PTY 312 (PATHOKINESIOLOGY)

C.M. ISHAKU BMR,PT, MSC, PGDM

2 ABNORMAL GAITS AND MUSCULOSKELETAL/NERVOUS
SYSTEM INVOLVEMENT

Antalgic Gait (Painful Gait):

Description:
• Characterized by a reduced stance phase on the affected limb to avoid pain. The
individual often compensates by limping.
Faults in Musculoskeletal System:
• This gait is typically due to pain in the hip, knee, ankle, or foot. Common causes include
arthritis, fractures, tendinitis, or other inflammatory conditions. There is reduced stance
phase to avoid full weight bearing, the hip and the knee joints are often in slight flexion.
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Trendelenburg Gait:
Description:
• Marked by excessive lateral tilt of the pelvis and compensatory trunk movements, dropping of the pelvis on
the contralateral side during the stance phase.
Faults in Musculoskeletal System:
• Stance Phase Deficit: During the stance phase of gait, the affected gluteus medius and minimus fail to stabilize
the pelvis.
• Pelvic Drop: On the contralateral side (unaffected limb), the pelvis drops instead of remaining level.
• Compensatory Trunk Movement: The patient leans the trunk towards the affected side to shift the center of
gravity and reduce the demand on the weak hip abductors.
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Spastic Gait:
Description:
• Characterized by stiff, jerky, and uncoordinated limb movements due to hypertonia
(muscle stiffness), exaggerated reflexes, and muscle weakness. This gait pattern is
commonly associated with upper motor neuron (UMN) lesions
Faults in Musculoskeletal System/Neurological affection:
• Hypertonicity and joint stiffness.
• Scissor gait, toe walking, circumduction, commonly seen in cerebral palsy, multiple
sclerosis, or stroke. There is increased muscle tone and hyperreflexia.
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Ataxic Gait:
Description:
• A wide-based, unsteady, and staggering gait. Individuals may appear as if they are drunk. Often due to
cerebellar dysfunction, which can be caused by conditions like multiple sclerosis, cerebellar ataxia, stroke,
or chronic alcohol abuse.
Faults in Musculoskeletal System/Neurological affection :
• There will be unstable trunk and uncoordinated joints movement. Erratic and poorly controlled limb
movement. Delayed or excessive foot lift, leading to irregular step lengths and Inconsistent foot placement
which increases risk of falls. Frequent stopping and adjusting to prevent falling.
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Parkinsonian Gait:
Description:
• It is characterized by slow, shuffling steps, reduced arm swing, forward-leaning posture, and difficulty
initiating or stopping movement.
Faults in Musculoskeletal System/Neurological affectation:
• Associated with basal ganglia dysfunction due to Parkinson's disease. There is reduced dopamine
production, leading to bradykinesia, rigidity, tremor, and postural instability.
• Decreased knee and hip flexion, leading to short, slow steps. Foot clearance is reduced, contributing to
shuffling gait. Reduced automatic postural adjustments, making it hard to adjust movements when
turning or navigating obstacles.
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Steppage Gait:
Description:
• is an abnormal walking pattern characterized by excessive hip and knee flexion during
the swing phase to compensate for foot drop (inability to dorsiflex the ankle).
Faults in Musculoskeletal System:
• This gait pattern arises from weakness or paralysis of the dorsiflexors, Inability to
dorsiflex the ankle during the swing phase leads to toe dragging, Exaggerated hip and
knee flexion,
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Waddling Gait:
Description:
• Waddling gait is an abnormal walking pattern characterized by bilateral lateral trunk sway,
excessive hip abduction, and a rolling movement of the pelvis, due to proximal muscle
weakness especially the hip abductors.
Faults in Musculoskeletal System:
• Often due to bilateral weakness of the hip girdle muscles. Common in conditions like
muscular dystrophy, congenital hip dislocation, or spinal muscular atrophy. The gluteus medius
and gluteus minimus fail to stabilize the pelvis, causing excessive side-to-side movement
(Trendelenburg-like gait on both sides).
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Scissors Gait:
Description:
• Is a pathological walking pattern characterized by excessive hip adduction causing the
legs to cross over each other during the gait cycle. This results in a narrow-based, stiff,
and spastic movement resembling a scissor-like motion.
