ClickCease
+1-915-850-0900 [email protected]
Select Page
Antalgic Gait: A Comprehensive Overview

Antalgic Gait: A Comprehensive Overview

by | Chiropractic, Mobility & Flexibility

Individuals walking with a limp that results in pain could have an antalgic gait, an abnormal walking pattern commonly seen in emergency clinics and primary care offices. Can recognizing the symptoms help healthcare providers develop an effective treatment for the underlying cause?

Antalgic Gait: A Comprehensive Overview

Antalgic Gait

Limping and having an antalgic gait usually indicate a larger issue within the leg or lower back. It is the most common type of abnormal gait. There are various causes of antalgic gait, including acute injuries and gradually progressing medical conditions. The most common causes include osteoarthritis in one of the leg’s joints, lumbar radiculopathy, or an injury to a ligament or tendon. Paying attention to when the limping occurs, and any accompanying symptoms can help determine its origins.

Walking

When limping, the stance phase during walking is shorter than the swing phase. Individuals may widen their legs apart to provide a support base to compensate for the imbalance. In severe cases, an individual may swing their leg irregularly or take several side steps.

Causes and Symptoms

Antalgic gait can be caused by pain in any part of the lower extremity. Limping when walking may be a primary concern but is rarely the only complaint. Other associated symptoms may also be present, depending on the cause. These include:

  • Limited range of motion
  • Joint stiffness
  • Muscular weakness
  • Numbness and tingling
  • Pain
  • Swelling
  • Leg instability or buckling
  • Clicking or popping

Common Causes include:

Hip, knee, and/or Foot problems

When the hip, knee, ankle, or foot joints are injured or have some issue, walking can be painful and lead to a limp.

Sprains, Strains, or Soft-tissue Injuries

Sprains, strains, and soft-tissue injuries can result from acute injury or chronic, repetitive activities over time. (Pirker W. and Katzenschlager R. 2017) Sprains affect the body’s ligaments, while strains impact muscle tendons. However, sprains and strains occur when the impacted structure is overstretched or partially torn. The damage can lead to pain and antalgic gait. An injury to several other soft-tissue structures, including a bursa or fluid-filled sacs that reduce friction, meniscus, or fat pad, can also lead to limping. Symptoms typically include swelling, pain, and limited range of motion. More severe injuries can also make the leg feel unstable and cause it to give way when walking. Sometimes, bruising can also occur in the area of the injury. (American Academy of Orthopaedic Surgeons, 2020)

Osteoarthritis

Osteoarthritis occurs when the smooth, articular cartilage that lines the ends of bones begins to thin and deteriorate. This can alter the normal movement of a joint and lead to pain. Osteoarthritis symptoms gradually progress, affect individuals over 50, and worsen after periods of sedentary activity (Arthritis Foundation, Osteoarthritis, N.D.) Typically, it results in pain, stiffness, clicking, and occasionally swelling in the affected joint. These symptoms are usually worse in the morning and at the end of a long activity day. Moving around and warming the joint improves osteoarthritis symptoms. (Arthritis Foundation, Osteoarthritis, N.D.)

Lower Back Radiculopathy

Lumbar radiculopathy is when the nerve roots branching off the spine’s lower region become compressed or inflamed. This can occur because of disc issues like bulging, degeneration, herniation, bone spurring, or, rarely, a growth or tumor. (Johns Hopkins Medicine, 2024) Because these nerves control movement, sensation, and strength in the legs and feet, irritation in one can lead to limping. (Yokogawa N. et al., 2015) The antalgic gait from this condition frequently comes on suddenly and is commonly accompanied by back pain symptoms. This can include shooting pain and paresthesia in the leg. Depending on which nerve is involved, individuals may also experience muscular weakness in certain areas of the lower extremity. Sometimes, the affected leg feels like it will buckle while standing or walking. (Johns Hopkins Medicine, 2024)

Other causes include:

  • Broken bones
  • Tumors
  • Infections
  • Blood clots
  • Vascular issues

Treatment

Treatment for antalgic gait depends on the underlying cause but can include:

  • Rest, ice, and elevation are important for injuries. Individuals can control their initial symptoms by icing, elevating the leg, and resting from irritating activities.
  • Activity modifications
  • Antibiotics for infections
  • Pain relievers
  • Anti-inflammatories
  • Physical therapy is also frequently initiated to strengthen the core and alleviate walking symptoms.
  • Chiropractic realignment
  • Non-surgical decompression
  • Acupuncture
  • A corticosteroid injection or joint replacement surgery may prove necessary in more advanced cases. (Arthritis Foundation, Osteoarthritis, N.D.)
  • A spinal injection or surgery can reduce the pressure on the nerve root if conservative interventions fail to improve antalgic gait patterns. (Johns Hopkins Medicine, 2024)
  • Crutches, canes, walkers, or assistive devices can reduce pressure traveling through an affected joint and improve overall walking quality. A study found that using a cane for two months helped reduce pain and improve function in individuals with knee osteoarthritis. (Fang M. A. et al., 2015)

