Addressing Gait Dysfunction with Physical Therapy
Gait dysfunction refers to changes in your normal walking pattern, often related to a lower extremity injury, disease, or underlying medical condition. Physical therapists are experts at addressing the root cause of your gait dysfunction and designing customized treatments to restore your gait and improve your function. In the video below, Mangiarelli Rehabilitation physical therapist Bobby demonstrates several gait training exercises to address gait dysfunction after a lower extremity knee injury.
What is Gait Dysfunction?
Your gait refers to the way that you walk. The “gait cycle” includes stepping with the heel, landing on one foot, rolling over that foot to the ball of the foot, and then lifting the foot off the ground again. Walking requires coordination and movement of the lower body as well as good balance.
Gait dysfunction refers to changes in your normal walking pattern, often related to a disease, underlying medical condition, or musculoskeletal injury that affects your ability to walk. These conditions can negatively impact your positional awareness, ability to keep yourself upright, and your normal mode of walking or running.
Gait dysfunction can be caused by inner ear disorders, nervous system disorders like Parkinson’s disease, muscular dystrophy, or musculoskeletal abnormalities like a fracture. Gait dysfunction can also occur after surgery to the lower extremity (such as knee surgery) that can cause weakness or tightness in your leg muscles or gait issues can develop as you age or become frailer. In fact, gait dysfunction is among the most common causes of falls in older adults, accounting for 17% of falls among seniors.
Gait dysfunction is classified into five different types of gait dysfunction:
Antalgic: This is a limp that is caused by bearing weight on an injured or painful leg, often due to arthritis or a traumatic injury to the knee. The individual takes slow short steps, then quickly tries to shift weight off of the sore leg, ankle, knee, or foot and back onto the unaffected leg.
Cerebellar Ataxia: This involves a wide-based, feet-width-apart stance with erratic foot placement. This can be related to having multiple sclerosis or having had a stroke and is seen in those that are intoxicated by alcohol or drugs.
Parkinsonian: This type of gait involves short, shuffled steps and occurs in those with Parkinson’s disease.
Steppage: In this type of gait dysfunction, the ankle “slaps” off the ground so the individual lifts the leg higher at the knee and hip to clear the foot when taking a step. This can occur in those with foot drop, or an inability to lift the ankle, and can be due to lumbar radiculopathy or neuropathy.
Vestibular Ataxia: This involves walking unsteadily, falling to one side due to inner ear-related issues, such as vertigo, vestibular conditions, or Meniere’s disease.
Waddling: This involves walking on the toes while swaying side to side and can occur in those with muscular dystrophy.
Physical Therapy for Gait Dysfunction
Physical therapists are experts at addressing the root cause of your gait dysfunction and designing customized treatments to restore your gait and improve your function. The physical therapist first conducts a series of tests to assess the condition, including observing the abnormal gait pattern; taking gait speed measurements; performing balance tests and strength and range of motion measurements to assess joint function; and evaluating your reflex and sensation to screen for any neurological condition affecting your gait.
It’s essential to address gait dysfunction as early as possible. When you have gait issues, the rest of the body compensates for the abnormality, which can lead to other areas of pain or injury in other parts of the body and compensatory injuries. With an abnormal gait, you also expend more energy than necessary to complete simple daily activities. Gait training with a physical therapist can not only relieve any compensatory pain in other areas of the body but can also reduce unnecessary energy use on simple tasks.
Physical therapy for gait dysfunction can involve:
Pre-gait training: These are exercises to help prepare you to improve your gait before taking a single step, such as standing and simply lifting your leg in place, stepping in place, and practicing initiating heel contact to the ground prior to other portions of the foot.
Gait training: This is targeted retraining of the way that you walk based on the root cause of the dysfunction. Gait training can involve walking on a treadmill, engaging in stepping over objects, and performing lower body and core strengthening exercises.
Balance and coordination exercises: The therapist guides you through a series of balance activities to help stabilize your walking pattern, beginning using the parallel bars and moving to our Astroturf and rebounder for more advanced balance training.
Neuromuscular re-education: This is done to activate inactive muscle groups that may be affecting your gait and ability to walk normally.
Use of adaptive equipment in severe cases: In some cases, gait dysfunction may be due to significant weakness, paralysis, or a severe medical condition. A physical therapist can help you learn to use adaptive equipment like a brace, splint, or even a cane to help you move safely.
Gait training helps to strengthen your muscles and joints, improve your balance and posture, build your endurance, develop muscle memory, increase your mobility, retrain your legs for repetitive motion, and lower your risk for a fall.
Exercises to Address Gait Dysfunction
Gait training exercises can include:
Range of motion exercises to restore normal mobility in your knee, hip, ankle, and foot.
Lower extremity strengthening that specifically targets hips, knees, and ankles and focuses on doing light resistance with high repetitions as walking is a low resistance, high repetition activity.
Balance and proprioception exercises as single-leg standing ability is key for proper walking motion. Walking requires that you spend about 40% of the time standing on one foot while the other foot is swinging forward through the air.
Step over obstacles to practice flexing the hips and bending your knees behind you when walking by stepping over obstacles or small hurdles. The therapist will then progress you to side-stepping to help you move in different directions when walking.
Target stepping is done to improve lower extremity coordination and your ability to place your foot exactly where you want it while walking.
Backward walking requires a toe to heel pattern and improves your hamstring flexibility, quadricep activation, balance, coordination, walking speed, and step and stride length. Backward walking also helps to reset the neuromuscular system as it challenges your lower extremity muscles and joints in specific ways.
Mangiarelli Rehabilitation physical therapist Bobby demonstrates several gait training exercises to address gait dysfunction after a lower extremity knee injury:
Are you experiencing problems with your walking pattern after an injury or due to a medical condition? Work with our physical therapists to address gait dysfunction and restore function and mobility to improve your gait!
