Hi, I’m back, refreshed from a family holiday in France and Spain and invigorated by an excellent ESMAC conference in Glasgow. Thanks to so many people that used the opportunity to say how much they liked the blog – I suppose I better keep going. The view counter passed 10,000 earlier today so let’s see if we can keep it ticking over.
I’ve no doubt that, for clinical gait analysts, the most important paper published over the last decade is Mike Schwartz’ study on the effect of walking speed on gait variables (2008). It’s the only paper that I maintain a link to on my desktop and I rarely interpret any patient data without referring to it. If you haven’t already done so then download it now and do the same (let’s see if we can knock Tom Novacheck’s  review of running biomechanics off the top of the Gait and Posture most downloaded papers table and replace it with a genuine scientific study!).
In the study quite a lot of kids were asked to walk at a range of walking speeds. The resulting gait trials were divided up into five groups by walking speed and the average gait variables for the different groups were calculated. The darker the blue in the figure above the faster the walking with the middle trace representing self-selected walking speed. You can see that the gait traces change quite considerably with walking speed even when there is nothing wrong with the child.
We were looking at data from a patient with a rare genetic disorder today. I think if I’d looked at the same data ten years ago I’d have made all sorts of pronouncement on his gait impairments. Now I just look at Mike’s paper and can say, “Yep, he’s walking slowly”, not only that but, “he’s walking slowly in exactly the same way as anyone else would walk slowly”. It might be worth trying to work out why he’s walking slowly but there is no evidence in the gait data of any specific impairment that is affecting his walking.
I was chatting about this in the group and talking about how we walk with different gait patterns at different speeds and one of my colleagues asked quite, “Why?”. It’s one of those simple questions that caught me completely unawares and started me thinking.
Kinematically, there is absolutely no reason why anyone shouldn’t walk more slowly by having exactly the same pattern of movement but simply going through that pattern more slowly. You could thus walk slowly in a way that gives exactly the same gait graphs (after time normalisation, see previous post on this). The answer of course is that walking is not primarily driven by the kinematics but the kinetics. The way that energy flows between the segments and the way this is mediated by muscle activity depends very much on how fast the segments move. Kinetic energy is proportional to the square of speed and forces and moments act to produce accelerations. Walking slowly efficiently requires quite different dynamic mechanisms to walking quickly efficiently.
Although this answers the question at one level it only does so partially. What would be really interesting would to be to look at how the curves change with speed from the context of how we understand the process of normal walking and see if we can explain why the gait pattern varies the way it does. Anyone who can do this easily and comprehensively has a better understanding of normal walking than I do. I’m going to have to go away and think about this.
One thing that I think would be quite instructive would be to try and do this practically. Stick some markers on yourself and record yourself walking normally. Then try and see if you can walk slowly but in the same kinematic pattern (after time normalisation). I wouldn’t mind betting that it’s not possible. Even if it is possible to match the kinematics this will require quite different kinetics and muscle activations. You may even be able to feel which muscles you are having to use differently. I suspect there’s be a huge amount to learn from such an exercise.
Novacheck, T. F. (1998). The biomechanics of running. Gait Posture, 7(1), 77-95.
Schwartz, M. H., Rozumalski, A., & Trost, J. P. (2008). The effect of walking speed on the gait of typically developing children. J Biomech, 41(8), 1639-1650.