I do a lot of thinking when I’m on my dog walks. If I happen to be preparing a talk, I’ll go over my talk in my mind, but more often than not, I’m thinking over clinical cases and especially the ones with lower back, hip, leg or foot issues because I’m thinking about the advice I give about walking. All my suggestions come from things that I’ve tried myself. Nuances of each new case make me re-evaluate and analyze things from different perspectives.

The mechanics of gait can be broken down into various phases but I’m hoping to not get overly technical in any of these upcoming posts about walking. Being able to analyze bio-mechanics of anything is not necessarily the way to improve the experience of it.

Location, location, location

One of the first questions to ask is “Where is the most noticeable sensation in my body when I bring my attention to the act of walking?”

· Is it your feet touching and leaving the ground?

· Is it the knees feeling a bit creaky?

· Is it the hips — maybe one of them feels sticky or reluctant as you push off behind you?

These are just a few possibilities. Where is your sensation? And I don’t mean pain necessarily but if you have pain, where do you feel it?

Where your attention goes, isn’t necessarily where you should focus. But sensations are often clues about your body’s points of weakness and I want to give you a way to think about those clues that might lead to relief. If you can start by noticing where you feel something, then you can better answer this next question.

The trigger

“What is this part of my body doing when I notice it — when the sensation (pain/discomfort) is most intense?” What is the exact motion that sets off the pain?

Be careful not to vilify the trigger. This goes for any trigger in any situation — whether it’s biomechanical, biochemical or emotional. Just because something is triggering pain somewhere in your body, does not mean that there’s anything wrong with that trigger activity, substance or emotion. It just means your body needs help reinforcing itself against that trigger — to be able to better tolerate it.

For now, my goal is to help you think through some mechanical triggers while walking. Slow it down and see what you notice when you, a) lift your leg, reaching your foot to take the next step, b) put weight on the leg rolling from heel/foot/toe (whatever your sequence might be), and c) push off with the leg behind you.

Just knowing at what point in your stride you feel the most intense sensation provides very important information to any physical medicine practitioner you might be seeing.

When people present with low back, hip or leg pain my job is to figure out if it’s really about the area that’s hurting or if the pain is being triggered in one location by something in a completely different location. That happens more than you would think — which is exactly what can make pain confusing and frustrating. We focus on the wrong thing.

Sometimes it’s the opposing structures causing the problem. Until we know the movement or effort involved with generating the pain, we can’t know all the “offending” structures involved.

The source

So, the third question then needs to be: “What are the structures either creating or controlling the movement that seems to generate pain?”

If it sounds too much like you need an anatomy lesson here in order to answer these questions, don’t worry, there is actually an easier way to think about things. In fact, I’ve developed a general rule of thumb that seems to hold true for many different pains that fall into the “everyday” category. That rule is: the muscles creating or controlling an uncomfortable or painful movement, are the muscles that need strengthening and stabilizing.

This means you don’t have to know exactly what those structures are. You just have to understand what the motion is that triggers pain and then find a way, without pain, to strengthen exactly that movement. Figuring out how to do this without pushing through pain (which is rarely a good idea…with some exceptions), is what requires a little help sometimes.

This idea of strengthening the area that hurts can seem counterintuitive when we’re feeling pain. The natural reaction is to avoid using structures that hurt and that sometimes means we allow those areas in most need of activation, to become dormant, which then can complicate and perpetuate pain.

If you take time to gather the information from these three questions, you will go a long way to helping yourself get the answers that you need, to become pain free.

Next week I’ll start to tackle specifics with The 5 Mistakes That People Make When Walking. These are 5 things that I’ve noticed can be subtle but significant obstacles when there is lower back, hip, leg or foot pain. We can get away with these mistakes for decades without any problem but as soon as there is pain, it can be essential to re-think what we’re doing.

My first post in this series (Top 3 Things You Didn’t Know About Walking) was more in regards to walking for exercise and enjoyment, but this is now about any time we spend on our feet.

---

As originally published on medium.com/@yalingliou on April 8th, 2022