Going back to my patient from last time..
Unfortunately a few laps up and down our hallway didn’t miraculously restore her to pain free walking. What it did do though is show her that she was able to make a change that reduced her pain, and that she could do an activity that she really enjoyed..walking. She wasn’t “broken” and, with a little help and guidance from me, she had the power to “get back to normal”.
The steps we took included mobilizing her hip, ankle and, perhaps surprisingly, her thoracic spine (upper back). I showed her some hip strengthening exercises, stretches for her hip ankle and upper back, and several balance exercises. Once she had some more flexibility and strength in these under used areas, we started to practice walking.
Initially she walked and I gave her cues to think about. This worked fairly well but not great. The most effective thing however, was getting her to change her walking speed. She had become so careful of her walking that she moved with a slow, very controlled and stiff gait. My cuing didn’t help. Once I had her try walking faster though, suddenly things evened out. She automatically aligned her feet better, rotated he body and swung her arms in a way that effectively balanced her momentum, and was able to walk with 80% less ankle pain. She also described the sensation as being “less like pain and more like a tired feeling”. Perfect! Now she was making those underused muscles do their job again.
Now we had something to work with. Now her homework was to walk fast. Spend some time each day walking quickly up and down her hallway at home, When she could, walk quickly in the hallway at work. If she got tired rest, but do her best to keep up the pace. She had a favorite loop that she used to walk in the evening. We started back to doing laps of that. Only one to start because the increased speed tired her quickly, but as of this week she is up to three, and she spent a day out shopping and walking with friends. Something she had avoided but really missed over the past few months.
So why did this work? In her case, she had put so much thought into how to move to protect her ankle that it was difficult to change her new gait pattern with more conscious actions. But when I had her stop thinking about how to place each foot and think of only going faster, her old patterns of movement started to appear. Automatic patterns that we were able to bring out by avoiding focusing on the parts and instead doing the whole movement, but in a way that stimulated her reflexive gait pattern. Something that she once did naturally, but had forgotten. We just had to trigger that reflexive pattern again, and keep triggering it until it became the new normal. So far so good.