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Monday, August 22, 2011

Basics of Gait Evaluation: Hips

When watching someone walk and/or run  (also known as gait evaluation), it is important to look at what the hips are doing. The hips are a reflection of shoulder motion (right shoulder and left hip), intrinsic hip and low back conditions, and  foot motion (or lack of). The green circle reflects normal hip motion and symmetrical right to left hip heights. The light purple circles represent some of the more common conditions seen. I am always asking if the hip evaluation represents shoulder abnormality, hip and/or low back abnormalities (including scoliosis and pelvic asymmetries), or foot and knee rotations. It is exciting to try to put the patterns together and make some sense out of them.

I remember one of my first race-walkers that I treated. Maryann had right hip pain with a long left leg, excessive foot pronation, exaggerated hip motion even in normal walking, and very tight ilio-tibial bands. As I co-treated her with a physical therapist, we successfully leveled the hips, stopped the excessive pronation, and stretched out the IT Bands. Yet, her hip pain was just as bad. A low back consultation felt that her pain did not come from the back, and the physical therapist did not feel that it was referred pain from her knee. Finally, I went to the track for one of her race walking training sessions. As I watched her walk, I realized and her coach, she did not move her left shoulder (or her right shoulder for that  matter). The hips should move equal and opposite to the shoulders (right hip and left shoulder) for maximal efficiency and ease of motion. The solution to Maryann's problem and then many years of painfree race walking was to get her to move her shoulders freely.

The checklist of hip gait evaluation observations is:

  • Symmetrical Hip Heights and Motion
  • Low Back Issues
  1. Lordosis
  2. Flat Back
  3. Scoliosis
  • Hip Motion Symmetry
  • Hip Height Difference
  1. Right Higher
  2. Left Higher
  • Trendelenberg (Hip Drop)
  1. Drop to Right
  2. Drop to Left
  • Hip Hike
  1. To Right
  2. To Left
  • Excessive Hip Motion
  1. Forward to Right
  2. Forward to Left
  3. Out to Right
  4. Out to Left
  5. Transverse Plane
  6. Sagittal Plane
  7. Frontal Plane
  • Limited Hip Motion

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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.