot due to altered biomechanics of hip joint. For this reason, it is important that you don’t concentrate only on single joint to isolate an evaluation but to look at the entire body.
Gait compensations can occur for a number of different reasons which can be due to current/previous injury, neurological/orthopedic disorders,
postural compensations, overactive/underactive musculature, footwear, This article will address potential lower extremity compensations in an otherwise healthy, active client.

“Each explanation below can be due to a number of reasons. we have chosen some of the more common clinical sign which we see in our daily practise”.

Assessment tips :

[restrict]While conducting a gait analysis, it is important to spend enough time. Make note of deviations occurring and where body compensated . It is important to take a thorough subjective evaluation prior, so you know if any compensations can be linked to other etiologies; e.g., joint replacement surgeries, osteoarthritis.

1) Weight bearing equally through both legs.

2) Equal and adequate hip extension bilaterally
If the patient does not demonstrate adequate hip extension while walking, it is important to assess the strength of the gluteals and/or length of the hip flexors. Clinically, strong or dominant hip flexors will limit a patient’s full hip extension.

3) Trunk control during single limb loading
While observing a patient gait cycle, note that torso remain relatively neutral or deviated on either side. A common faulty movement pattern seen in patient’s with low back pain . There is excessive pelvic motion or rotation through the spine. Their hips are relative stiff. This impairment may indicate poor motor control of the core muscles or poor lumbopelvic rhythm. The body fails to disassociate lumbar spine and hip joint movement . If this is noted, further motor control testing should be performed.

4) Lacking ankle and knee motion
If a patient have inadequate ankle dorsiflexion, they may compensate by out-toeing their foot . Moreover, there is also an early heel rise. This compensation lead to inadequate force production by gastroc throughout the full range of motion. Gradually whole kinetic chain get disturbed. The compensation at the ankle can create achilles issues, knee pain , or low back pain.

5) Trendelenburg sign:
The ability to remain pelvic stable during stance phase through the hips will demonstrate the strength or motor control of the outer hip muscles. When either a Trendelenburg or compensated Trendelenburg is observed, it is important to assess gluteus medius strength. Additionally, this sign can be an indication to assess lumbar mobility and hip mobility. The poor gluteal performance will often load asymmetrically with each step.

6) Knee valgus during single limb stance
knee valgus observation during the gait assessment is another indication for assessing gluteal strength. Knee valgus is typically accompanied by femoral internal rotation and adduction. Additionally, knee valgus is common in people who over pronate foot.

7) Excessive pronation or supination
it is important to monitor for excessive supination as well. When supination is noted throughout the gait pattern, it may indicate joint mobility restrictions in great toe extension, subtalar eversion and/or restrictions in hip internal and external range of motion.

MOVEMENT ADVICE:

Appropriate strength ratios between agonist and antagonist muscles is necessary to stabilize joints. when these ratios are altered due to imbalance of the agonist/antagonist muscles, altered joint biomechanics and gait compensations can occur.

When dysfunction is present in walking patterns which can lead to several problems including joint pain, injury, decreased force output and long-term complications.

When analyzing gait pattern, be sure to be systematic and accurate. Look for common substitutions first, then verify these impairments during your joint-by-joint approach. Identifying these common movement substitutions will make you a more efficient.

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