Reciprocal Implications At Play In Gait

A gait analysis can range anywhere from a quick glance to confirm ataxia or evaluate a limp, to an ultimate screen to assess full-body function. Although there is little debate when someone says, “that limp may be causing your low back pain”, few follow and understand the full implications of a gait finding. What is really needed is a way to know if a gait finding is important in a clinical presentation: whether this finding is causing pathology or symptomology, resulting from pathology or symptomology, or an artifact that is seemingly unrelated.

Three quotes to drive this discussion:

1.  “Posture follows gait like a shadow” – Sherington
2.  “Gait assessment is the most challenging functional assessment” – Chaitow
3.   “Simplicity is the key to brilliance” –Bruce Lee

 

3 ways to look at a gait finding:

1.      Ground up
2.      Brain down
3.      Feedback loop

Ground Up

The way your foot forms a relationship with the ground sends a blueprint to your brain to determine how all following movements need to occur. I can tell you as a former carpenter that a bad blueprint will destroy a house quicker than any wear and tear. When the knee crashes medially creating strain on the meniscus, MCL, ACL, etc. it is simply the brain doing its best job to build off of a bad blueprint. The brain is not to blame! Every muscle that you focus on with activation techniques, every joint you mobilize, every pattern you groove, will eventually deteriorate if the foot is sending the wrong information to the brain, because the brain ALWAYS wins.  The brain is an excellent builder and quickly creates the best myofascial pattern from information it receives from sensory input. We need a better blueprint.

Thus, a gait finding can be responsible for any pain or dysfunction in the body.

Brain Down

When there is a lesion in the musculoskeletal or nervous systems, an adaptation must be made to complete a task around the lesion. If the head of the femur begins to deteriorate, the brain automatically writes a new program to protect and avoid the weak structure. Typically a coxalgic gait pattern is written, which uses the torso  to lean the body weight over the injured hip. This de-stresses the gluteus medius, a major compressor of the hip joint and slows the hip degeneration. This is an example of a brain down gait finding because structurally there is nothing that causes the torso to lean over the injured joint, it is instead a compensatory decision of the brain. Perhaps a better example of a brain down gait finding is that of ataxia, where a brain lesion directly creates a change in the gait. A goal of the practitioner should be to determine if the gait finding is caused by the foot or the brain.

Feedback loop

A feedback loop is when two or more elements in a system affect one another. Element A sends a signal to element B, element B adapts to that signal and sends different signal back to element A, which further adapts. This is what we see happen in hyper speed with human biomechanics. A ‘Ground Up’ gait issue will cause a ‘Brain Down’ reaction that creates a new ground up signal that further changes the brain down reaction, etc. This is what we see most frequently in a clinical setting. If we can identify the root cause (ex: Plantar-flexed first ray, impaired stereognosis, etc.) we have the best chance at cutting the poor feedback loop and preventing global degenerations. We must fix the ground up issues AND re-groove the brain down reaction to cut the loop. The best treatment strategies do this simultaneously. This will be expanded upon in the upcoming GRIP Approach Seminars!