This article discusses gait deviations associated with pain syndromes in the pelvis and knee. While this information focuses on certain regions of the body, remember that the human body functions within a kinetic chain. No one movement is ever completely isolated and without effect on another.^[1]

For a review of the gait cycle, please see this article. For an overview of gait deviations, please review this article. To review common gait terminology and definitions, please see this article.

Pain Syndromes and Gait Deviation[edit | edit source]

Gait deviations are likely related to the development of and / or associated with musculoskeletal pain syndromes. It is often the complaint of pain that will lead a patient to physiotherapy. It is the role of the physiotherapist to educate the patient on the aetiology of their pain while treating and correcting the noted gait deviation.^[1]

A gait deviation is an abnormality in the gait cycle that can effect the trunk, hip, knee, or ankle joint. Gait deviations can stem from increased age and / or certain pathologies. These pathologies can be musculoskeletal or neurological in nature.^[2] Gait deviations can have a tremendous impact on a patient’s quality of life, morbidity, and mortality.^[3]

The most commonly noted gait deviations for pain syndromes include:^[1]

1. Decreased gait velocity (most frequent gait deviation for patients with neurological deficits)
2. Decreased vertical oscillation of centre of mass
3. Delayed heel off

Walking Speed, the Sixth Vital Sign[edit | edit source]

According to a 2009 paper by Fritz,^[4] walking speed (ie gait velocity) is “almost the perfect measure.” Patient self-selected walking speed has been found to be a reliable, valid, sensitive and specific measure which correlates with functional ability, and balance confidence.^[4]

“Walking speed, like blood pressure, may be a general indicator that can predict future events and reflect various underlying physiological processes. While walking speed cannot stand alone as the only predictor of functional abilities, just at blood pressure is not the only sign of heart disease; walking speed can be used as a functional “vital sign” to help determine outcomes such as functional status, discharge location, and the need for rehabilitation.”^[4]

Applications of walking speed as a clinical measure:^[4][5]

1. Has the potential to predict future health status and functional decline
2. Can be used to predict future hospitalisation, discharge location and patient mortality
3. Reflects both patient functional and physiological changes
4. Is a factor in determining potential for rehabilitation
5. Aids in prediction of falls and fear of falling
6. Walking speed progression has been linked to clinical meaningful changes in quality of life

According to Fritz et al 2009, the average walking speed for geriatric adults is 1-1.4 m/sec.^[4] The preferred average walking speed in healthy adults, aged up to 50 years, is 1.4 m/sec.^[6] This suggests that deviant gait velocity is measured at a pace slower than 1-1.4 m/sec.^[1]

The average stride length in healthy adults ranges between 150 and 170 cm. The average cadence in young adults ranges between 115 and 120 steps/min. Geriatric adults prefer a 40 % wider step width than younger adults. A 2017 study found that ageing is “associated with a decline in gait speed and step length whereas cadence remains relatively stable.”^[6]

Please watch the following video for further discussion on walking speed and how to measure it in the clinic using the 10-metre walk test.

^[7]

Example of a vertical ground reaction force.

Ground reaction force is a summation of all the forces transmitted from the ground up into the body.^[1] Ground reaction force is influenced from all directions: vertical, anterior-posterior, and medial-lateral. These forces are typically measured and recorded using a three-dimensional force plate.^[8][9]

Example of an anterior-posterior ground reaction force.

During walking, the vertical ground reaction force is the largest component of the total ground reaction force. This creates forces greater than a person’s total body weight per step. The graphed curve of the vertical ground reaction force consists of two peaks: the impact loading^[1] or passive (weight acceptance as the heel strikes the ground) peak and the active (push off) peak.^[8][10] The passive peak is caused by the foot pushing against the ground, whereas the active peak is caused by the active force applied by the foot as it pushes away from the ground. The anterior-posterior ground reaction force includes braking peak and propulsion peak.^[8] The unique patterns of these peaks illustrate the load forces at the joints and muscles of the lower extremity. These forces felt throughout the limb can influence the development or exacerbation of musculoskeletal overuse or stress injuries.^[10][11]

When interpreting a ground reaction curve, the steeper the curve the more significant the impact forces. The curve on the anterior-posterior curve (the breaking forces) will be negative. In general, the greater the forces, the greater risk for stress or overuse injuries.^[1][11]

Please view the following video for a quick yet detailed overview of ground reaction forces during the human gait cycle. This video provides excellent visualisation of how ground reaction forces shift in different directions as the person moves through space.

^[12]

Pain Syndromes Associated with Gait Deviations^[1][edit | edit source]

Recommended videos of gait deviations:

• Gait Deviations: Hip, Pelvis, Trunk

^[15]

• Gait Deviations: Knee Joint

Recommended Journal Articles:

Clinical Resources: