Waddling gait- definition|role of muscle|gait analysis|kinematic and spatiotemporal deviations| physiotherapy treatment

This powerpoint is about WADDLING GAIT,muscle that cause waddling gait , its causes, reasons for why this gait is called duck gait and pregnancy gait, gait analysis , and its physical therapy treatment

1. Waddling gait JASNA OK 4 th year BPT

2. INTRODUCTION NORMAL GAIT Human gait refers to locomotion achieved through the movement of human limbs. Gait is a series of rhythmical & alternating movements of trunk & limbs which result in forward progression of center of gravity & the body . ABNORMAL GAIT Abnormal gait  is when a person is unable to walk in the usual way. This may be due to injuries, underlying conditions, or problems with the legs and feet.

3. In general gait deviation fall under following headings. Neurological gait :- Parkinson gait, Hemiplegic gait, Ataxic gait, Scissoring gait(crossed-leg gait) 2 . Muscular weakness gait:- Gluteus medius gait, Trendelenburg’s gait, Waddling gait, Gluteus maximus gait , Quadriceps (hand to knee gait) , High stepping gait Genu Recurvatum gait, 3. Joint or muscular limitation gait:- Toe tip gait, Calcaneal gait, Hip flexor contracture gait, Stiff knee gait 4. Leg length discrepancy gait:- Equines gait 5. Painful gait:- Limping gait .

4. Waddling gait It is an abnormal gait pattern ,the patient walk like a duck Usually found in the people with bilateral weakness of gluteus medius muscles. which is the primary hip abductor. Role of hip abductors in gait The hip abductor muscles stabilize the hip within the frontal plane during the single-limb support phase of walking. ( i.e. when a given limb enters mid stance , the opposite leg is in it’s swing phase –not in contact with the ground)

5. The tilting of pelvis is controlled by the hip abductor muscle of the stance extremity For example, pelvis drop on the side of the right swing is controlled by the isometric and eccentric contraction of the left hip abductor muscle

6. Role of hip abductors – in waddling gait The gluteus medius originates from the ilium (between ant. and post. gluteal lines), an d it inserts on the lateral surface of the greater trochanter. Its contraction pulls the two insertion sites toward one another, thus elevating the opposite side of the pelvis.  Its weakness causes contralateral sagging of the pelvis (Trendelenburg Sign)

7. Trendelenburg described it as a pelvic drop on the side of the swinging leg and compensatory lateral trunk bending towards the side of the standing leg If the weakness of gluteus medius is only in one side (contralateral) the gait will be Trendelenburg gait Bilateral weakness of gluteus medius leads to dropping of the pelvis on both sides during walking leading to waddling

8. When the patient walks, he / she can't stabilize the pelvis, When one side of the pelvis drop , in order to avoid fall the patient will laterally bend the trunk to opposite side This gait is also called “ DUCK GAIT ” – because the patient is walk like a duck while walking the patient’s body sways from side to side on a wide base. Therefore the patient lurches on both sides while walking

9. There will be increased lumbar lordosis with shoulder thrust backward and abdomen being protuberant Waddling gaits are commonly seen in pregnant women, especially during the third trimester. Therefore it also called pregnancy gait

10. Gait analysis During the mid-stance, the pelvis drop towards the non weight bearing extremity, in order to compensate the fall , person will shift the weight in the stance extremity or to keep the COG over the stance leg Then the body will swing towards the weight bearing leg And trying to get hyperlordotic and lock back over the other hip

11. Kinematic deviations During stance phase: The weakness of proximal muscles of hip girdles, will interferes with the stability of the pelvis during walking Excessive trunk lateral flexion occurs in frontal plane Posterior pelvic rotation Hip adduction increases Increase in hip flexion in sagittal plane Knee flexion occurs with valgus Dorsiflexion also increases

12. During swing phase: The failure to stabilize pelvis, it will produces exaggerated rotation of the pelvis with each steps Pelvic tilt downward Anterior pelvic rotation Increased knee flexion in sagittal plane during acceleration phase Dorsiflexion increases in sagittal plane during acceleration and midswing phase

13. Spatio-temporal deviations Short steps or step length will decreases Stride length will become less step width:- will increase Wide base of support Stance duration increases swing duration will be less Cadence increases speed reduction longer double-support time

14. Causes of waddling gait Myopathies, such as muscular dystrophy. developmental dysplasia of the hip (DDH; formerly called ‘congenital’ dislocation) Superior gluteal nerve injury Pregnancy trauma to the pelvic musculature like a slip and fall or a motor vehicle accident that may be causing the weakness of the pelvic muscles resulting in a Waddling Gait. Osteomalacia L5 Radiculopathy OA of hip Avulsion of gluteus medius tendon following hip surgery

15. Waddling during pregnancy During the second trimester, body starts producing relaxin, a hormone that relaxes the joints and ligaments in pelvis, allowing it to widen. it can affect the way of walking. In the later stages of pregnancy, the belly starts to jut out significantly, which can throw off the center of gravity and make it harder to balance, especially while walking. The spine and pelvis may also start to curve , to support the growing belly , causing to lean back slightly while standing or walking. Both of these factors can also cause a waddling gait.

16. Having a waddling gait while pregnant is normal and nothing to be concerned about. In fact, it can even reduce the risk of falling. Waddling gaits tend to go away after delivery characteristics wide base of support increased lumbar lordosis lateral shift of the trunk

17. Physiotherapy management  Main purpose of physical therapy is to strengthen the abductors of the hip. To improve balance To correct the posture Improve the gait The management include :- Strengthening programs Gait training Functional balance exercises

18. Strengthening programs Primarily target the muscle that are responsible for gait (gluteus medius muscle) The muscle to be strength while walking is gluteus maximus and  hamstring  for hip extension, quadriceps for knee extension, soleus &   gastrocnemius   for ankle planterflexion and dorsiflexion to step forward. Progressive resisted exercise using weight cuff, theraband, resistance tube  Active ROM to the hip joint: the movement involves hip flexion, hip extension, hip adduction, hip abduction and rotation

19. Strengthening exercises are starts with supine hip abduction Hip Abduction in supine lying Repeat this on both sides Side lying Hip abduction Repeat this on both sides

20. Resisted supine abduction with theraband Side lying Hip abduction with theraband

21. Resisted abduction with theraband Sitting abduction with theraband

22. Abduction – using weight cuff Resistance exercise using resistance tube

23. clamshell exercise Lie on one side, with legs stacked and knees bent at a 45-degree angle. Rest the head on lower arm, and use top arm to steady your frame. Be sure that your hipbones are stacked on top of one another, as there is a tendency for the top hip to rock backward. Engage your abdominals by pulling your belly button in, as this will help to stabilize your spine and pelvis. Keeping your feet touching, raise your upper knee as high as you can without shifting your hips or pelvis. Don’t move your lower leg off the floor. Pause, and then return your upper leg to the starting position on the ground. Do 20 reps on each side.

24. Clamshell exercise with theraband Place the band around both legs, just above the knees. Lie on one side with knees at a 45-degree angle, legs and hips stacked. Contract your abdominal muscles to stabilize your core. Keep your feet in contact with one another as you raise your upper knee as high as you can, without moving the hips or pelvis. Don’t allow your lower leg to move off of the floor. Pause at the top for a few seconds before returning the top knee to the starting position. Do 20 reps on each side.

25. Isometric Single - leg Wall Lean Standing parallel to a wall, flex the hip closest to the wall to 90 degrees, with the knee bent. Press the foot of the stance leg into the floor while driving the bent leg into the wall. Do it on both side The gluteus medius of the standing leg will fire to stabilize the pelvis.

26. Swiss ball exercises Single Leg Squat with Isometric Hip Abduction

27. Gait training Patients with waddling suffer from abnormal range of motion in hip and trunk Parallel bar walking by placing a mirror in front of the patient this will provide a biofeedback to increase the hip and trunk range of motion therapists watches and gives advise/correction to posture, so as to facilitate proper gait re-education Make patient to walk without support  During walk promote heel strike at initial contact with the floor Prevent hip dropping and stabilize the pelvis

28. Walking with cane Tilting of pelvis can be avoided by pushing down through walking aids on the swing side. when the arms exert a force on the cane to help minimize pelvic drop on the side opposite the weight-bearing leg.

29. Pelvic brace Using a pelvic brace will reduce the pain occurs during waddling gait

30. Functional balance training Static exercises :- sit to stand Tandem standing(stand on both legs) with or without support stand with eye open and close Dynamic exercises :- Straight walking Tandem walking Side walking

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