Gait Deviations Associated with Pelvis and Knee Pain Syndromes: Difference between revisions

No edit summary
No edit summary
Line 102: Line 102:
* Leg length discrepancy  
* Leg length discrepancy  
|-
|-
|Lack of knee separation or "absence of daylight" between thighs or knees
|Lack of knee separation  
 
* "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.
|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.
|When walking and viewed from front or behind, there is an absence of space or "daylight" between the knees or thighs.
Line 123: Line 125:
* Achilles pain
* Achilles pain
* Plantar heel pain
* Plantar heel pain
|-
|Foot crossing the midline
|When walking and viewed from front or behind, the opposite foot strike should be visible and not cross a vertical line which travels from the belly button to the ground.
* When walking, feet should remain on the ipsilateral side of the line
* When running, feet should be on the line
|When walking and viewed from behind, the opposite foot strike is not visible because the foot crosses the vertical line.
* Can be compensation for an anatomically short leg
|
* Asymmetry of arm swing
* Asymmetry of trunk rotation
|
* Gluteal tendinopathy
* Hip osteoarthritis
* Anterior and or lateral knee pain
* Patellofemoral arthritis
* Medial tibial stress syndrome
* Achilles pain
* Plantar heel pain
|-
|Popliteal skin crease
* Excessive femoral medial rotation
|When viewed from behind during stance phase, the skin crease on the back of the knee should be horizontal.
|When viewed from behind, the skin crease will be oblique from superiolateral to inferiomedial (inferring there is excessive movement of the femur into medial rotation).
* Possibly due to an anatomically long leg
|
* Pelvic drop
* Lateral shift of the pelvis
* No daylight between the knees
* Genu valgus
* in-toe gait
* Heel whip
* Excessive pronation
|
* Gluteal tendinopathy
* Piriformis syndrome
* Trochanteric buristis
* Anterior and lateral knee pain
* Patellofemoral arthralgia
* Achilles pain
* Metatarsalgia
|-
|Varus thrust
|During stance phase, when viewed from front or behind, there should be little to no lateral/medial deviation or translation of the knee
|During stance phase, when viewed from front or behind, there is a high-velocity small-amplitude lateral deviation of the knee with a rapid return to neutral alignment.
|
* Excessive lateral lean of the trunk
* Unequal stance time
* Asymmetrical arm swing
|
|}
|}



Revision as of 03:27, 27 May 2022

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

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

Introduction[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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
  • "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
Foot crossing the midline When walking and viewed from front or behind, the opposite foot strike should be visible and not cross a vertical line which travels from the belly button to the ground.
  • When walking, feet should remain on the ipsilateral side of the line
  • When running, feet should be on the line
When walking and viewed from behind, the opposite foot strike is not visible because the foot crosses the vertical line.
  • Can be compensation for an anatomically short leg
  • Asymmetry of arm swing
  • Asymmetry of trunk rotation
  • Gluteal tendinopathy
  • Hip osteoarthritis
  • Anterior and or lateral knee pain
  • Patellofemoral arthritis
  • Medial tibial stress syndrome
  • Achilles pain
  • Plantar heel pain
Popliteal skin crease
  • Excessive femoral medial rotation
When viewed from behind during stance phase, the skin crease on the back of the knee should be horizontal. When viewed from behind, the skin crease will be oblique from superiolateral to inferiomedial (inferring there is excessive movement of the femur into medial rotation).
  • Possibly due to an anatomically long leg
  • Pelvic drop
  • Lateral shift of the pelvis
  • No daylight between the knees
  • Genu valgus
  • in-toe gait
  • Heel whip
  • Excessive pronation
  • Gluteal tendinopathy
  • Piriformis syndrome
  • Trochanteric buristis
  • Anterior and lateral knee pain
  • Patellofemoral arthralgia
  • Achilles pain
  • Metatarsalgia
Varus thrust During stance phase, when viewed from front or behind, there should be little to no lateral/medial deviation or translation of the knee During stance phase, when viewed from front or behind, there is a high-velocity small-amplitude lateral deviation of the knee with a rapid return to neutral alignment.
  • Excessive lateral lean of the trunk
  • Unequal stance time
  • Asymmetrical arm swing

Resources[edit | edit source]

  • bulleted list
  • x

or

  1. numbered list
  2. x

References[edit | edit source]