Gait Deviations Associated with Pelvis and Knee Pain Syndromes

Original Editor - Stacy Schiurring based on the course by Damien Howell

Top Contributors - Stacy Schiurring, Kim Jackson, Lucinda hampton and Jess Bell  

Introduction

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 is without effect on another.

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

Pain Syndromes and Gait Deviation

Gait deviations are likely related to the development 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 etiology of their pain while treating and correcting the noted gait deviation.

Gait Deviation Definition HERE

The most commonly noted gait deviations for pain syndromes include:

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

ADD INFORMATION re: Fritz 2009 article about gait speed

Gait Deviations

Gait Deviation	Expected Movement Pattern	Deviant Movement Pattern	Secondary Signs Associated with Deviant Movement	Associated Pain and Pain Syndromes
Increased vertical oscillation of centre of mass "Too much up and down motion"	Choose a fixed location such as the top of the head, sacrum, or belt line. Compare the highest point during swing phase to the lowest point during stance phase. When running: 6-8 cm or 2-3 inches (ADD Souza 2016) When walking: 9.5cm or 3.5 inches (Perry 1992)	Bounding or bouncy gait is deviant if decreasing the magnitude of the vertical oscillation of centre of mass decreases or eliminates pain symptoms	Increased float time in running A loud foot strike Extra vibration during treadmill running Early heel off	Back pain Knee pain Medial tibial stress syndrome Achilles pain in runners Plantar heel pain syndrome
Decreased vertical oscillation of centre of mass	(Same as above)	shuffling gait	Increased amount of time in double limb stance Slow gait velocity, less than one metre/second Increased cadence, greater than 120 steps/minute Delayed or late heel off Fall risk
Contralateral pelvic drop	During stance phase, a line drawn between the posterior superior iliac spines (PSIS's) should deviate no more than four degrees inferiorly.	During stance phase, the line between the PSIS's will deviate inferiorly greater than four degrees. Can be related to an anatomically long leg during stance phase	Lateral pelvic shift Absence of daylight between the thighs and knees Foot strike occurs across midline of the body Oblique popliteal skin crease Excessive medial femoral internal rotation Excessive pronation	Back pain Hip labral injuries Gluteal tendinopathy Piriformis syndrome Anterior and or lateral knee pain Patellofemoral arthralgia Iliotibial band pain Medial tibial stress syndrome Ankle pain Achilles tendon pain Plantar heel pain
Contralateral pelvic elevation (Hip or pelvic hiking)	During stance phase, a line drawn between the posterior superior iliac spines (PSIS's) should deviate no more than four degrees superiorly.	During stance phase, the line between the PSIS's will deviate superiorly greater than four degrees. Commonly seen in patient with neurological impairments	Listing of trunk to the ipsilateral side Cicumduction of contralateral lower extremity during swing phase	Back pain Hip pain Knee pain Leg length discrepancy
Lack of knee separation or "absence of daylight" between thighs or knees	Unless morbidly obese, when walking and viewed from front or behind, there should be a space or "daylight" between the knees and thighs.	When walking and viewed from front or behind, there is an absence of space or "daylight" between the knees or thighs. Anatomically short leg	Lateral pelvic drop Lateral pelvic shift Excessive medical femoral rotation Oblique popliteal skin crease Genu valgus Excessive pronation	Gluteal tendinopathy Lateral knee pain IT band syndrome Knee osteoarthritis Medial tibial stress syndrome Posterior tibial tendon pain Achilles pain Plantar heel pain

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