Gait Deviations Musculoskeletal Pain Syndromes: Is there a gait deviation or cluster of gait deviations which is common across musculoskeletal pain syndromes?

Gait deviations are considered risk factors and/or causative drivers for musculoskeletal pain syndromes.

There is a growing body of research showing a relationship between gait deviations and musculoskeletal pain syndromes injuries: shin pain (here, & here,) ; patella-femoral arthralgia (here); IT band syndrome; Achilles pain; plantar heel pain (here, & here). There is growing consensus among healthcare professionals cueing the individual to consciously alter gait deviations (here, here, here & here), to movements that are normal movement pattern when walking or running can:

• Alleviate pain
• Perhaps prevent injury
• Improve performance.

Research suggests there may be several gait deviations that are associated with different musculoskeletal pain syndromes. For example, the gait deviation of excessive pronation has been associated with both shin pain and plantar heel pain.

Given that a gait deviation can contribute to different musculoskeletal pain syndromes, it would be helpful to be able to identify a specific gait deviation or a cluster of gait deviations that contributes to all or most musculoskeletal pain syndromes.

Is one gait deviation or one cluster of gait deviations that is common across all or most of the musculoskeletal pain syndromes?

A few investigators have looked at this question.

Christopher Bramah and colleagues looked at a group of runners with injuries to determine if injured runners exhibited a gait deviation or cluster of gait deviations compared to runners who did not have an injury. They concluded that injured runners were more likely to exhibit a gait deviation of excessive lateral pelvic drop. Lateral pelvic drop is excessive movement of the pelvis. Image a female model walking on the runway accentuating the sway and movement of the pelvis.

Seyed Hamed Mousavi and colleagues conducted a systematic review of literature and meta-analysis to identify the common gait deviations associated with the most common running-related lower extremity injuries. Specifically, they were comparing gait deviations present with injured runners to a group of healthy runners. Their conclusion excessive pronation was the only gait deviation reported in all of the papers looking at lower extremity injuries.

Like much of medical research there is conflicting evidence.

Susanne Jauhiainen and colleagues investigated whether injured runners can be classified into subgroups based on observed clustering of gait deviations and whether the cluster of gait deviations occur independently of injury. They discovered clusters of gait deviations do occur. They identified 5 clusters.  However, they found no relationship between observed gait deviations and injuries.

The above investigations focused on injured runners. However, the purpose of the investigations is appliable to other musculoskeletal pain syndromes such as pains associated with osteoarthritis of hip or knee, or plantar fasciitis.

Bottom line my opinion:

• It makes sense that the way we walk and run is likely related to the development of musculoskeletal pain syndromes
• There is conflicting evidence whether a gait deviation or a cluster of gait deviations is more significant than another.
• Currently, there is no definitive evidence suggesting one gait deviation occurs more frequently or is more important than another
• Until additional research is available analysis of gait deviations needs to be individual clinical examination and development of working hypothesis between the healthcare provider and client
• Individual healthcare providers can develop a systematic procedure when choosing which gait deviation to intervene first during the clinical reasoning process solving pain associated with gait deviations

Damien Howell Physical Therapy – 804-647-9499 – Fax: 866-879-8591 At-Home, At Office, At Fitness Facility – I come to you, I do home visits Damien@damienhowellpt.com