Faults in Musculoskeletal System/Neurological affectation:
• The hip adductors are excessively tight and overactive, pulling the thighs together, weak
hip abductors and extensors reduce pelvic stability and stride control. Excessive internal
rotation of the hips due to spastic hip flexors. Ankle plantarflexors are often spastic,
contribute ng to toe-walking.
10 CORRECTIVE THERAPY FOR ABNORMAL HUMAN
GAITS
Antalgic Gait (Painful Gait)
Corrective Therapy:
• Pain Management: Use NSAIDs, acetaminophen, or other pain relievers. Consider corticosteroid
injections for inflammation (This should be used with caution by a train injection therapist).
• Physical Therapy:
- Stretching and Strengthening Exercises: Focus on muscles around the affected joint.
- Modalities: Heat, ice, and ultrasound to reduce pain and inflammation.
• Assistive Devices: Crutches, canes, or walkers to reduce weight-bearing on the affected limb.
• Orthotics: Custom orthotics to provide support and reduce pressure on painful areas.
• Treatment of Underlying Conditions: Address specific issues like arthritis, fractures, or tendinitis.
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Trendelenburg Gait
Corrective Therapy:
• Strengthening Exercises: Focus on hip abductors, especially the gluteus medius and minimus.
- Exercises: Side-lying leg lifts, resistance band exercises, hip abduction exercises.
• Gait Training: Improve walking patterns and reduce compensatory movements.
• Orthotics: Custom orthotics.
• Surgical Intervention: In severe cases, surgical correction of underlying conditions such as hip
dysplasia.
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Spastic Gait
Corrective Therapy:
• Physical Therapy: Emphasize stretching to reduce spasticity and improve flexibility.
- Techniques: Passive and active stretching, heat therapy.
• Medications: Antispasmodics such as baclofen or tizanidine.
• Botox Injections: To temporarily relax spastic muscles.
• Orthotic Devices: Ankle-foot orthoses (AFOs) for stability and support or any one as the need may
be.
• Functional Electrical Stimulation (FES): Improve muscle function and gait.
• Surgical Intervention: Selective dorsal rhizotomy (SDR) or tendon lengthening in severe cases.
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• Ataxic Gait
• Corrective Therapy:
• Physical Therapy: Balance training, coordination exercises, core strengthening.
• Techniques: Treadmill training with harness support.
• Occupational Therapy: Improve fine motor skills and daily activities.
• Assistive Devices: Walkers or canes for stability.
• Vestibular Rehabilitation: If ataxia is related to vestibular dysfunction.
• Medications: Treat underlying causes, e.g., vitamin B12 supplementation for deficiencies.
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Parkinsonian Gait
Corrective Therapy:
- Physical Therapy: Large-amplitude movements, balance training, flexibility exercises; stretching
and coordination exercises.
• Techniques: LSVT (Lee Silverman Voice Treatment) BIG therapy.
• Occupational Therapy: Assist with daily activities and improve hand function.
• Medications: Dopaminergic medications such as levodopa.
• Deep Brain Stimulation (DBS): For advanced cases unresponsive to medication.
• Gait Training:Visual and auditory cues to improve stride length and reduce freezing episodes.
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Steppage Gait
Corrective Therapy:
• Physical Therapy: Strengthening exercises for dorsiflexors (e.g., tibialis anterior), stretching
tight calf muscles.
• Ankle-Foot Orthosis (AFO): Support foot and ankle, preventing foot drop.
• Functional Electrical Stimulation (FES): Stimulate the peroneal nerve to improve
dorsiflexion.
• Surgical Intervention: Tendon transfer surgeries in severe cases.
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Waddling Gait
Corrective Therapy:
• Physical Therapy: Strengthening hip girdle muscles, core strengthening exercises.
• Occupational Therapy: Assist with mobility and daily activities.
• Assistive Devices: Walkers or canes for stability.
• Surgical Intervention: Address underlying conditions like hip dysplasia.
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Scissors Gait
Corrective Therapy:
• Physical Therapy: Stretching to reduce spasticity, strengthening weak muscles, gait training.
• Botox Injections: Reduce spasticity in adductor muscles.
• Medications: Antispasmodic drugs such as baclofen or diazepam.
• Orthotic Devices: AFOs or supportive devices for leg positioning and stability.
• Surgical Intervention: Tendon release surgeries or selective dorsal rhizotomy in severe cases.