What causes a limp ?

Anyone at any age can develop a limp. Few  would be aware of one developing. They might start off as  a slight hip stiffness or a slight list and end up with an ungainly side to side wobble.

They can be caused by conditions such as congenital dislocated hips, or neurological conditions such as cerebral palsy and strokes.  The effects of polio affect the gait of those  who  missed  vaccination.    A leg that is much shorter than the other, (sometimes following orthopaedic surgery for trauma) or congenital scoliosis may be responsible.  (NOTE: Most people have slight leg length discrepancies of a centimeter or two. These have NOT been proven to cause pain or a limp).

Obesity can trigger a limp if thigh muscles are unable to work in a normal alignment.

Limps are most commonly caused by pain or injury. They can start with a fracture or something as trivial as a corn or a vague niggling pain in the spine, hips, knee or feet. They can linger on long after a painful problem has been (apparently) resolved by time or surgery.

 The science is vague on the cause of  a lingering limp. They might be brushed off several ways: eg as due to arthritis, osteoarthritis  or an ongoing injury OR ‘weakness’ OR, more commonly (NO) thanks to Freud, as a psychosomatic problem.  That is:  ‘all in their heads’. YET according to the American psychiatric bible, the DSM V, the term psychosomatic now means someone who overreacts or worries about a condition rather than someone whose pain (or limp) is caused by a psychological condition (and why wouldn't anyone worry about a unexplained condition?).

 The idea that limps are psychological is false and harmful. I have seen wives, husbands, parents frustrated and annoyed with their relative’s limp. I have been told by a parent that their child was ‘just attention seeking’.  Some  suggest relatives  are  ‘cowardly’ about pain or ‘ not  trying hard enough.’

Yet: Limps and stiff painful joints/spines are formed and maintained at a deep level of the brain/neurophysiological system. They are not made up or caused by a psychological or emotional conditions.   Few can even imitate them: it takes trained actors a lot of work to develop an authentic and consistent limp. 

Fear and anxiety can play a supporting role if patients are told that their pain is due to ‘wear and tear’ or damage and instructed to protect their joint.  They become reluctant to put  weight through a painful leg in case it causes more damage. This avoidance behavior can  lock in a limp. Limps can become  dangerous as they increase the risk of a fall.

Instead:

Weight put gradually through  injured bones  helps repair them and sensible weight bearing exercise is good for joints. 

So how do we explain limps that linger  after pain has gone?

Some basic neuroscience:

Walking becomes autonomous (meaning : done without  thinking) from an early age.    The muscles are programmed to function by the  neuro muscular system. If there is danger or damage, say a bad fall, or overstretched (or strained) muscles, or following a fracture, or surgery or following pain this system changes gear. It creates a new template for walking to protect the limb. It takes the weight off joints and bones to assist healing. It weakens hips muscles which triggers the side to side waddle. This  pattern can quickly become   the new default pattern creating the limp.  The longer left in this default the harder it is to reverse and,gradully, the more exaggerated (adn dangerous) it becomes. With age the  system   more readily goes to a protective pattern but is less able to reverse it.  It is like driving a car  in first gear on slippery roads then  forgetting how to change  gears back. At a certain point these limps can become almost impossible to reverse. SO it is important to prevent them starting and or getting worse.    

See my blog on what to do about a limp.