The Art of Gait Analysis

In today’s age of technology, there are so many ways in which we can analyze a patient’s gait (manner in which someone moves). Years ago I purchased Dartfish Software, which along with a high definition video camera, my office treadmill (or a trip to the track), and time to break down the video, I would come up with a detailed breakdown of someone’s walk or run.  I was particularly interested in breaking down the asymmetric patterns of gait, rotational differences, compensations, vertical displacement and posture.  Today, with an iPhone and any of a dozen apps (golf apps work great too!) you could learn in minutes that your left hip is dropping, right knee buckling, over pronating on your left foot, have a high shoulder, forward pelvic tilt, asymmetric arm swing and tilted head.  There are even clip on and in shoe sensors that can give you acceleration, rotational velocity, impact load and any other number of data points to help measure and analyze running.  Once you have the details, the next step is to use that data.  But how?  If you are at a shoe store and the expert shoe salesman is watching you walk or run, then of course you get the shoe that will fix it all.  Locally (in Boston), there is both Spaulding rehab center and Children’s Hospital that offer not only Gait analysis labs, but also have clinics to help people retrain how they run.  Of course, there are countless Physical therapy practices and running coaches who offer gait analysis as well as clinics that can help you identify your weaknesses and retrain your gait.

The premise of gait analysis is great.  After all, we need to be able to identify why someone is getting hurt or why someone isn’t performing as they should.  It is also logical to assume that if we know what is going on, we should be able to fix it.  If life were only that simple.  Ask any high handicap golfer who has their swing analyzed and takes lesson after lesson and practices and practices to better their game.  How many of them go from high handicap (high handicap means you need a lot of help with your game) to a scratch golfer (meaning you really fixed whatever problems were identified in the analysis)?  Virtually no one is able to do this.  The one’s who do best are the one’s who devote hours and hours to meaningful practice.  Yet still, the best hope would be to become better, not perfect.  Do patients really have the patience to devote so much time to correct their habits of movement, especially when it could take years to make change?  Don’t we just want to run now?

In today’s modern world, we can analyze gait like never before.  The limitations are no longer in understanding, but in correcting.  Every human being is different and every one of us develops our own unique signature pattern of walking, moving and running.  The patterns develop early in life and are constantly adapting to changes in growth, years of sitting while in school (negatively affecting posture) as well as having feet that perpetually change in relation to your footwear (feet grow at different rates than shoes).  People sustain injuries as well as participate in sports that require specific asymmetric movement. These all have a major impact on the habits and patterns of movement we display throughout life.

With a myriad of differences each human being displays, the “fix” for problems identified in any gait analysis must be customized to each person and their specific need(s).  Or does it?  Also, who’s to say that the person analyzing the gait is correct in what they see, or in the presumptions they make?  Assuming that the clinician or individual who is assessing gait is 100% correct in their analysis and the specific needs of that patient, then who is to say that the person being analyzed is moving/walking/running in a way that is reflective of how they became injured in the first place?  After all, running form at mile 18 of a 21 mile run on week 17 of a 20 week marathon training build is likely going to be different (fatigue of the training and fatigue of the run) than the 1^st 5 minutes on a treadmill while someone is fresh, injured, or not warmed up, etc.  For all of these reasons, no matter how much science is put into gait analysis, it’s the Art of gait analysis that makes it work.  Cookie cutter programs, group workshops, books on better run form or any other potential “quick fix” is limited in its ability to truly impart lasting and meaningful change.  Many of the programs are, however, very useful in helping people start the foundation towards better movement and at the very least, get people thinking about what they ultimately should be trying to do.  In a prior article, How to Run, I stressed the importance of feeling the change, not forcing the change.  Children are not taught to walk or run, it’s something they are programmed to do. It is a learned process that develops over many years.  As much as it makes logical sense that you can teach someone to walk or run, it’s still something that has to come from within that individual, and from within their centers of the brain that control basic movement patterns.

Is there a proper way to run and do we all have to run the same way? 

My answer would be that it depends.  I would say that the correct way to run would be the method that helps us best sustain posture over the long term.  When you are walking and running (and moving) in proper posture, then your movements are efficient; i.e. made with much less effort.  Less effort means less fatigue and less fatigue means less likelihood of injury.  Chronic injury, after-all, will result when your body moves in a way that forces bones, joints, muscles, tendons and ligaments to perform actions in a manner that they are not designed to perform…repetitively.  Therefore, running with proper posture is the manner in which we all should be running.  Yet, there are so many variances of posture in human beings, that posture will in fact look different from one individual to another, even though they are running “the same,” or, in posture.  There are, of course, many people with body adaptations, poor work-life balance, or other physical/neurologic limitations that prevent their ability to obtain proper posture.  What then?

Each of us has a threshold we can reach where it won’t matter how poor our form is, we won’t become injured.  That threshold could be 2 miles for some, 100 miles for others.  It could be trying to run a 20 minute 5K when natural ability dictates 22 minutes.   Further, the threshold lowers with the cumulative stresses of repeatedly trying to outpace your current ability in addition to other non-running related factors that affect (injury) threshold; lack of sleep, poor nutrition, increased stress to name a few.  Once we cross our natural limiters, we’ve crossed a threshold where injuries can happen.  If someone’s activity level always remains below that injury threshold, then they should be able to run as they like with little risk of injury, and not have to worry about trying to improve something that needn’t be improved, or realistically can’t be improved.

There is absolutely a place for gait analysis, and something that I will continue to do in trying to help the injured athlete, or try and help the motivated athletes become more efficient.  At the same time, it’s important understand that the greatest benefit one can obtain from Gait analysis, is when the Science of the analysis is blended with the Art of understanding how to properly guide each individual based on where they are at, what their realistic goals are, and most importantly, how patient they will be in seeing them through.