Injury Medical Chiropractic and Functional Medicine Clinic

Though it can be tempting to ignore the limp and push through it, discussing the condition with a healthcare provider is important. A thorough medical exam and diagnostic tests, such as X-ray, MRI, or EMG, can help determine the underlying causes of a limp, help discover the cause of the problem, and help improve the quality of walking. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers if other treatments are needed.

Chiropractic and Integrative Healthcare

References

Pirker, W., & Katzenschlager, R. (2017). Gait disorders in adults and the elderly : A clinical guide. Wiener klinische Wochenschrift, 129(3-4), 81–95. https://doi.org/10.1007/s00508-016-1096-4

Arthritis Foundation. (N.D.). Osteoarthritis. https://www.arthritis.org/diseases/osteoarthritis

American Academy of Orthopaedic Surgeons. (2020). Sprains, strains, and other soft-tissue injuries. https://orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries/

Johns Hopkins Medicine. (2024). Radiculopathy. https://www.hopkinsmedicine.org/health/conditions-and-diseases/radiculopathy

Yokogawa, N., Toribatake, Y., Murakami, H., Hayashi, H., Yoneyama, T., Watanabe, T., & Tsuchiya, H. (2015). Differences in Gait Characteristics of Patients with Lumbar Spinal Canal Stenosis (L4 Radiculopathy) and Those with Osteoarthritis of the Hip. PloS one, 10(4), e0124745. https://doi.org/10.1371/journal.pone.0124745

Fang, M. A., Heiney, C., Yentes, J. M., Harada, N. D., Masih, S., & Perell-Gerson, K. L. (2015). Effects of contralateral versus ipsilateral cane use on gait in people with knee osteoarthritis. PM & R : the journal of injury, function, and rehabilitation, 7(4), 400–406. https://doi.org/10.1016/j.pmrj.2014.09.018

Trendelenburg Gait

Trendelenburg Gait

by | Conditions Treated, Foot Orthotics

A Trendelenburg gait is an abnormal walking gait resulting from a defective or weakened hip abductor. The gluteal musculature is the primary musculature that includes the gluteus medius and gluteus minimus muscles. Weakness in these muscles causes sagging/dropping of the pelvis on the opposite side while walking. There will be a noticeable side-to-side motion if the glutes are too weak to support the body’s weight when walking. It can look as though the individual is limping or missing a step. Individuals can minimize the effects with foot orthotics, core strengthening, chiropractic, and physical therapy.

Trendelenburg Gait

Trendelenburg Gait Causes

This gait often results from straining the hip abductor muscles during physical activity. Exercises specifically for the glutes done improperly are a common cause. When improper exercise form is the cause, the abnormal gait usually goes away as muscle inflammation fades. The gait can also present after total hip replacement surgery, as the procedure requires incisions in the gluteus medius muscle. This can weaken the muscle causing an abnormal gait. Weakness in these muscles can also be caused by:

  • Nerve damage or dysfunction in the nerves that run through the gluteal minimus and medius muscles.
  • Osteoarthritis is a type of arthritis that occurs when joint cartilage starts to wear down.
  • Muscular dystrophy is a condition that causes the muscles and bones to become weak over time.
  • Poliomyelitis is a condition associated with polio that weakens the muscles.
  • Cleidocranial dysostosis is a condition present from birth that can cause your bones to develop improperly.

Symptoms

The walking gait is made up of two phases:

  • Swing – When one leg moves forward.
  • Stance – The other leg stays still and maintains balance.

The main symptom of Trendelenburg gait can be seen when one leg swings forward and the hip drops down and move outward. This is because the hip abductor of the other leg is too weak to support the weight. Individuals may lean back or to the side slightly when walking to maintain balance, or they may lift the foot higher off the ground with each step to avoid losing balance or tripping as the pelvis shifts unevenly.

