Gait Training Exercises In Physical Therapy

If you have a lower extremity injury or have had surgery, you may be having a problem with walking normally. Physical therapists (PT) call walking "gait." Your gait cycle includes stepping, landing on one foot, rolling over that foot, and lifting the foot off the ground again. If you are having problems with gait, you may be referred to physical therapy for gait training.

Gait training is a set of exercises that are specifically implemented by your physical therapist to help you walk better. The exercises involve improving motion in your lower extremity joints, improving strength and balance, and mimicking the repetitive nature of your legs that occur while walking.

The ultimate goal of gait training in physical therapy is to help you walk normally and safely.

Common types of gait abnormalities that may require gait training include:

• Trendelenburg gait
• High steppage gait
• Spastic gait
• Antalgic gait (gait abnormalities due to pain)

If you have had lower extremity surgery or an injury, you may have weakness or tightness in your legs that prevent you from walking normally. Your balance and proprioception may be affected. Your PT can assess your gait and tailor an exercise program that can improve your gait.

Before starting any exercise program for improved gait, check in with your physician or physical therapist. They can ensure that you are exercising properly and exercise is safe for you to do.

1

Choosing the Right Assitive Device

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You may need an assistive device to help you walk immediately after your lower extremity injury or surgery. Your PT can help you choose the right one. Examples of assistive devices may include:

• Crutches
• Wheeled walker
• Standard walker
• Lofstrand crutches
• Quad cane
• Standard cane

Your PT can make sure the device is the proper size for you. They can also make sure you are using the assistive device properly.

Some people use their assistive device temporarily; others with significant impairments need to use it permanently. Your therapist can help you determine when it is time to ditch your assistive device.

If you are working on gait training in the PT clinic, you may use parallel bars to help you. The bars are extremely stable and allow you to use your arms for support while learning to walk again.

2

Range of Motion Exercises

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After lower extremity injury, you may need to work on regaining and maintaining normal range of motion (ROM) in your joints. Often after surgery, swelling may limit joint ROM.

Range of motion may also be limited by tight muscles or structures that occur after a period of immobilization following injury or surgery. Working to regain that motion may be part of your gait training exercise program.

Exercises to improve lower extremity ROM may include:

• Ankle pumps
• Calf stretch with a towel
• Heel slides to improve knee ROM
• Hamstring stretches
• Hip rotation stretches

Maintaining full ROM as you learn to walk again can help your joints move freely as you step and bear weight onto each leg.

3

Lower Extremity Strengthening

Ben Goldstein

Strengthening exercise may be incorporated into your gait training exercise program. If you have weakness in your hips, knees, or ankles, this may prevent your from walking safely. Exercises for your lower extremities may include:

• Straight leg raises
• Quad sets and short arc quads
• Ankle strengthening with resistance bands
• Mini squats
• Step ups

Exercises should be done slowly, and it is recommended that you use light resistance and high repetitions for lower extremity gait training exercises. Why? Because walking is a low resistance, high repetition activity. Your exercises should mimic that type of motion.

4

Stepping Over Obstacles

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One way to improve your gait is to accentuate the motions that occur in your legs while walking. One way to do that repetitively is to perform stepping exercises over obstacles or small hurdles. This forces you to flex your hips up high and bend your knees up behind you when walking.

Obstacle Gait Training

Here is how to perform obstacle gait training:

1. Set up five or six small obstacles in a row about 15 inches apart. Obstacles can be rolled up towels, athletic hurdles, or small stacks of books.
2. Stand facing the obstacles, and step over one with one foot.
3. Place your other foot next to your first foot.
4. Repeat walking over the obstacles with one foot. Then, turn around and step over the obstacles leading with your other foot first.
5. When this becomes easy, step over the first obstacle, then step all the way over the next obstacle in the row. Be sure to lift your knee up high and lift your foot and ankle up towards your buttocks when taking steps.
6. Repeat walking over the obstacles for 10 repetitions.

Side-Stepping Gait Exercises

Once obstacle stepping has become easy when stepping forward over the hurdles, you can try stepping over sideways. This alteration to your normal forward gait can help you move in different directions while walking.

Here's how to perform side-stepping gait exercises:

1. Stand with your obstacles to your side
2. Step one foot sideways over the first obstacle. Be sure to raise your knee up high.
3. When placing your foot down on the other side of the obstacle, be sure to leave enough room for your second foot to land.
4. Lift your second foot up, high knee.
5. Place your second foot next to your first foot. Repeat over all the obstacles.

Precautions

Since obstacle stepping requires you to take big steps with high knees, it requires you to spend extra time standing on one leg as you step. This can help improve gait, but it may also create instability as you step. So, be sure you are safe while performing this exercise; someone should be with you to help guide you as you walk.

If you are unsure of your ability to do this gait training exercise, visit your local PT. They will be able to help.

5

Target Stepping

In order to improve lower extremity coordination during your gait training exercise routine, you may wish to perform target stepping. To do target stepping:

1. Place four or five targets on the ground in a semicircle. The targets should be about one foot apart. You can use small pieces of paper or paper plates as targets.
2. Stand to one side of the targets on the floor.
3. Slowly step with on foot to tap a target.
4. Return that foot to the starting position, then reach out again to another target and tap it with your foot.
5. Repeat tapping each target with one foot, and then the other. Try to softly and slowly land each tap.

This exercise helps to improve your ability to place your foot exactly where you want it while walking and has the added benefit of encouraging single-leg standing.

6

Retro Walking

Backward walking may be recommended by your physical therapist to help improve your gait.1 The benefits of backward walking may include:

• Improved hamstring flexibility
• Improved quadriceps activation
• Improved balance
• Improved coordination2
• Improved walking speed
• Improved step length and stride length

Backward walking seems to reset your neuromuscular system, challenging your lower extremity muscles and joints in specific ways that may improve your gait.

Forward walking is a heel-to-toe motion. Retro walking is a toe-to-heel pattern.

The safest way to implement retro walking into your gait training exercise program is with a treadmill:

1. To start, stand on the treadmill facing backward.
2. Start the belt moving at the slowest speed possible.
3. On the treadmill, reach one foot backward and place your toe down.
4. Roll onto your mid foot and then to your heel.

Retro walking should be done slowly and in control. Be sure you remain safe while retro walking by using the safety emergency stop function on the treadmill.

7

Balance and Proprioception Exercises

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Walking requires that you spend about 40% of the time standing on one foot. One foot is on the ground while the other swings forward through the air. That means that single leg standing is an important component to safe walking. Balance and proprioception training should be a component of your gait training exercise program.

Exercises that can help improve balance and proprioception may include:

• Single leg stance
• Single leg stance on an unsteady surface
• Single leg stance with eyes closed
• Tandem standing and walking
• Single leg stance on a BOSU or BAPS board

To improve your balance, you have to challenge your balance. This means creating situations where you may be a little unsteady. Your body then has to correct for this unsteadiness.

As you practice, your balance should improve along with your gait. But, you must remain safe while balance training. Be sure you are able to hold onto something stable while practicing balance exercises.