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Tuesday, January 1, 2013

Limping: Possible Causes

Dr. Blake,

For majority of my life I've been told that I walk with a limp or that I'm stiff.  I've been tested for scoliosis and nothing was found.  I did notice that I sometimes have pain in left leg from walking and that I can't stand for long periods of time without ache in hips.  I saw primary care doctors and an orthopedic specialist, but I'm told it's just the way I walk.  I saw a chiropractor and he said I had a muscle weakness in my hip.  So I did physical therapy and it  improved but the problem is still there.  Are there any other options for solving this issue?

Thanks,

Anita (name changed)

Dear Anita, 
     
     Thank you for the email on limping. When approaching the problem, I typically go from simple to complex, or most obvious to least obvious cause. The most common cause of limping is pain or avoidance of pain. Since the pain can be focused at your hips, a workup of your hips for muscle imbalances or structural problems (like boney poor alignment) or degenerative problems is the starting point. Sounds like this was evaluated well.

     If I send a patient to a physical therapist, I love to have them do a complete muscle strength and flexibility exam of the lower extremities. This tests the 6 muscle groups at the hip, 2 muscle groups at the knee and 4 muscle groups at the ankle for both strength and flexibility . Hopefully, this has been done, but you may want to discuss this with the PT you saw. 

     I always watch the patient walk and study the gait pattern. Limb dominance, or a tendency to lean to one side, is commonly seen. This is a common reason patients feel that they limp, since one side of the body is taking more weight than the other. Short Leg Syndrome is the most common problem and my blog has extensive material on this subject. 80% of patients have one leg longer structurally, so it is very common. Treatment of that short leg may be all you need with some muscle imbalance corrections.

Limb Dominance to the Left with Short Right Leg


     Functional asymmetries, or a difference in how the right side of your body functions compared to the left side, has many many causes. Yet, it also is a very common cause of limping. One arch being higher than the other, one achilles tighter, one muscle or ligament weaker, can all lead to a functional asymmetrical walk. The body cries symmetry, so if asymmetry occurs, compensation to balance the eyes horizontal can force the body to limp. 

     So, in summary, the following are common, and typically ease corrections for limping:

  1. Correction of a Source of Pain (injections, physical therapy, bracing, etc)
  2. Muscle Strength Imbalances
  3. Muscle Flexibility Imbalances
  4. Short Leg Syndrome
  5. Functional Asymmetries
I hope this will give you some avenues to explore. Dr Rich Blake


     

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.