How to recover from a Limp

Part 2.

Practise even walking and weight bearing  within 48 hours of hip or back or knee or foot pain/weakness/stiffness or as soon as is safe after a fracture or surgery or fall. Otherwise the protective walking pattern (limps or a waddle) become the brain's new norm/default setting.  Once locked in, a limp/sideways waddle   is hard to reverse. 

Limping can also lock in pain.

To help: practitioners need to address the components of gait:

1. An even normal sized step

2. Even weight through each limb

3. Hip/pelvis stability: no sway side to side (Trendeleberg)

4. Strike the ground with heel first.

5. Walk tall. NO leaning forward, eyes forward (this can be the hard bit: good eyesight is needed to scan the ground ahead).

6. Reasonable Speed.

7. Trunk rotation (seen as a gentle arm swing)

THEN

• Every good step using good balance   prevents the brain learning and locking in  poor patterns. NO limping to the toilet or ‘just around the house.’

• Tailor and constantly upgrade exercises:  NO  generic tear off sheets. 

• Do them  little, often and diligently.

• Reminders and cues can help. Exercise when watching the  news  OR, when  waiting for the  kettle, OR before each meal/ after each cup of tea/whenever cleaning teeth or brushing hair: whatever works .

• Teach exercises at  home. Use the  kitchen /bathroom bench for safety.  

• Do exercises carefully, slowly, patiently, and CORRECTLY  to retrain walking patterns.

• Strength is an important component of gait. However, there is  too much focus on hip 'strengthening' and too little on good control and balance. Done badly, strengthening exercise can reinforce, not reverse, bad gait habits.

• DO NOT do that sideways hip abduction exercise. It is NOT functional and unless done perfectly, can lock in bad habits.

• Visual and sensory clues help balance. For therapists and helpers to ‘get’ this, try standing on one leg, eyes shut (again: practitioners NOT patients). A ‘fairy touch’ of finger nails on a bench makes balance significantly easier. Similarly: a light touch on a  walker  helps train  balance.

• Practice hip stability hourly . Stand up, pull up tall, (don’t lean forward) and feel weight evenly through both legs before walking forward.

• Whenever washing hands in front of the bathroom mirror, practice slight side to side actions to feel weight go steadily through each leg and the trunk hip muscles thrust upwards. Do  not let the hip or trunk collapse down or sideways.  Shoulders should  NOT dip.  

•  See video: concentrate on the quality of weight bearing and walking.

• Whenever standing/cooking/queuing check weight is going through both feet evenly. Most are not aware they stand on one foot more than the other.

• Walk up and down hallways (ideally with a mirror at the end of it to help correct side to side waddle) several times a day practising normal sized strides and minimizing side to side waddle. Touch walls if needed for balance.

• Measure the normal stride length (e.g about 55 cm or 21 inches for me). Put chalk marks on the floor every 55 cm or FIRM tape on floor to practice an even stride (take care not to create a trip hazard). OR use the apple app (see below)

• Marching in time to music, can help. Use arms for    rhythm/coordination and to loosen up trunk rotation.  

• Try walking in water for buoyancy if safe or supervised. Use water level to develop a stable pattern(i.e. don’t let this point on your arm sink below the water when walking). Water play is great for children with limps.

• A walking aid helps recovery, prevents falls and reverse limps.Remember  limping is a worse look thatn aids (and eventually  more dangerous). 

  I might say: ‘a walking stick looks better than a wobbly limp or waddle’.

  or perhaps ‘relatives will feel more comfortable taking you out if you are safer’ OR ‘Imagine falling in public: how awkward would that be?’

• OR use a walking pole or even better, two, to even things up. As someone said it looks and feels as if you are about to tackle a mountain: so much better than a walking stick.

• Aids should provide minimal physical support for weak joints/muscles. Importantly: instead they provide sensory clues that help balance.

• Use walking sticks in the OPPOSITE hand to the weak/painful leg

• Strong limps eventually make people feel more off balance and fearful which makes them slower and more watchful, so they look down. Walking slowly whilst looking down further decreases balance even in a fit young person (try it: its hard). This further reduces confidence. Its a downward spiral.

• To build up speed, try a light weight, easy to fold 3 wheel walker. 

• If prescribing a walking stick was hard: try promoting a walker! Ninety year olds tell me they are only for the infirm. This  is a pity. It’s no different seeing a young footballer with a walking stick or crutch after a knee reconstruction or using an exercise bike. Both can help regain fitness and decrease pain (or a limp). Aids should be viewed as means to an good end, not ‘the end’.

• I might say: ‘An  walker is an exercise gadget that will help get you out and about safely and improve your walking, fitness and balance. It can help the body/brain learn new patterns, and enable safe cardiovascular and endurance training which is vital at any age for general well being. Walking more evenly, safely, briskly and further will improve your  chances of continued independent living.’

• A walker should encourage upright gait and smooth even, normal sized steps with even weight through each leg. To  retrain:  use a  light touch  through the handles but keep  losing good upright gait . I   see folks, out and about,leaning into walkers. Similary mums pushing prams, arms reaching forward, bending their backs and leaning forward.  INSTEADF Step right into the frame (pram) with each step, keeping elbows BENT and locked in at the waist to avoid stretching arms forward and leaning.

• If a walker is unavailable try out a shopping trolley (loaded for ballast and NO wonky wheels). Take advantage of a shopping trip. Get there before the crowds and practice striding up /down safe empty areas to build up confidence for outdoor walks. ALWAYS use lifts with trolleys never escalators.

• Good patterns must continue to be practiced little and often. Every good, even step is yet another message to the brain to relearn good gait. Persist.

• Walking well takes concentration. Limp patterns become the brain’s default pattern. While they can be consciously corrected they usually re emerge whenever fatigued, emotionally tired, confused or nervous about safety. They are NEVER signs of attention seeking. This is a terrible misconception. Remember: It is very hard to fake a consistent limp.

• Do NOT sit long periods as this can lock in hip/ back stiffness which contribute to limps.

• If limping on a weak leg, stairs can be risky. Use the ‘bad leg to hell’ going down. BUT then  practise stepping down  a thick wooden bread board, holding the kitchen bench. See a physiotherapist regularly.

• Even with all the will in the world some limps cannot be completely reversed. At a minimum, exercise to prevent limps from getting worse and minimize the risk of falls, pain and injury.

  SAFETY first

July 2021 update:a useful function on iphone can help. Look for the health app with the heart on it. It reports walking distance which is a great incentive to progress steps every day.

In the ‘all health data’ section it measures walking asymmetry which detects side to side sway. It should ideally be 0 %. Keep the phone on your body as close to the midline as possible to give an accurate reading. If above 3% work through the above program/video to bring it down. This could take weeks/months.

It also measure stride distance . Many can use this technology as helpful biofeedback so give it a go.

Do not give up if progress is slow. It can take many many months to change limps.