As we discuss in earlier article, Gait is a person's manner of walking. Humans have bipedal walking pattern i.e. walking on rear 2 limbs. Conditions which causes abnormal gait.

A. Brain conditions;-

-       Cerebral palsy

-       Stroke

-       Post brain tumors

-       Post brain trauma

-       Multiple sclerosis

B.   Diseases of spinal cord

-       Traumatic paraplegia

-       Spinal cord tumors

-       Spastic spinal paralysis

-       Muscular atrophy

-       Post-polio syndrome

-       Degenerating diseases of vertebrae

-       Herniated Inter-vertebral disc

-       Spinal cord abnormalities 

  •    Spina-bifeda
  •    Spondylolisthesis

C.   Muscular diseases 

-       Muscular dystrophy

-       Myopathies

D.   Peripheral Nervous diseases 

-       Lesions of the lumbar & sacral plexus

-       Peripheral nerve lesions

-       Polyneuropathy

Testing Muscle Strength

          Walking needs all lower limb muscles strength of at least grade 4 or 5 for normal walking pattern to achieve.

          Weak muscle causes gait deviations causes abnormal pressure on joints involve in walking as well as lower &upper back/ spine. 

MMT Grading :-     

No  contraction      0        

Flicker  contraction      1        

Full  ROM in gravity eliminated      2        

Full  ROM against gravity      3        

Full  ROM against minimal resistance      4        

Full  ROM against maximum resistance      5      

Checking for muscle strength

a.     Knee extension force

b.    Hip extension force

c.     Knee flexion force

d.    Hip flexion force

e.     Ankle dorsi-flexion 

Checking of defects 

a.     Fixed flexion deformity above 15°

b.    Hip flexion contracture

c.     Sever lower limb spasm

d.    Joint deviation/ deformities

e.     Capsular or ligament instabilities

f.     Hyper-mobility of ankle joint

g.    Limb-length discrepancy more than 7 cm

Testing joint mobility/ ROM 

a.     Ankle joint

b.    Fixed Flexion Deformity in knee

c.     Vagus/Vagus deviation of knee

d.    Hip flexion contraction

e.     Limb-length discrepancy 

Exercises to improve Lower limb muscle strength 

a.     Knee extensors

-       B/L dynamic quads

-       Unilateral dynamic quads

b.    Hip extensors

-       Side lying hip extension

-       Prone leg raise

-       Dynamic hip extension in standing

-       Quadrepod kicks with knee 90° bent

c.     Knee flexors

-       Prone knee bending (unilateral or B/L)

-       Hamstring curls in standing

d.    Hip flexors

-       Dynamic Hip flexion in sitting

-       Dynamic Hip flexion in standing

-       Spot march

e.     Hip abductors

-       Side SLR in supine

-       Side SLR in side lying

-       Dynamic hip abduction in standing

-       Quadripod side dog kicks 

Exercise to improve mobility 

a.     Calf stretch

-       Self with stairs/ wall support

-       Passive stretch by therapist

b.    Hip flexor stretch

-       Lunges with wall support

-       Passive stretch by therapist

c.     Hip extensors

-       Hamstring stretch

-       Gluteal stretch

d.    Knee extensor

-       Quads stretch in standing

-       Quads stretch passive in prone

e.     Knee flexors

-       Hamstring stretch 

Progression of exercises to improve muscle strength & mobility

a.     Knee extensors

-       With Theraband

b.    Hip extensors

-       With Theraband 


Please note,

          Therapy should only be carried out in presence of qualified physiotherapist and only if the physiotherapist has taken in to consideration all the contraindications.

Gait training exercises

a.     To attain even weight distribution.

b.    Exercises for stabilization.

c.     Practicing initial heel contact up to stance phase.

d.    Practicing double step.

e.     Walking backwards & sideways.

f.     Walking on incline/decline surface.

g.    Walking on stairs

h.    Walk on uneven ground

i.      Low intensity sports

-       Walking in park

-       Walking the dog

-       Golf

-       Cycling 

Enjoy normal walking…