•  

    Move Forward Guide

    Physical Therapist's Guide to Gait Dysfunctions

    Gait dysfunctions are changes in your normal walking pattern, often related to a disease or abnormality in different areas of the body. Gait dysfunctions are among the most common causes of falls in older adults, accounting for approximately 17% of falls. This guide will help you better understand how gait dysfunctions are categorized, and how treatment by a physical therapist can help you regain a healthy gait. Physical therapists are experts at identifying the root causes of gait dysfunctions, and designing treatments that restore gait.


     

    What are Gait Dysfunctions?

    Gait dysfunctions make the pattern of how you walk (ie, your gait) appear “abnormal." Most changes in gait are related to underlying medical conditions. Gait dysfunctions can be related to disorders involving the inner ear; nervous system disorders such as Parkinson's disease; muscle diseases such as muscular dystrophy; and musculoskeletal abnormalities such as fractures. In many cases, treatment of the underlying medical condition will help normalize the gait pattern.

    Common classifications of gait dysfunction include:

    • Anatalgic. This type of gait dysfunction is often caused by bearing weight on a painful leg. It can be related to arthritis or a traumatic injury, and is what many people refer to as a "limp." People with this dysfunction take slow and short steps, and quickly try to shift their weight off of the sore leg, ankle, or foot, and back onto the unaffected leg.
    • Cerebellar Ataxia. This gait dysfunction is often seen in individuals who have a condition of the cerebellum (a region of the brain), drug or alcohol intoxication, multiple sclerosis, or have experienced a stroke. The affected individual will have a wide-based stance (feet wide apart), and display inconsistent and erratic foot placement.
    • Parkinsonian. This type of gait dysfunction is often related to Parkinson’s disease and is characterized by short, shuffled steps.
    • Steppage. This dysfunction occurs in people with "foot drop" (an inability to lift the ankle), which is related to conditions, such as lumbar radiculopathy and neuropathy. Because the ankle will "slap" off of the ground, the individual will often lift the leg higher at the knee and hip, to clear the foot when taking a step./li>
    • Vestibular Ataxia. This pattern is often related to vertigo, Meniere’s disease (an inner-ear condition), and labyrinthitis (a type of inner-ear disorder in 1 ear). It causes people to walk unsteadily, often falling toward 1 side. 
    • Waddling. This pattern often arises from muscular dystrophy and myopathy, and causes individuals to walk on their toes, while swaying side-to-side.

    Note: These are only a few of the many possible gait dysfunctions. If you suspect you are walking differently, call your physical therapist for a gait assessment.

     

    How Is It Diagnosed?

    There are many different strategies and tools that can help a physical therapist diagnose a gait dysfunction. While other health care professionals are educated in the screening for potential conditions related to the gait abnormality, a physical therapist is the expert in diagnosing the actual type of gait dysfunction. Your physical therapist will ask you questions, such as:

    • When did you notice you were walking differently?
    • Is the problem getting better or worse?
    • Has it resulted in a fall or any additional problems?
    • Are you in pain while you walk?
    • Have there been any recent changes in your medical history, including changes in medications?

    Your physical therapist will also conduct certain tests to learn more about your condition. Your assessment may include:

    • Observation. Your physical therapist will ask you to walk back and forth, to observe any abnormalities in your gait pattern. 
    • Gait speed measurements. Your physical therapist will time your walking speed. Studies have shown that complications like falling are related to how fast you walk.
    • Balance tests. Your physical therapist may also assess your balance to determine your risk of falling.
    • Strength and range-of-motion measurements. These tests can help determine whether the dysfunction is due to musculoskeletal limitations. A physical therapist may utilize tools, such as a goniometer to measure your joint motion, or dynamometer to measure your strength. 
    • Reflex and sensation screenings. These measurements will help your physical therapist determine whether a neurological (brain or nervous system) condition is present.
     

    How Can a Physical Therapist Help?

    Physical therapists play a vital role in helping individuals improve their gait. Your physical therapist will work with you to develop a treatment plan to help address your specific needs and goals. Your physical therapist will design an individualized program to treat your specific condition.

    The treatment strategy may include:

    Pre-Gait Training. Your physical therapist may begin your treatment by having you perform activities and exercises that will help you understand how to improve your gait, without taking a single step. These exercises may include simple activities, such as having you stand and lift your leg in place, to more complex strategies like stepping in place and initiating contact with your heel to the ground, prior to other portions of the foot. 

