Image credit: https://www.researchgate.net/figure/Phases-of-the-normal-gait-cycle_fig3_309362425
Do you have a lingering limp that just won’t resolve? Perhaps after an injury or surgery? Let’s observe the movement pattern of walking and see what your limiting factor might be!
If you watch the path of one leg, we contact the ground with our heel after the leg swings forward. We then take our full weight on this leg, assuming a single leg stance. Then as our body moves forward, the heel peels off the ground and we push off through the ball of our foot during toe-off, leading to an airborne leg that swings forward before contacting the ground again. This path is equivalent to two steps, as the opposite leg is going through the same motions reciprocally.
It is very common for walking to be affected by a lower body injury or surgery. It can also be challenging to resolve a limp that has been established pre-surgery (adapted pattern) because of pain or avoidance patterning after injury. To understand how this pattern has evolved, let’s look at 4 phases of the walking cycle:
1. Heel Contact
During this phase, full knee extension is so important! We contact the ground with our heel and, optimally, our knee completely straight. A straight knee is an example of joint stability, which creates a stiffness for us to impact the ground and take force. When we are missing knee extension, this can produce a limp because of the lack of symmetry: the uninjured leg contacts the ground straight and the injured/post-surgical side does not, resulting in a lop-sided walking pattern.
You will notice that the knee quickly changes from a straight to a slightly bent position after contacting the ground. This is an example where muscle control is so important – you only want the knee to bend a certain amount. It must happen in a timely manner to allow you to transition to the next phase of walking. Pain can prevent this muscle control from working properly, contributing to a limp because the amount of bend in the knee is too much or happens too quickly for your body to stop it in time.
During the heel contact phase, we need good strength in our quadriceps (front thigh muscle) to control the transition from knee straight to bent, as well as ankle dorsiflexion to lift the foot up (opposite of the pointed foot position) and control the flattening of our foot on the ground.
If we took a picture of this phase, it would show that you are completely weight-bearing through one leg. Often, after an injury or surgery, this can be a painful part of walking. In response to pain, we quickly offload from this side and shorten the stance phase. As a result, we do not spend the same time on each leg, which creates an asymmetrical gait pattern or limp. To improve single-leg weight-bearing, it can be helpful to practice this stance phase in isolation. Use light support under your hands at the kitchen counter and practice single leg weight-bearing endurance. In addition to good quadriceps (front thigh) strength to maintain knee extension, hip abductor strength (the muscles of the outer hip) works to maintain the pelvis level when we transition to a single-limb support stance.
3. Toe Off
During this phase, the following joint positions should be achieved: hip extension (behind the midline of the body), knee extension (again, that straight leg position), ankle plantar flexion (pointed foot) and 1st (big) toe extension. Any of these joints may demonstrate joint stiffness (i.e. arthritis) or muscle tension limiting joint movement. It is not common for this specific phase in gait to contribute to a limp in your walking pattern.
Smooth transition from toe-off to swing phase (leg off the ground) requires knee flexion (bending), 1st toe extension (toe pushing on the ground), and ankle dorsiflexion strength. If the knee of the toe-off leg is stiff, and doesn’t allow passive knee bending, your body may compensate by hiking your hip to create clearance for the leg to swing through with a straighter knee. Ankle dorsiflexion strength is responsible for lifting the top of the foot up, so the toes don’t catch on the ground, which happens in ‘foot drop.’ Once the leg is in the air and has enough clearance, the rest of the phase is passive (happens without specific muscle activation or coordination), until the quadriceps become active to straighten the knee in preparation for heel contact.
As you can see, the ability to walk without a limp may have multiple contributing factors, including joint mobility (stiff versus flexible), muscle strength and length, as well as coordination of muscle firing and control. Sometimes, altered walking patterns have compensated for an injury or pain, and the joints and supporting muscles must be retrained. The adapted patterns can be challenging to unlearn even when the initial threat has passed or resolved. Have a limp and want to get your stride back? Contact us at Royal City Physio so we can help you keep moving with a strong gait!
Mikaela Barnes has a Bachelor of Science in Kinesiology and Master of Physical Therapy, both at Western University. Mikaela is passionate about understanding human movement, promoting body awareness, and establishing efficient motor patterns. Book with Mikaela today.