Sunday, November 20, 2016

Posture & Gait Assessment in the Clinical Setting

Morgan Walker, B.S., ACSM EP-C   November 3, 2016

Currently, there are over 47 million Americans age 65 years and above (56% women) and rising with the baby boom generation nearing retirement.1 An important aspect of aging is musculoskeletal atrophy and frailty which decreases function.  Two manifestations of atrophy and frailty are postural weakness and impaired gait patterns.  Postural weakness and impaired gait increase the risk of chronic low back pain and falling.  It is the obligation of the exercise physiologist to address these issues in order to improve the client’s function and quality of life.
Most clinical patients in the cardiopulmonary rehabilitation setting experience some type of low back pain.  Non-specific low back pain (NSLBP) is lumbosacral dysfunction and/or pain caused by one of several possible origins: stroke, arthritis, overuse, vertebral fracture, congenital malformation, etc.2 Whether postural weakness is the cause or result of the pain is irrelevant.  To address the pain, postural muscles must be assessed for strength and flexibility.
Loss of strength and flexibility in the postural muscles are often a result of decrease in physical activity due to the many factors of aging.  Using various special tests and functional movement assessments the EP can help reduce pain and increase physical activity by strengthening postural muscles with resistance training and stretching tight muscles.  Gait imbalances are also a concern with the aging population.
Gait imbalances can occur for many of the same reasons as postural weakness but the chief risk falling is simply aging.  According to one study, gait disturbance prevalence in people over 70 years old is 35%.3  In the cardiopulmonary rehabilitation setting, gait imbalances seen include: drop-foot, external hip rotation, shuffling gait pattern and various others.  Gait should be analyzed and progressively corrected in order to reduce fall risk.  Balance work should be incorporated into the strength and flexibility program.  Allowing the client to test his/her limits within a safe environment will boost confidence and teach the client to recognize the signs of weakness that could lead to a fall.  Ultimately a well-rounded exercise prescription that includes specific strength and flexibility training as well as balance work can improve quality of life for the client.
Low back pain and especially gait patterns have a multitude of origins.  Some are more affected by exercise programs than others.  It is the duty of the EP to research into each situation in order to design an intervention or work with other professionals in order to meet the client's’ goals and improve quality of life.        

1United States Census Bureau. (2015). American Fact Finder.  
2 Ehrman J., Gordon P., Visich P. & Keteyian S. Clinical Exercise Physiology-3rd edition. 2013.
3 Klaus Jahn, PD Dr. med., Andreas Zwergal, Dr. med., & Roman Schniepp, Dr. med. Gait    

 disturbances in old age. Dtsch Arztebl International. 107(17): 306–316.

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