Healing Bridge PT- If it walks like a duck... PT in Bend Oregon

Wellness Concept

If It Walks Like A Duck…?

From the Healing Bridge Physical Therapy
August 2009 Wellness Notes

Most people have never really thought about how they walk unless they've been told that they're "pigeon-toed or that they "walk like a duck". Most folks just walk and assume it's working because they are able to get from point A to B without any difficulty. That is, until wear and tear breakdown of poor movement patterns showing up in their adult years. For some people it can occur in their back or neck. While others may feel it in the shoulders, hips, or knees. Although some of these aches and pains may interfere with walking, one might never consider that it may be HOW they walk is influencing or causing these aches and pains, unless the pain is in their feet.

When the feet hit the ground, everything changes! This is the title of a course offered to physical therapists, and it couldn't be more accurate. The truth is that our feet were designed to be walking on a three dimensional surface (the earth), without the consistency and one-dimensionality of pavement and flooring, and uninhibited by shoes with stiff soles and increasingly supportive insoles. Our ancestors also engaged in a variety of movements which went beyond forward walking. For these early hunter-gatherers, there were more lateral, side to side movements included in their day to day activities which helped maintain balanced strength and musculature through their feet, legs and backs.

From the time you were born, you learned how to walk through the influences of your environment - which usually meant flat floors, shoes for walking outdoors, and mimicking your parent's patterns of movement. Our current environment is wrought with such opportunities for developing poor walking patterns. These patterns may contribute to your aches, pains and injuries, or may be interfering with effective recovery from an accident. These patterns may also make one more vulnerable to injury due to the weaknesses and imbalances that have developed over the years. Effective corrections can be as simple as going out for a walk - with a new awareness and ability to pay attention to old patterns while playing with new possibilities.

Although most corrections should be individualized to each person or patient, I have noticed some generalities about healthy gait (or walking) patterns.

Let me recommend that as I describe these movements, you stop, play and explore to discover each of them for yourself. Initially, each of foot goes through 3 very basic phases each time they hit the ground:

1.	HEEL-STRIKE: This is when your heel meets the ground after swinging through the air following the previous step.
2.	FOOT-FLAT is what we call the phase as you let the rest of your foot come in contact with the floor.
3.	PUSH-OFF is when your heel lifts and (hopefully) you press through the ball of your foot to send yourself forward towards the next step on the opposite foot.

Ah, if it were all just that simple, you'd be home free. Let me point out some common errors and corrections in each of these phases. As you read these, I encourage you not to try them all at once. You may be overwhelmed and will give up! Instead, pick one or two, play around with them for a while, then add in another strategy.

1.	HEEL-STRIKE: Ideally is fairly central on the heel. However, if you check the bottom of your shoes, a common error for many people is to land towards the outside of their heel and you can usually identify this through the wear pattern on your shoe soles.
2.	FOOT-FLAT: Many people go quickly and directly from Heel-Strike to Push-Off missing some very important and useful functions of the "Foot-Flat" phase. After placing your heel, centrally on the floor, you want the outer part of your foot to come in full contact with the floor so that you are aiming towards your 5th/pinky toe. This DOES NOT mean to walk on the "outside" of your foot, lifting the inside of your foot. If you imagine a good "hang ten" foot print, you want some emphasis on creating that outer part of your own foot print. Think of letting the floor or ground "massage" the bones towards the outer edge of your foot.
3.	PUSH-OFF: This is where I see the greatest errors. Whether you have "high arches" or "flat feet", folks often go directly from heel strike to the base of the first toe, and emphasize the push off from there. Thus, missing the important outer edge of the foot during "foot flat", as well as the rest of the supporting toes. This one takes practice, and starting in slow motion can be helpful. After a thorough "foot flat" phase, your push off should start with the ball of the foot by the 5th/pinky toe and roll towards the first/great toe for the final Push-Off phase. Many people have learned to over-emphasize the push-off thought the 1st toe, so I teach my patients to aim for the 2nd or 3rd toe to push off through the middle of the ball of the foot. Although the ball of your foot before your first/great toe will ultimately be your final push-off toe, by emphasizing the 2nd and 3rd toes you will bring this inaccurate habit to balance through a more effective place with the rest of your foot. Another useful tip, is to learn to spread your toes through the Foot-Flat phase. Most people have had their feet in shoes that often inhibit full foot and toe movement. Freeing up the toes can make a significant difference in support and balance.

Finally, a common walking error is a tendency to lean a bit backwards, or hold the trunk a bit behind the pelvis. This is called, "sitting in the hips". This interrupts good back alignment and will place undo strain anywhere along the kinetic chain: Foot bones connected to the leg bones, connected to the back bones, connected to the shoulders and neck, etc…

Below are some additional tips for correcting this which could be applied during the Push-Off phase:

1.	Slight forward lean starting at the foot/ankle to the top of the head. (not to be confused with slouching through the mid-back and shoulders.)
2.	Think of holding your heel down slightly longer before lifting the back leg - Or, think of keeping the back leg behind you a ½ second longer before bringing it forward. (This does not necessarily mean taking longer steps)
3.	By keeping the back leg behind you longer, you can also think of a slight stretch in the front of the hip on the same side.
4.	Tilt your body slightly forward from the foot (not the hip, pelvis, or low back). Think of a laser beam coming out the top of your head up onto the ceiling. If you're Standing straight, it would be directly above you. In walking, with your body tilted slightly forward, the laser would point on the ceiling just ahead of your body.
5.	Feel into the length and strength of the toe pushing off, through the leg, through the lengthening of the spine, out the top of the head. Or, you can feel it from the top down: as if you had a string coming out the top of your head gently pulling you upward and slightly forward, sensing down through your head, neck, spine, pelvis, leg, and foot.

This is by no means a comprehensive description of all the things that go into healthy walking, but it is probably more than enough new information to get you started with your own healthy walking discoveries. (For more information, see reference at end of article).

As both a Feldenkrais Practitioner and a Physical Therapist, I wear two distinct hats. The P.T. in me gives you the parameters for healthy gait correction. The Feldenkrais practitioner in me encourages you to be playful, explore, notice how it feels when you use your feet and trunk in different ways, and come to your own conclusions through healthy explorations of what feels good, strong, and supportive for your body.

It's also useful to know that no one will ever get it "perfect", and there's always more to learn. The choice to notice, explore and play gives your muscles, tendons and tissues variety and helps keep the wear and tear breakdown at bay. Enjoy your new walk, even if, just to see what it feels like and compare different strategies, it means playfully walking like a duck

Reference: Walk Yourself Well by Sherry Brourman, PT

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