My journey as a therapist has been an interesting one. I started off wanting to work with athletes and found myself striving to be a spine specialist instead. I spent the first five years of my career working primarily on back and neck pain. This in turn led me to start a wellness center where I spent ten years working with a multitude of different conditions and where I really found my style of experimenting and devouring research studies. And that led me to opening my office in Saratoga five years ago where I found myself connecting these seemingly unrelated areas into treating patients as a whole rather than a body part or particular diagnosis.
The really interesting part is how each of these seemingly different directions kept me on track to stay open to learning new things and simultaneously focused my way of treating patients in a more and more complete way.
Let me give you an example. Several years ago I was treating a patient for lower back pain when I noticed he was walking with the same abnormal gait leaving as he had been when he came in. The strange part for me was that he had responded to the treatment and was leaving with no back pain. So why was his gait still off?
I started researching to find out and learned a lot about the mechanics of gait, but truthfully the reason for his gait eluded me.
Fast forward to about five years ago when I opened my office in Saratoga and my main referral source was a podiatrist so I was getting even more exposure to gait abnormalities. It was during this period of my career that I was doing a lot of experimenting with people trying to really understand what was happening to them individually. I learned the general way of looking at things and started testing how they worked on the individual. In my mind I was trying to find the most efficient and effective ways to teach them how to alleviate their symptoms.
During that time I treated a patient with a fractured fibula from a snowmobile accident. His gait mechanics were decent but he had pain every step. So I decided to figure out what way of walking caused the most relief and the most pain. He taught me that the best exercises for restoring his function to normal...the ones that supported the foot during ambulation...was not what I had learned from my research or my schooling. Or at least what I learned in school and research were not the best for this individual. This helped me see that it is crucial for the individual to find what works for them!
This experimental way of treating patients with an emphasis on finding what worked for them individually came full circle when I started noticing that the unusual gait I was seeing with patients that had lower back pain was also happening to patients with foot pain. And the treatments I learned from my research were not as effective as the treatments I had found experimenting on individual patients through the years.
I am often teaching my patients that the solution to their condition is to find the source of the problem and not focusing on the symptoms. So when someone comes with foot pain I want to make sure that their hip and lower back are moving properly because I have found trying to resolve foot pain with an abnormal gait coming from a painful back is way harder.
There are cases where someone’s foot problems are the source of the problem, of course, which leads to an abnormal gait. The bottom line is, in my opinion, you have to assess the whole system to find the issue with how you walk. This means if your balance is off, you have to investigate the whole system...the back...the hips...the knees...the feet and how these all work separately and how they work together.
I have also found that when I ask people to modify their gait by making their steps slightly more narrow, a whole lot of interesting things happen at the foot/ankle and above at the hips and lower back. Unfortunately when people feel unsteady they turn their hips and feet out to create a wider base of support. This leads to a side to side movement of the trunk instead of a rotational movement we normally have.
You may have noticed someone walking like they are wobbling side to side as they go. This person is not more balanced...despite the wide stance, the change to how they step actually makes them less balanced.
Often at this point, the person will unconsciously shorten their step length, thinking it is safer. Unfortunately smaller steps makes you even less secure. The comparison I use with this is a coffee table with legs closer together. If you bring the legs in together the coffee table is less stable, and so are we.
Another common area of confusion is choosing the right footwear to help with walking. Often people assume that if their feet hurt, then more cushioning will help. While some say it feels good to have more cushion, I have noticed people with a lot of cushioning in there shoe actually walk even worse, meaning they turn their feet out more and they widen their stance more. In addition these individuals will become heavier on their feet, essentially stepping harder to feel the ground.
And remember shoe manufacturers are trying to sell a product and often the research does NOT verify the claims being made by the companies. The memory foam in shoe is NOT helpful for your balance. I often compare it to walking on couch cushions all day. Even though it may feel good when you try them on, they may not be the best choice and may be contributing to your difficulty walking.
Some safe ways to start improving your balance and gait include building your strength in the muscle needed for walking...starting with the hips. I recommend marching in place to start holding onto something stable, and progressing to marching while walking in a hallway or by a counter. Next I recommend side stepping in a hallway and progressing to marching sideways holding onto a wall or counter for safety.
As far as actual walking I recommend starting with your feet closer together and keeping the narrow gait. I recommend this along a wall in a hallway or counter top for support. Remember that if you are not sure what to do, get help! Be safe!
My recommendation for footwear is to avoid stiff shoes with a lot of cushion. I believe that anyone recommending inserts (orthotics) should watch you walk before and after the inserts are made. Standing on a machine that measures your foot is fine...but in my opinion not enough. Walking and standing require different responses from the foot and an insert that helps standing may not be helpful for walking.
I believe that having an assessment is very helpful because if you have foot pain but your issue is coming from your lower back you want to make sure you address it at the source, otherwise you may create two issues instead of one. I also believe learning some mobility exercises help you stay active and this is especially true with walking and balance.
If you have had difficulty with your gait or balance, it can be helpful to take a fresh look at the variables that may be contributing to your issues. Often looking at the whole instead of the parts can help to shift your results.