Walking and running are a skill, and for the silent majority they are subconscious skills.
Somehow, for some reason, we just assumed and expected that nature would lead us to a proper gait as we moved from the crib, to crawling, to walking and eventually to running. But, with 36+ years combined experience, my partner in crime, Dr. Waerlop and I are certain of one thing, that nature left most of us with the parts to ambulate properly but with no rule book or users manual on how to use the parts correctly or most efficiently. We basically assumed that the neurological developmental windows or landmarks that we achieve from each developmental stage as an infant and young child would be learned on time, correctly, and with proper assimilation with the prior developmental landmarks.
Unfortunately, this is quite often not the case. We see evidence of these gait related neurological developmental delays or premature landmark achievements every day. Even our experienced patients who have been re-learning under our corrective eye for some time find they cannot go to a mall or airport or local cross country meet and not be amazed by the number of truly tortured gaits that are moving amongst us.
Our experienced patients admit they do not know what is wrong with what they have seen, but they most definitely know that what they have seen is not normal or optimal. They express wonder as to why no one addressed their own gait aberrancies sooner. We like to tell them that “no one gave us the Users Manual at a young age.” Truth be told, even if a “users manual” for the body was present, it would have to be pre-assembled and specific for their body type and specific body parts (ie. bowed legs), and then there would be the issue of being able to understand the complexity of such a manual at the necessary young age of required reading, not to mention the adolescent perspective of “Why do i have to pay attention to this manual? I already have enough reading homework, I am moving about just fine, I have no pain, I do not walk in circles and I run fast. Sure I might run funny, but look at everyone else, they do it too !”.
You see the dilemma here. The key word missing from that whole diatribe is the magical word, “Yet”. They are not yet in pain, not yet the slowest person on the field. Their gait patterns are not yet aberrant enough or have not been present long enough to create inflammation at a joint or generate sufficient dysfunction within enough muscles to present conscious problems. But, they are there, brewing beneath the conscious awareness; waiting, lurking.
The problems are there, waiting for that wrong step off the porch when you turn your ankle “for no reason”, when the knee suddenly buckles “for no apparent reason” when you are carrying the grocery bags up the stairs or when your knee suddenly begins aching at mile 5 “for no apparent reason” when on yesterday’s 15 mile run it was just fine. Like in the stealth of night, our body finally reaches that magical pinnacle moment, “I have had enough, I cannot compensate any longer”. It is as if the body is trying to say, “Look buddy, we have been dealing with this problem for months at a subconscious level, trying to figure this out. We have been cheating around your sad pathetic gait patterns long enough. Heck we even tried turning out that right foot. Nothing is helping anymore. We have had a meeting of ‘The Parts’, and we have decided we cannot go on like this any longer. It is time to let you know. We had to hit The Pain Button and bring this to your conscious attention once and for all.”
Almost everyone can walk and run, but few can walk or run correctly and efficiently. Lack of efficiency or essential skill are what lead to pain, compromise of the body parts (joints, muscles, neurology) and complex compensation patterns. The difficulty however is that most of those walking among us, do not know that they are walking or running incorrectly until the “parts” start complaining. And by then, the body has been compensating around the problems for some time. Sometimes months, sometimes years. It is not until enough inflammation or tissue compromise has occurred that pain presents itself, and by then, most of us are far into a well engrained motor compensation pattern. Before we know it, someone is asking us why we are limping unbeknown to us. Before we know it, someone is asking us how long we have been turning out that right foot ?
As we like to say, “the brain will find a way”. What we mean by that is this; the brain has a task and goal at hand, whether that is to climb a tree, walk to the store, cut the lawn or run a marathon. The brain will inventory all the parts and players of the body and get busy with the task in the most efficient manner with the parts available. And if some parts are a bit rusty and degenerated, short or weak etc the body will begin to detour from the “standard protocol” use of the parts and initiate a compensation pattern that uses the parts differently, tap into others to assist, or move the anatomy into another plane to find an alternate strategy to avoid pain or achieve better force, power or efficiency (ie. turning out the foot to better engage the gluteus medius to avoid pain at a degenerative hip or knee). This is a subtle unconscious process that occurs under the veil of conscious awareness, the brain knows that pain is a deterrent to efficiency because pain is inhibitory to muscles and thus renders joints functionally unstable. So, like we said, “the body will find a way”, or better put “the brain will find a way”.
So, what is one to do with this information ?
Well, it is a difficult sales job to convince someone to take their body in for an evaluation of their gait and running, especially if there are no problems apparent or they don’t have any outward signs or symptoms that are obvious to them. But, we do this regularly for our cholesterol levels, we do it twice a year with our automobiles and we do it with our home furnace every so often. Why would it be so strange to do it with how we move ?
We don’t know why someone would not do it. We would rather have something evaluated and drawn to our attention while we can still make a difference rather than wait until the muscles are so tight or weak from compensating that it takes months of physical therapy to fix, or a joint replacement to amend, or God forbid daily pain medications to cope. Regardless, it still remains a rare occasion when a person will come into see us and ask us to just “look under the hood” and kick the tires and make sure things are working right and that they are walking and running properly. Sadly, the case is usually one of, “My knee has been killing me on my long runs for 5 weeks now, but nothing happened, I promise !”. It would be nice if they followed that sentence with, “However, I did sprain my ankle 3 months ago, I have had a hernia repair on that side two years prior, and my parents proudly told me that I barely crawled rather, I walked quite early on in life. Maybe we should talk about these things or at the very least look at my ankle rocker and hip extension ranges of motion because they feel a little off on the right, left internal hip rotation feels limited and I think I am into premature heel rise on the right.”
Heck, lets be honest, I would probably swallow my brain, a split second before I face plant on the floor in an all out neurosuppressive faint.
There is a saying that crops up from time to time in our lectures, one that has some great truth, “You cannot beat the brain.”
Sometimes wonderful things come to us when we have a day off from patients, when we get to enjoy a warm cup of joe while staring out the window at a beautiful sunrise on a spectacular Fall morning. I think I will go for a run now, it is still early so no one will be out to see my right foot turn out as i subconsciously compensate down my leaf covered road. - Dr. Allen