Many patients present with gait patterns that I would categorize as un-propulsive, meaning they do not walk with purpose. Usually this presents as not pushing off the big toe, not achieving hip extension, or limited arm swing (usually unilateral). This pattern is often a result of or leads to tightness to the anterior hip, limited thoracic rotation, or lack of ankle dorsiflexion.
If you come across this presentation, here are a few steps to restore a better pattern.
1. Restore mobility
Check to see if mobility is lost through the ankle. Can they accomplish a closed chain dorsiflexion of 40 degrees? Next check for hip extension mobility using a Thomas Test Confirm they can extend the hip to at least neutral to 10 degrees of extension. Finally check thoracic rotation to assure they can rotate at least 45 degrees left and right in the T spine.
If mobility is an issue at any of these target joints, it needs to be improved and then integrated back into the gait pattern.
For ankle dorsiflexion, I like using a floss band. Wrap the ankle distal to proximal with a 50% overlap and moderate stretch. Then have the client rock back and worth in closed chain for 2 sets of 30 reps. Remove the band and retest.
Preferred Tool: RockFloss
If hips are a problem use the test as the treatment and perform the Thomas Test stretch for 2-3 sets of 30-60 second holds.
Preferred Tool: Skilled Clinician or Half Kneeling Hip Flexor Stretch
With a thoracic restriction I prefer using a peanut tool with arm raises, followed by sidelying rotational stretch (TIP: keep hips above 90 degrees flexed). Do 10 reps of arm raises with the peanut between your shoulder blades, then roll to your side and complete 5-10 trunk rotations.
Preferred Tool: SKLZ Dual Point Massager
Re-test your mobility and see if you made progress.
2. Activate the proprioceptors & the nervous system of the involved limb.
Now that mobility is no longer a limiting factor, lets move on to getting the limb primed for weight bearing and push off.
A classic option here is “Steamboats” or self perturbation in single leg stance. Place a loop band around both ankles. Stand on the involved limb. Rapidly kick the uninvolved limb out to the side about 6-12 inches. Do 15 reps laterally, then kick 15 reps anterior, then 15 reps posterior. You should feel the stance foot and hip really have to work to stabilize the motion and hold single leg balance.
Preferred Tool: SKLZ Exercise Band (yellow resistance; stronger is not better)
Another option here is to do standing cone touches or a star pattern. I recommend standing on the involved leg and then reaching with the other foot to touch cones at “X” distance. Start with 2 feet away from the involved leg and increase it as necessary. To advance this, you can switch to touching the cones with your hand to create a more hip dominant movement.
Preferred Tool: SKLZ Mini Cones
3. Integrate in an effort to generate force.
Specifically – we need force through the ground. We need to appreciate placing force into the ground and tolerating load.
Here I like to build strength in the limb, so we build on the cone-touch drill from above. Using a slider or glider, place one uninvolved foot on the glider. Be sure the client is stable and keeps 95% of the body weight on the ground based foot. Only 5% of the body weight hoes on the glider. Then begin a lunge matrix routine. Start with a reverse lunge and push the glider posterior with the uninvolved leg. Progress to then pushing the glider anterior. Then increase the challenge by pushing the glider laterally (TIP: be sure only 5% of weight is on the glider). And finally, push the glider laterally and posteriorly to open the hip into external rotation.
This matrix creates an outstanding strength environment for the involved limb, while incorporating balance and control. It is more task oriented so the body will value the experience, store the program, and transfer it to related tasks.
Preferred Tool: SKLZ Slidez
Final step is to translate this new mobility, activation, and strength into an integrated gait pattern. My favorite way to do this is with resisted walking. Using an elastic belt or band around the clients waste. Hold the resistance behind them, allow them to walk forward against the resistance. As they walk forward, follow them in order to keep the resistance level constant. The resistance should be light enough that the gait pattern looks normal or ideal, but it needs to be enough that they get the feeling they have to push through the ground to move forward. This subtle hint of resistance should allow for them to really feel what it means to push through the ground and create an effective gait pattern.
Preferred Tool: SKLZ Recoil 360
This is a strategy I use often in the clinic can be done with many clients. Be sure to evaluate your client and confirm these movements and exercises are safe for them and their level of function. I hope this process helps improve your clients movement and quality of life!