An Introduction to Gait and Gait Abnormalities

Have you ever had knee, hip, back, or leg pain? Maybe the better question is—who hasn’t? Whether you are currently suffering from chronic pain or want to prevent pain in the future, gait could be key to achieving your goals.

We’re here to break it all down so you understand what gait means, how gait problems can create a vicious cycle of chronic pain, and how you can improve your gait to enhance your health and wellbeing.

What is gait?

In really basic terms, gait is the way you walk, how you move your limbs to get from one place to another. Each person’s gait is unique, which is why you can often recognize someone from afar by the way they walk.

However, if you ask a physical therapist to define gait, you might get a more complex answer. They might say that gait is the physics of the ground reaction force creating various forces or moment arms acting upon the body during each phase of the step cycle.

What is normal gait?

During the gait cycle, three things happen:

1. You move forward
2. You stabilize yourself on one leg while the other is in the air
3. You clear your swinging leg with every step

Your muscles should work to counteract the external force of your body weight connecting with the ground, your steps should be even, and the length of your step should be appropriate for your height and weight.

Normal gait requires good coordination because for a brief moment between each step, your weight rests solely on one leg. It happens so fast that you may not notice it, but whilst one leg swings forward, your other leg is holding you up. If your gait is normal, you won’t feel like you’re losing your balance when this happens.

Similarly, with a normal gait, you should be able to walk on a flat surface, with ease, and not have to think about how to place each step.

Why does your gait matter?

Walking might seem simple, but it’s actually very complicated (just ask a toddler!). Your gait involves numerous muscles, bones, and joints working together in a complex choreography.

To get an idea of how much coordination is required for the joints in the feet, ankles, knees, hips and lower back to produce a healthy gait, have a look at the illustrations of the feet and legs below.

Your Feet

More than 30 joints and over 100 muscles are in each foot alone and they all must work with your ankle, knee and hip joints when you walk. That’s quite a feat (pun intended).

Your legs and hips

You also use all the muscles in your legs and hips, including:

• Your quadriceps at the front of your thighs
• The hamstrings in the back of your thighs
• The gastrocnemius in the back of your lower leg
• The gluteus maximus muscles in your rear

What can happen if your gait isn't "normal"?

When someone has an abnormal gait, it can affect all the joints, bones, and muscles involved in the walking process. Gait problems also tend to be a vicious cycle—pain causes you to walk abnormally, which in turn puts excessive stress on your joints and causes more pain.

For example, if you have knee osteoarthritis, it can affect the joint positioning, whereby the cartilage degenerates the one side more than the other creating typically bowing legs. The increased force on the knee joint can further exacerbate the pain around the knee, hip or lower back. Osteoarthritis also affects all the muscles around the knee that are forced to compensate to support the knee. The muscles can become stiff and painful, preventing the knee from moving freely, which can create more difficulties swinging the leg during the gait cycle.

As you walk, when your foot hits the ground it sends shockwaves up your foot and leg. When your gait is normal, most of the shock is absorbed by your muscles around the foot and knee joints, and the rest travels in a straight line to the center of your body.

But when your gait is abnormal, the shock isn’t absorbed properly. For example, if you have varus legs (bow legs), the shock travels up your leg and exerts more force to the inner part of the which may push your knee outwards. Your muscles have to work extra hard to absorb the pressure on your knee, or else your knee can push even further.

These processes create the vicious cycle. The damaged knee places a load on different parts of the leg, which forces the muscles to work harder, which puts more pressure on the damaged knee and worsens the pain.

When your knee hurts and the muscles around it have to work harder to compensate, it also makes walking more tiring. Therefore, in some cases, you may not feel pain because your muscles are doing such a good job compensating, but you will find yourself tiring quickly due to the extra energy your body is expending.

Health conditions that can affect gait

There are many health conditions that can affect your gait including:

• Neurological disorders that impact balance, such as Parkinson’s
• Joint pain in your knees or hips, from arthritis or other inflammations
• Back problems such as a compressed disc
• Migraine headaches
• Injuries like a sprained ankle

But if you think all medical clinicians are experts in gait, you’ll be surprised to know this is not the case. The study and management of gait is actually a medical specialty that most doctors and physical therapists do not have a deep-level understanding in. To address gait problems, you would need to go to a gait specialist such as an Apos® trained clinician.

Can you fix your gait?

The short answer is yes, thanks to something called motor learning. Your gait is dynamic, which is both good and bad news. Most people who have an abnormal gait haven’t been walking that way since childhood—people generally start off with a normal gait, which is then affected by illness or injury. Once the original problem is resolved—such as a sprained ankle that heals—the person may have already unconsciously adopted an abnormal gait. This unconscious adoption of patterns of movement is called motor learning. Luckily, motor learning also works in the other direction. If your gait is abnormal, you can use motor learning to re-educate your body and brain to use your muscles correctly during the gait cycle which in turn can reduce and reverse those compensatory movement patterns. Physical therapy, for example, can help restore normal gait by strengthening weakened muscles to relieve pressure on joints. This can be painful if the affected joints are not biomechanically addressed. Apos^® supports motor learning using a foot-worn device worn that modifies your abnormal gait and gradually re-educates your body to healthy movement patterns. In order for the brain and body to learn new patterns of movement, two key things must happen:

1. A new, better way of moving must be introduced.
2. The new way of moving must be repeated in order to form a new motor pattern i.e. habit.

Apos^® combines both. It reduces the pressure on the affected joints and supports the biomechanics, therefore reducing the pain. When patients wear the device while going about their day-to-day tasks involving repetitive movements, such as walking, over time it fixes the patient’s movement patterns. A 2020 study published in the Journal of the American Medical Association showed that 92% of patients with knee osteoarthritis who were treated with Apos^® reported more than a 30% reduction in pain while 83% reported more than a 50% reduction in pain⁴².

How does Apos® help correct your gait?

Apos^® uses a personalized foot-worn device with pods that redistributes the force when your foot hits the ground to reduce the pain and support the affected joints and muscles. It improves your biomechanics and increases muscle control and coordination so that your gait becomes more fluid and controlled even when you aren’t wearing them. This is called motor learning.

The Apos^® foot-worn device and treatment treatment plan is FDA-cleared that relieves knee and hip pain and addresses lower back pain, which helps you move better, and reduces the use of pain medications, injections, and knee surgery.