Wednesday, June 25, 2014

Wisdom Wednesday: GAIT MECHANISMS

The last step in the QA protocol is the evaluation for gait. The neurological organization required to walk upright is very complex. (Please review my blog “Did Walking Upright Make Humans Smart” posted on Friday, June 6, 2014) It takes most of us about a year to learn the process as infants. These neurological patterns develop from the “cross crawl” human babies use prior to walking.

Gait evaluation examines these patterns looking for distortion as it relates to structural issues. I commonly test the latissimus dorsi or “lat” bilaterally as my last step during an office visit. With the patient standing, feet even, I test for a strong latissimus dorsi with the left arm. Then the patient takes one step backward with the left foot. Now they are in a gaited position, as if they were walking. The left latissimus dorsi should now become weak if there are no abnormal gait patterns at work. The procedure is repeated on the right, looking for the muscle to weaken with the right foot back.

The concept is that we walk with a cross crawl pattern. That is the left leg and right arm move forward together as do the right leg and left arm. The latissimus dorsi must weaken as the opposite leg moves forward in order to allow the arm to come along. If this does not occur, a gait mechanism is present.

The presence of a gait mechanism indicates that some additional structural misalignment still exists and needs to be corrected. Usually, it is misalignment of one or more of the major joints in the legs or pelvis. However, misalignment of a shoulder, elbow or wrist can also result in a gait issue.

Once corrected, neurological patterns then support normal function and help the patient “hold their adjustment” rather than reinforcing the problem. I never cease to be amazed how correcting a misaligned ankle can be the key to a chronic case of sciatica.

If a patient has symptoms for more than a week, they will typically have a gait mechanism. It is just a mechanical compensation for their musculoskeletal problem. However, with very chronic issues, the gait often does not appear on the initial visit. It is only when the patient has had some level of recovery – reduction in pain or inflammation – that the gait will suddenly appear. This is usually a good sign as it requires resolution of some or most of the major factors that drive chronic musculoskeletal problems.

It is much like trying to correct a bad golf swing. The longer the mechanics have been employed improperly, the harder it is to “relearn” to hit the ball properly. In fact, it is much easier to teach the novice golfer to hit the ball right than it is to teach the seasoned golfer with bad habit.

The patient with acute low back pain, first episode, of less than a weeks’ duration is an easy fix. It is the chronic low back patient with multiple, overlapping episodes, that presents a challenge.

Over the course of the past several months, I have reviewed the step-wise protocol of QA (Quintessential Applications) on Wednesday Wisdom. I hope you can appreciate how the format takes this complex human body and allows the practitioner to correct imbalances in a sequential process that maximizes results.
In my office, every patient is evaluated through the first six steps and the last six steps regardless of their chief complaint. That addresses the nervous system, inflammation, and musculoskeletal issues. The middle steps are reserved for immune, endocrine, and digestive issues.