Compensation patterns and the baloney sandwich: What kinda crap are you feeding your clients ?

For as long as we can remember we have been saying that what you see in someone's gait is not their problem, it is their strategy to cope with loading, movement and locomotion, taking into account the clients neuromusculoskeletal parts and the primitive reflexive patterns we learned, or didn't learn. We see in someones movement the parts that are available to actually participate in the task, the strategies that are often more pain free, and the ones that help the client feel stable. That does not mean, BY ANY MEANS WHATSOEVER, that the deployed pattern is more efficient, economical or stronger. It means the client and their nervous system chose the deployed movement strategy for a reason that is meaningful to their system.  Sometimes that means they feel less pain, sometimes more stable, sometimes stronger -- it all depends on the task and demand. A weightlifter might shift their squat load to one leg more because it feels stronger, a runner might feel more endurance in a pattern, a gymnast or ballerina might feel more balance and stability in a certain pattern, an elderly person might be searching for stability and less pain.  It all depends.  These things may not be via conscious choice, they are often not.

In this study they found that by increasing a foot toe-in pattern and a wider step width that this gait modification seemed to be successful in reducing knee joint loading in all three planes during stair ascent, regardless of knee alignment.  This pattern appeared to be a pain reduction choice, whether conscious or unconscious, likely both over time. Sometimes it is about pain, sometimes it is not.

This once again goes to prove that making recommendations off of what we see in a gait analysis is often useless and fraught with a load of lies and baloney if there is no further correlative information, we see it all the time in reports from gait lab reports we are shown.  It also means that making gait or running change recommendations off of the gait analysis alone, without a clear understanding of normal gait or absence of the findings off of a physical exam, completes the utter nonsense of the baloney sandwich. One might say there is little value, or nutrition, in this silly process when it is all you serve your client.   

Dr. Shawn Allen, the other gait guy

Effects of Toe-In and Wider Step Width in Stair Ascent with Different Knee Alignments.

Bennett, Hunter J.; Zhang, Songning; Shen, Guangping; Weinhandl, Joshua T.; Paquette, Max R.; Reinbolt, Jeffrey; Coe, Dawn P.