    Gait Training. Your physical therapist will help you focus on retraining the way you walk. Because the underlying condition may be vestibular, neurological, or muscular, variations in the training exist. Your physical therapist will design the safest and best training for your specific condition.

    Balance and Coordination Training. Your physical therapist may prescribe balance activities for you to perform to help stabilize your walking pattern.

    Neuromuscular Reeducation. Your physical therapist may employ neuromuscular reeducation techniques to activate any inactive muscle groups that may be affecting your gait.

    Bracing or Splinting. If the gait dysfunction is due to significant weakness or paralysis of a ligament, your physical therapist may teach you how to use adaptive equipment, like a brace or splint, to help you move.

     

    Can this Injury or Condition be Prevented?

    Because gait dysfunctions are related to many different types of underlying conditions, they may not be preventable. However, if they are addressed and treated early, many gait dysfunctions can improve and will not result in additional problems, such as falling. 

     

    Real Life Experiences

    Renee is a 44-year-old nurse who covers a lot of ground making her rounds at a local hospital. About 2 months ago, while carrying her laundry basket upstairs at home, she lost her balance on the third step and fell down to the bottom of the stairs. She "shook it off" and continued with her busy day.

    In the weeks following her fall, Renee noticed she was having a little difficulty walking in a straight line. She began to avoid certain activities, like going to the gym. She recently noticed an onset of clumsiness while walking at work. She called her physical therapist.

    Renee's physical therapist conducted a full physical examination, and asked about her symptoms. Renee reported that, in addition to the clumsiness at work, she experienced fatigued and just felt an overall "weakness."

    Renee's physical therapist noticed a decrease in strength throughout both of her legs and ankles. Using further testing, he detected that Renee also had poor balance while standing, and heightened reflexes (when tapping her leg with a reflex hammer, her leg extended more than it should). When observing Renee walking, he noticed a wide-based gait pattern, and that Renee was placing her feet in different places with each step.

    He explained to Renee that the symptoms he identified may be related to a condition of her nervous system. He contacted her doctor, who ordered several tests, including a spinal tap and an MRI. The test results confirmed that Renee had multiple sclerosis.  

    After she began the medical treatments her doctor prescribed, Renee was referred back to her physical therapist to determine a plan of care to address her strength, balance impairments, and gait dysfunction. Renee and her physical therapist developed a plan of care that addressed each of these conditions, while working toward her goal of returning to the gym. 

    Renee attended physical therapy sessions for several weeks. She learned how to perform exercises that focused on her ability to bear weight on 1 leg while moving the other, which would ultimately improve her gait and balance.

    After 6 weeks of physical therapy, Renee was able to return to the gym. She continued a home-exercise program designed by her physical therapist, to maintain her strength, flexibility, and restored gait pattern. Today, she's looking forward to taking her first short hike through the local shopping district, with her new-found walking group.

    This story highlights an individualized experience of a gait dysfunction. Your case may be different. Your physical therapist will tailor a treatment program to your specific needs.

     

    What Kind of Physical Therapist Do I Need?

    All physical therapists are prepared through education and experience to treat conditions, such as gait dysfunction. However, when seeking a provider, you may want to consider:

    • A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
    • A physical therapist who is well-versed in the treatment of gait dysfunctions.
    • You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

    General tips when you're looking for a physical therapist (or any other health care provider):

    • Get recommendations from family and friends or from other health care providers.
    • When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with gait dysfunctions.
    • During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and keeping a journal highlighting when you experience pain will help the physical therapist identify the best way of approaching care.
     

    Further Reading

    The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions, and also prepare them for their visit with their health care provider.

    The following articles provide some of the best scientific evidence for the treatment of gait dysfunctions. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

    Morris ME, Martin CL, Schenkman ML. Striding out with Parkinson disease: evidence-based physical therapy for gait disorders. Phys Ther. 2010;90(2):280–288. Free Article.

    Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin North Am. 2006;90(5):807–824. Article Summary in PubMed.

    Lopopolo RB, Greco M, Sullivan D, Craik RL, Mangione KK. Effect of therapeutic exercise on gait speed in community-dwelling elderly people: a meta-analysis. Phys Ther. 2006;86(4):520–540. Free Article.

    Jette DU, Latham NK, Smout RJ, Gassaway J, Slavin MD, Horn SD. Physical therapy interventions for patients with stroke in inpatient rehabilitation facilities. Phys Ther. 2005;85(3):238–248. Free Article.

    *PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

    Authored by Joseph Brence, PT, DPT, FAAOMPT, COMT, DAC. Reviewed by the MoveForwardPT.com editorial board.