Gait and posture are far more closely connected than originally thought
Oftentimes it is easy for health care providers to break people into parts and think less about the sum, or “whole,” of these moving pieces. Gait and posture are two common tools for assessment and indication of function that health care professionals rely on every day to make sound decision making to guide treatment.
We must realize, however, that we do not live in a static world, and once we view posture as dynamic it becomes very easy to see the significant implications it can have on our movement efficiency.
How we move
To be good movers, we need to be efficient. To be efficient, we need to have access to joints and connective tissues. It is through this access to joints and connective tissues that we can combine things such as gravity, and ground reaction force for free energy.
The body has numerous proprioceptors embedded in fascia that are constantly sensing change in length and tension and communicating this information to proper muscles in the surrounding area. If we have good mobility in connective tissues and joints, these receptors are more likely to respond favorably to changes in length/tension and force in order to allow us smooth, quality movements like those we find in gait.
Posture is our way of interacting with our environment for completion of tasks and maintaining maximum efficiency, however in a world where we are sitting and remaining static more than ever before it is only natural to attempt to use some of those gait and posture strategies for movement.
To continue this idea we will attempt to explore what happens in our posture that can directly affect the way we walk. We will attempt to discuss the implications of several common postural faults such as an increased anterior pelvic tilt, a Trendelenberg gait or frontal plane leak, and finally — resting foot position, to connect posture and movement compensations in our patients.
In observed body positions where increased anterior pelvic tilt is the preferred option for creating tension along the anterior and posterior chain, one loses optimal “preloading” capability for potential energy, and thus creates load to spinal segments posteriorly rather than anterior connective tissues. This can result in low-back pain, a very rigid gait, poor shock attenuation, inhibition of hip extension, and an anteriorly-placed femoral head causing strain on the hip flexors.
Assessment of breathing patterns, hip flexor mobility, hip extension patterns followed by treatments such as utilization of IASTM to promote body awareness and kinesiology taping for biomechanical cueing are crucial in re-training a more effective gait pattern.
Frontal plane compensations such as Trendelenberg to improve efficiency can often be a sign of lack of proprioceptive awareness of the trunk and lower extremity. The less we have to “think” about moving, the more efficient we become. The frontal plane — connected to the lateral line connective tissue (as dissected by Tom Myers in “Anatomy Trains”) has connections to the inner ear, so again we can see a connection to head position and the importance of vestibular system to control the frontal plane.
Compensations here can arise from prolonged positions of sitting or carrying items or growing babies on the same side of the hip throughout development. Treatment here can include a variety of measures — from proprioceptive drills, body positioning that challenges hip and lumbopelvic relationships, as well as the use of IASTM and kinesiology taping along lateral connective tissue for similar reasons previously mentioned.
Foot pressure and injury
Variation in static foot posture has been shown to increase lower limb injury regardless of whether your foot has a fallen arch or a high arch. The former, along with increased hip external rotation positioning, has been more closely linked to medial tibial stress syndrome as well as patellofemoral disorders.
A lot of this has to do with force attenuation through the lower extremity. By utilizing proper heel strike with walking gait patterns and allowing the foot to follow through a natural supination-pronation cycle, we can not only better convert ground reaction force into kinetic energy, we will allow for even distribution of energy among connective tissue structures.
Achieving better foot posture
One way to achieve better foot posture is to utilize the thousands of sensory nerve endings in the foot and incorporate walking barefoot. Walking barefoot enables increased forefoot spreading under load and habitual barefoot walkers have anatomically wider feet. Furthermore, barefoot walkers show reduced step/stride length and increased cadence.
This results in lower peak plantar pressures and pressure impulses. As when incorporating any new treatment, graded exposure to improve tissue tolerance gradually over time should be utilized.
Whole-body connections with gait and posture
When thinking about the patient we need to think about the entire body, and when thinking about the entire body we need to think about the nervous system. The body will always go to positions of comfort and efficiency based on task, environment, goals, and even emotional experiences.
Gait and posture are far more closely connected than originally thought — it is time to look at the whole picture.
For more on gait and posture go to the CE resource center.