Physical therapists are a key player in diagnosing and treating movement disorders, making posture and gait assessments must-have skills. Mastering these gait assessment strategies helps PTs develop effective treatment plans, improve patient outcomes, and enhance overall mobility and quality of life.
This article will explore what posture and gait are, assessment strategies, and ideas on how to develop treatment plans.
Understanding posture
Posture refers to how the body is aligned and positioned. Good posture evenly distributes body weight, reducing muscle and ligament strain. Proper alignment helps prevent injuries, improves breathing, and improves overall movement. Poor posture can lead to discomfort, pain, and long-term issues like scoliosis or kyphosis (especially as a child), impacting a patient’s quality of life.
Related: A Concise Guide to Lower Extremity Differential Diagnosis, Pathologies, and Special Tests
Common postural deviations
Some common postural deviations include:
- Forward head posture: Often from using electronic devices like cell phones, leading to neck and shoulder pain.
- Rounded shoulders: Caused by muscle imbalances (often resulting in tight chest muscles), restricting shoulder movement.
- Anterior pelvic tilt: Often due to tight hip flexors, this can cause lower back pain.
These issues often stem from prolonged sitting, poor ergonomics, and muscle imbalances, leading to pain and dysfunction.
Postural assessment techniques
There are several ways to assess posture, but a combination of multiple techniques is preferred to give a better overall picture of any deviations:
Visual observation
Visual observation is a primary tool in postural assessment. Physical therapists should look for alignment in the head, shoulders, hips, knees, and ankles to identify any deviations. Observing a patient’s posture while standing, sitting, and moving provides an all-round view of potential issues. Asymmetries associated with pain, like uneven shoulders or hips, can indicate underlying problems and guide treatment strategies.
Palpation and measurement tools
Palpation allows therapists to assess muscle tension and joint alignment. Tools like plumb lines and inclinometers provide objective data to support clinical observations. Inclinometers measure joint angles, helping therapists determine the extent of postural deviations. Digital posture analysis systems offer precise measurements and visual feedback, identifying subtle issues not visible to the naked eye.
That said, not every therapist has these tools available, and they are not necessary to determine postural deviations. However, they can be very helpful in determining a diagnosis.
Functional movement tests
Assessing posture during movements, like reaching or bending, helps identify dynamic postural issues that may not be apparent when the patient is stationary. These tests provide insight into how posture affects activities. For example, evaluating how a patient lifts an object can reveal compensatory movements that may contribute to pain or injury.
Understanding gait
Gait refers to how we walk. The gait cycle has two main phases:
- Stance phase: The foot is on the ground, accounting for about 60% of the cycle.
- Swing phase: The foot moves forward, making up the remaining 40%.
Understanding these phases helps therapists spot normal and abnormal gait patterns. A smooth gait is important for balance, energy conservation, and injury prevention.
Related: An Overview of Hip and Knee Rehabilitation for the Physical Therapist, Updated
Gait assessment strategies
Just like with assessing posture, it’s a good idea for physical therapists to take several approaches in their gait assessment strategies:
Video gait analysis
Video gait analysis captures detailed movement patterns. Slow-motion playback allows therapists to identify subtle issues that may cause pain or dysfunction. This analysis visualizes movement sequences, joint angles, and timing. Reviewing video footage provides visual feedback, improving patients’ understanding of gait deviations and encouraging active participation in rehabilitation. It also helps catch anything that was missed during visual observation.
Pressure plate analysis
Pressure plate analysis evaluates foot pressure during walking or running. This assessment identifies issues like overpronation or supination, which can affect the entire kinetic chain. Analyzing pressure patterns also detects areas of excessive force or instability, providing valuable information for customizing orthotics or recommending footwear changes. It’s especially useful for athletes or those with complex gait issues.
Functional and dynamic tests
Dynamic tests, like walking on different surfaces or at different speeds, help assess gait adaptability. These tests provide a comprehensive view of how gait changes under different conditions. Walking on an incline can reveal ankle weaknesses, for example, while uneven terrain highlights balance issues. Functional tests can include stair climbing or navigating obstacles, mimicking real-life challenges.
Common gait abnormalities
Gait abnormalities vary, with the most common ones ranging from overpronation and supination to antalgic gait:
- Overpronation: An excessive inward foot roll can lead to knee and hip pain.
- Supination: AKA outward foot roll may result in ankle instability.
- Antalgic gait: Often due to pain, shortens the stance phase on the affected side.
Conditions like cerebral palsy, stroke, or multiple sclerosis can also lead to distinctive gait patterns as well.
Impact on health
Gait abnormalities can cause compensatory movements, increasing injury risk in other body parts, like the knees, hips, or lower back. For example, limited ankle mobility may lead to excessive hip and knee flexion, causing overuse injuries. Early identification and intervention prevent further complications, improving mobility and reducing pain.
Developing a treatment plan
Combining posture and gait assessment findings allows therapists to create personalized treatment plans. These plans address specific issues, helping patients achieve optimal function and mobility. For example, a patient with anterior pelvic tilt and overpronation may need core-strengthening exercises and foot arch stabilization. Targeting the root causes of postural and gait deviations promotes long-term improvements.
Interventions and therapies
Treatment options include:
- Strengthening exercises: To target weak muscles and support proper alignment. This is often a key part in gait and posture rehabilitation. For example, a study found that hip strengthening exercises help alleviate low back pain better than no strengthening exercises.
- Flexibility exercises: To alleviate tension in tight areas and improve range of motion.
- Orthotics: To correct foot alignment and support the kinetic chain.
- Manual therapy techniques: Such as joint mobilization and soft tissue massage to restore normal movement patterns.
Patient education on posture and gait improvement is also important for long-term success. Educating patients about proper body mechanics, ergonomic adjustments, and regular exercise empowers them to take an active role in their recovery.
Education may also include management strategies for when a patient has a flare-up, which can improve plan adherence and overall quality of life.
Conclusion
Posture and gait assessment strategies are fundamental in physical therapy, offering insights into movement patterns and potential issues. By mastering these strategies, physical therapists can offer tailored interventions that improve patient outcomes, promoting better posture, proper and efficient gait, and improved quality of life.
Continued education and practice in these areas are important for staying up to date in patient care and rehabilitation. As therapists refine their skills and integrate new technologies, they can continue to make a significant impact on patients’ lives, helping them achieve optimal movement and function.
