Is the wrong gait a gateway to pain?
Not every walk of life is straightforward. The way in which we put one foot in front of the other has an impact on our health, as well as on our psyche.
When the lower back becomes too painful to bear or knee pain has your patient on their knees, their gait may be playing a key role. With her ‘Gait Analysis’ programme, Kirsten Götz-Neumann is showcasing an innovative diagnostic and consecutive therapy method.
Kirsten Götz-Neumann, who has a degree in physiotherapy, explains: “The assumption that the source of foot, knee, hip or back pain can always be traced upwards from the foot is obsolete.” Pain can just as easily come from above, i.e. from the hip or from the body’s incorrect centre of gravity. The expert adds that: “Naturally it can also come from the feet, and it can originate from both directions, but the key is to observe closely and examine the entire process.” This includes a structured in-depth diagnosis of the entire individual – including a renewed examination of earlier injuries – that takes place while the person is in motion. One cannot rely solely on the findings of x-rays, as these are generally taken when people are lying down. Treadmill analyses, on the other hand, focus solely on the leg while ignoring everything else, and are commonly used to sell shoes or special soles. “While it is true that each of these approaches helps deal with the symptoms, they do not eliminate the cause,” explains Kirsten Götz-Neumann. Biomechanics work differently, and that is why the patient is observed from every angle while they are in motion. In order to sensibly integrate this science into a therapy, she worked with her mentor, Dr. Jacquelin Perry from California, to develop the ‘Gait Analysis’ programme. This is a “systematic method for the observation, documentation and analysis of the gait in accordance with the guidelines of the Rancho Los Amigos Medical Center in Los Angeles.”
Walking is not always as straightforward as it seems
This method did not simply appear out of the blue: it is not at all uncommon for the cause of the most common problems in physiotherapy – pain in the knees, ankles and back – to be found in a pathological gait. As the expert puts it: “A good example would be loud stomping, something that indicates that the muscles that should be acting as shock absorbers are inactive.” The result: passive structures such as the intervertebral discs or the cartilage of the knee end up doing the job instead, meaning the person suffers more with each and every step. Kirsten Götz-Neumann: “This puts paid to a light and easy gait, and sometimes can even be seen in the painful grimace of the patient.” Yet her work does not only focus on pain, but also on overload. Some people really have to focus in order to put one foot in front of the other – no wonder, if they would rather be taking the lift or would prefer to remain seated.
More than just two steps: A gait cycle comprises eight phases
This is no reason to belittle the patient, however. Instead, one must work with them closely in addressing their problem. As Kirsten Götz-Neumann puts it: “My client has a right to understand why the leg and trunk muscle chains need to be activated, or why a shock absorber is particularly important in a specific phase of their gait.” In all, a total of eight phases can be identified in each gait cycle, extending from the initial stationary stance through the forward swing to the terminal swing phase. Where the heel strikes the ground in phase one, the current joint positions determine the shock absorption behaviour of the leg. In order to explain these aspects to laypersons such that they can compare their implementation to the individual phases, the patients are observed and filmed from every angle as they walk. Here, it is essential that the therapist filter out the things that constitute natural deviations from the things that represent serious functional problems. According to the expert: “There is no ideal gait – every person's gait is infused with their own personality.” Some people swing their arms further than others, or take shorter steps. A person’s destination – be it the dentist’s for a root canal, or a friend's place for dinner – also influences their gait. “Even so, whenever pathomechanical movements are evident, one can – and must – optimise the movements comprising the biomechanics of walking in the patient,” emphasises Kirsten Götz-Neumann.
What the programme should achieve
The programme comprises ten units of one to one-and-a-half hours each, and by the time a patient has completed three units at the latest, they should already be experiencing a notable improvement in their symptoms. The overarching goal is to train the muscle chains and the torso posture to make it possible for the patient to enjoy an easy gait, without any misgivings. In order to achieve this effect, the programme takes an interdisciplinary approach. In practice, this means that observational gait therapists – generally physicians and physiotherapists – understand the work being done by their colleagues, and are able to give targeted recommendations. “We always account for the patient’s wishes. I always ask which ‘jungle of life’ we will be releasing them into afterwards – one in which people do no more than walk to the bakery, or one where people are doing triathlons,” says the expert. This demonstrates how a healthy gait can take different forms, and how it is always linked to personal freedom – and therapists need to do everything to achieve this, including in interdisciplinary teams.
This is how you can learn to analyse gait
To find out when the next four-day basic and advance training courses are being held, visit the website at www.gehen-verstehen.de and go to the ‘Kurse’ [Courses] menu item. Cost: 1,040 euros. In-house training courses for hospitals and practices are also possible on request.
A book on this topic in German: