Your gait analysis is lying to you more than you think. The more difficult motor program your client is running occurs before the gait analysis even begins.

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Even before you client walks back to your treatment room, there are several things that we may not be aware of. Gait initiation is a different and more complex motor program than the simple gait motor program.

Here is a little something we do in our clinics, all the time. When the session room is open for the next client, we greet our client in the lobby. We do not have our staff send them back to the room to change and wait for us. We watch them closely, but without them knowing. How does the client stand up? How do they initiate their gait cycle ? How is their balance? How do they carry their bags, purse, backpack ?
We ask them to head back to the session room to get changed, letting them think we are grabbing a drink of water. And then, in a sneaky manner, we watch them stand, initiate gait, and walk back to the room.
We do this, because, gait initiation is separate motor program. It requires several component parts, a squat, weight shift, double support balance acquisition, COP (center of pressure acquisition), step length precalculations, step width precalculation, foot strike targeting, weight shift again, initial weight transition, and then the gait cycle. And gait initiation is different and asymmetrical in people with pain, we know this for a fact in clients with painful osteoarthritis. These clients develop adaptive posturomotor strategies that shorten the monopodal phase on the affected leg.*
For many gait disorders, these are the component parts that will first show up if there is a problem in the system. Gait initiation is more difficult than gait perpetuation. Besides, how we walk when we do not think we are being watched, when we are carrying our things (purse, phone, bottle of water, backpack, etc) is how we typically walk. Clients will show all the goodies we need to see: the turned out foot, the hiked shoulder, the limps, the staggers, stumbles, speed, step width, and the like. We also get to see how they move in the shoes they live in, the heeled ones, the broken down ones, the work shoes.

So, when your client is having a formal treadmill gait analysis, what are you seeing? Their best behavior, or the truth ? One thing is for sure, you do not see the most important program the precedes their treadmill analysis, namely, how they get out of the chair and up onto the treadmill. This stuff matters.
There are clues everywhere, grab all of them, in as natural a manner as possible.

The Gait Guys

*Arch Phys Med Rehabil. 2000 Feb;81(2):194-200.
Asymmetry of gait initiation in patients with unilateral knee arthritis.
Viton JM1, Timsit M, Mesure S, Massion J, Franceschi JP, Delarque A.

Not moving.

Not moving: the fundamental but neglected motor function.

Have you ever had a client tell you that prolonged standing is their biggest challenge ? "My feet kill me when I have to just stand in a booth at a trade show !" , or "My low back kills me when I stand for 2 hours at a cocktail party". In many of these cases, if they start to move, they feel better. I have plenty of trade show folks complaint of foot pain from the sustained standing. The muscles are under a constant sustained load, there is little to no joint movement, the ligamentous support systems undergo creep, and other things. So, i have them walk back and forth the 5-6 steps within the confines of their trade show booth. Movement is medicine. Sustaining a postural position and thus a fixed joint position over time, even with modest load, is fatiguing and eventually leads to multi-tissue failure. Sustained loading, even when suboptimal, is a problem. The nervous system becomes cranky too as discussed in the abstract below.

Here is an interesting article we are trying to get our hands on (please share if you have access to it). It is not a strong correlation to the discussion above, but there is some conceptual spill over we hope to dive deeper into, perhaps on an upcoming podcast.

Abstract

"The function of the motor system in preventing rather than initiating movement is often overlooked. Not only are its highest levels predominantly, and tonicaly, inhibitory, but in general behavior it is often intermittent, characterized by relatively short periods of activity separated by longer periods of stillness: for most of the time we are not moving, but stationary. Furthermore, these periods of immobility are not a matter of inhibition and relaxation, but require us to expend almost as much energy as when we move, and they make just as many demands on the central nervous system in controlling their performance. The mechanisms that stop movement and maintain immobility have been a greatly neglected area of the study of the brain. This paper introduces the topics to be examined in this special issue of Philosophical Transactions, discussing the various types of stopping and stillness, the problems that they impose on the motor system, the kinds of neural mechanism that underlie them and how they can go wrong.This article is part of the themed issue 'Movement suppression:brain mechanisms for stopping and stillness'."

Philos Trans R Soc Lond B Biol Sci. 2017 Apr 19;372(1718). pii: 20160190. doi: 10.1098/rstb.2016.0190.

Not moving: the fundamental but neglected motor function.
Noorani I1, Carpenter RH2.

Trunk control in locomotion: What you may be realizing by now, if you have been with us here long enough, is that if you are getting good at the deepest of gait stuff, you are truly looking at your clients completely.  You are considering vision, vestibular, cerebellar, postural patterns, sensory and motor aspects, movement patterns, proprioception, coordination, S.E.S., stability, mobility, compensation patterns, dual tasking abilities and so much more.  We are working on new presentations and projects, soon for your eyes. Here is a slide from a new presentation to wet your whistle.

Trunk control in locomotion:
What you may be realizing by now, if you have been with us here long enough, is that if you are getting good at the deepest of gait stuff, you are truly looking at your clients completely.
You are considering vision, vestibular, cerebellar, postural patterns, sensory and motor aspects, movement patterns, proprioception, coordination, S.E.S., stability, mobility, compensation patterns, dual tasking abilities and so much more.
We are working on new presentations and projects, soon for your eyes. Here is a slide from a new presentation to wet your whistle.