Diagnosis

Abnormal hip movement during a swing of one or both legs can give a doctor enough evidence to diagnose a Trendelenburg gait. A doctor will observe the individual’s walk in front and behind to get a detailed view. A doctor will also use the Trendelenburg test to diagnose the condition. The doctor will instruct the individual to lift one leg for 30 seconds. If the individual cannot keep the hips parallel with the ground while lifting, it could indicate Trendelenburg gait. X-rays of the hip will be used to identify any causes of weakness in the gluteus minimus or medius.

Treatment Options

Treatment options will depend on the severity and cause of the gait.

Medication

  • If the gait is causing pain, over-the-counter nonsteroidal anti-inflammatory NSAIDs, like ibuprofen or acetaminophen, will help ease symptoms.
  • In severe cases, a doctor may prescribe cortisone injections to help reduce pain.

Foot Orthotics

  • A doctor could also recommend using a foot orthotic in one or both shoes to compensate the hip abductor muscle weakness.

Chiropractic, Physical Therapy, and Exercise

Chiropractic and physical therapy can help adjust, realign, and strengthen the muscles to regain control of the Trendelenburg gait. The chiropractor or physical therapist will move the legs in various directions to help the joints become more accustomed to moving in certain directions and increase muscle strength and resistance. Exercises that can strengthen the hip abductor muscles include:

  • Lie on the side and extend the leg straight out.
  • Lie on the floor and move one leg up, over the other, and back in the opposite direction.
  • Step sideways and onto an elevated surface, then back down again.

Talk with a doctor or chiropractor before beginning any new exercise routine so they can recommend specific exercises and educate on proper form.

Complications

If left untreated, moderate-to-severe cases of Trendelenburg gait can become debilitating, leading to severe complications. These include:

  • Pinched nerves.
  • Sciatica.
  • Pain, stiffness, or grinding in the hips.
  • Loss of range of motion in the hips and gait.
  • Losing the ability to walk, which could require the use of a walker or wheelchair.
  • Paralysis of the lower body.
  • Osteonecrosis or death of bone tissue.

Trendelenburg gait is treatable with special shoes, orthotics, and exercises designed to strengthen the hip abductor muscles. Chiropractic and physical therapy can help limit the condition’s impact on the body’s health, the ability to walk, and reduce the risk of complications.

Body Composition

Heart-Healthy Foods

Citrus

  • The bright and tangy fruits are packed with vitamins and unique plant compounds known as polyphenols that can help lower blood pressure naturally.
  • However, it’s important to note that grapefruit and grapefruit juice could interact with certain prescription medications.

Beans and Lentils

  • Foods high in magnesium, potassium, and fiber can help maintain healthy blood pressure.
  • This is where beans and legumes come in, as they are high in fiber, potassium, and magnesium.
  • Individuals that swapped beans and lentils noticed a lower blood pressure, whether or not they had been diagnosed with hypertension.

Pumpkin Seeds

  • These seeds are packed with potassium, magnesium, and arginine.
  • Arginine is an amino acid used to make nitric oxide, which helps the blood vessels relax and dilate, allowing lower blood pressure.
  • A study found that postmenopausal women who took 3 grams of pumpkin seed oil daily for six weeks saw a significant decrease in their systolic blood pressure.

Garlic

  • Garlic contains nitric oxide, which has been shown to relax blood vessels.
  • Kyolic garlic, in particular, has been shown to help with arterial stiffness and can improve cholesterol levels.
References

Feyh, Andrew et al. “Role of Dietary Components in Modulating Hypertension.” Journal of Clinical & experimental cardiology vol. 7,4 (2016): 433. doi:10.4172/2155-9880.1000433

Gait abnormalities. (n.d.).stanfordmedicine25.stanford.edu/the25/gait.html

Gandbhir, Viraj N., et al. “Trendelenburg Gait.” StatPearls, StatPearls Publishing, 19 August 2021.

Giangarra CE, et al. (2018). Clinical orthopedic rehabilitation: A team approach.sciencedirect.com/science/book/9780323393706

Gilliss AC, et al. (2010). Use of osteopathic manipulative treatment to manage compensated Trendelenburg gait caused by sacroiliac somatic dysfunction.
jaoa.org/article.aspx?articleid=2093879

Maricelli JW, et al. (2016). Trendelenburg-like gait, instability and altered step patterns in a mouse model for limb-girdle muscular dystrophy 2i. DOI:
10.1371/journal.pone.0161984

Mayo Clinic Staff. (2017). Osteoarthritis.mayoclinic.org/diseases-conditions/osteoarthritis/home/ovc-20198248

Michalopolous N, et al. (2016). A personalized monitoring and recommendation framework for kinetic dysfunctions: The Trendelenburg gait. DOI: 10.1145/3003733.3003786

Mastodon