Gait Deviations Associated with Pelvis and Knee Pain Syndromes
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:
- Decreased gait velocity (most frequent gait deviation for patients with neurological deficits)
- Decreased vertical oscillation of centre of mass
- Delayed heel off
Walking Speed, the Sixth Vital Sign[edit | edit source]
According to a 2009 paper by Fritz, 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.[1]
"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." [1]
Applications of walking speed as a clinical measure:[1]
- Has the potential to predict future health status and functional decline
- Can be used to predict future hospitalisation, discharge location and patient mortality
- Reflects both patient functional and physiological changes
- Is a factor in determining potential for rehabilitation
- Aids in prediction of falls and fear of falling
- Walking speed progression has been linked to clinical meaningful changes in quality of life
Average walking speed for geriatric patients and those with a known fall risk is greater than one-metre to 1.4 metres/second. Deviant gait velocity is measured at a slower pace.[1]
Gait Deviations[edit | edit source]
Gait Deviation | Expected Movement Pattern | Deviant Movement Pattern | Secondary Signs Associated with Deviant Movement |
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Increased vertical oscillation of centre of mass
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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.
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Decreased vertical oscillation of centre of mass | (Same as above) |
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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.
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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.
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Lack of knee separation
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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.
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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.
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When walking and viewed from behind, the opposite foot strike is not visible because the foot crosses the vertical line.
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Popliteal skin crease
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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).
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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. |
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Pain Syndromes Associated with Gait Deviations[edit | edit source]
Gait Deviation | Associated Pain
and Pain Syndromes |
---|---|
Increased vertical oscillation of centre of mass
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Decreased vertical oscillation of centre of mass |
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Contralateral pelvic drop |
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Contralateral pelvic elevation
(Hip or pelvic hiking) |
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Lack of knee separation
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Foot crossing the midline |
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Popliteal skin crease
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Varus thrust |
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Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Fritz S, Lusardi M. White paper:“walking speed: the sixth vital sign”. Journal of geriatric physical therapy. 2009 Jan 1;32(2):2-5.