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Archive for June 27, 2011

15 Things Your Walk Reveals About Your Health

15 Things Your Walk Reveals About Your Health

 By Paula Spencer Scott, senior editor

Walk into an exam room and a trained eye can tell a lot about you in seconds: Your stride, gait, pace, and posture while walking can reveal surprising information about your overall health and well-being.

“Many physicians are keenly aware, when they see someone walking down the street, what their diagnosis might be, whether their underlying health is good or bad, and if not good, a number of tip-offs to what might be wrong,” says Charles Blitzer, an orthopedic surgeon in Somersworth, New Hampshire, and a spokesperson for the American Academy of Orthopedic Surgeons.

Find out what the following 15 walking styles may signal about your health.

Walking clue #1: A snail’s pace

May reveal: Shorter life expectancy
Walking speed is a reliable marker for longevity, according to a University of Pittsburgh analysis of nine large studies, reported in a January 2011 issue of The Journal of the American Medical Association. The 36,000 subjects were all over age 65. In fact, predicting survival based on walking speed proved to be as accurate as using age, sex, chronic conditions, smoking, body mass index, hospitalizations, and other common markers. It’s especially accurate for those over age 75.

The average speed was 3 feet per second (about two miles an hour). Those who walked slower than 2 feet per second (1.36 miles per hour) had an increased risk of dying. Those who walked faster than 3.3 feet per second (2.25 miles per hour) or faster survived longer than would be predicted simply by age or gender.

A 2006 report in JAMA found that among adults ages 70 to 79, those who couldn’t walk a quarter mile were less likely to be alive six years later. They were also more likely to suffer illness and disability before death. An earlier study of men ages 71 to 93 found that those who could walk two miles a day had half the risk of heart attack of those who could walk only a quarter mile or less.

Simply walking faster or farther doesn’t make you healthier — in fact, pushing it could make you vulnerable to injury. Rather, each body seems to find a natural walking speed based on its overall condition. If it’s slow, it’s usually because of underlying health issues that are cutting longevity.

Walking clue #2: Not too much arm swing

May reveal: Lower back trouble
“It’s really amazing the way that we’re made,” says physical therapist Steve Bailey, owner of Prompt Physical Therapy in Knoxville, Tennessee. As the left leg comes forward, the spine goes into a right rotation and the right arm moves back. This coordination of the muscles on both sides is what gives support to the lower back, he says.

If someone is walking without much swing to the arm, it’s a red flag that the spine isn’t being supported as well as it could be, because of some kind of limitation in the back’s mobility. Back pain or a vulnerability to damage can follow. “Arm swing is a great indicator of how the back is functioning,” Bailey says.

Walking clue #3: One foot slaps the ground

May reveal: Ruptured disk in back, possible stroke
Sometimes experts don’t have to see you walk — they can hear you coming down the hall. A condition called “foot slap” or “drop foot” is when your foot literally slaps the ground as you walk. “It’s caused by muscle weakness of the anterior tibial muscle or the peroneal muscles,” says podiatrist Jane E. Andersen, who has a practice in Chapel Hill, North Carolina, and is a past president of the American Association for Women Podiatrists.

A healthy stride starts with a heel strike, then the foot slowly lowers to the ground, then it lifts from the toe and slings back to your heel. But with drop foot, muscle control is lost and the foot can’t return slowly to the ground. Instead, it “slaps” the ground.

“This could be a sign of a stroke or other neuromuscular event, or of compression of a nerve,” Andersen says. A ruptured disk in the back is a common cause, since it can compress a nerve that travels down the leg. A rare cause of drop foot is simply crossing your legs, Andersen says, if the common peroneal nerve is disrupted from the pressure.

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Walking clue #4: A confident stride (in a woman)

May reveal: Sexual satisfaction
Your stride and gait don’t always indicate bad things. A study conducted in Belgium and Scotland, reported in the September, 2008, Journal of Sexual Medicine, found that a woman’s walk can reveal her orgasmic ability. Women who have a fluid, energetic stride seem to be more likely to easily and often have vaginal orgasms, researchers said. They compared the gaits of women known to be orgasmic (defined as by penile intercourse, not direct clitoral stimulation) with those who were not.

What’s the connection? The theory is that orgasms contribute to muscles that are neither flaccid nor locked. Result: a freer, easier stride, researchers found, as well as greater sexual confidence and better self-esteem.

Walking clue #5: A short stride

May reveal: Knee or hip degeneration
When the heel hits the ground at the beginning of a stride, the knee should be straight. If it’s not, that can indicate a range-of-motion problem in which something is impairing the ability of the knee joint to move appropriately within the kneecap. “Degenerative changes in the knee sometimes need to be addressed by manual therapy to stretch out the tightness and improve that range of motion,” Bailey says.

A similar cause of a short stride is lacking extension, or good range of motion, in the hip. By taking shorter steps, the walker doesn’t have to extend as far. “Unfortunately, that compensation puts more stress on the back,” Bailey says. “In older people, a big issue in the back is having enough space for the joints and nerves as it is. When you don’t have a lot of hip extension, there’s not a lot of room to play with, and it can cause back pain and neural issues, such as drop foot.”

Walking clue #6: Dropping the pelvis or shoulder to one side

May reveal: A back problem
Muscles called the abductors on the outside of the hips work to keep the pelvis level with each step we take. So while we’re lifting one leg and swinging it forward, and standing on the other, the abductors keep the body even — unless those muscles aren’t working properly, Bailey says.

What happens then is that the body compensates. In a common walking pattern known as the Trelendenberg gait, as the heel strikes the ground on the unaffected side, the pelvis drops on that side to try to reduce the amount of force the muscle has to produce on the other side. Sometimes the compensating is so pronounced that the whole shoulder dips as well.  The ultimate cause of the weak abductors is often a back problem, Bailey says.

Walking clue #7: Bowlegged stride

May reveal: Osteoarthritis
“Think of the classic image of the old, slow, bow-legged cowboy,” says orthopedic surgeon Blitzer. “He probably looks that way because of arthritic knees.” Eighty-five percent of people with osteoarthritis (OA), the wear-and-tear form of the disease associated with aging, have a slightly bowlegged walk, he says. Bowlegs (also called genu varum) happen because the body can’t be supported adequately; the knees literally bow out.

Rickets or genes can also produce a bow-legged walking style, but these causes are more commonly associated with kids than grown-ups, and they can be outgrown or corrected with braces.

Walking clue #8: Knock-kneed appearance

May reveal: Rheumatoid arthritis
Rheumatoid arthritis (RA), the kind that’s an inflammatory disease, produces a knock-kneed walk, where the knees bend in toward one another. “About 85 percent of people with rheumatoid arthritis are knock-kneed,” Blitzer says. In knock-knee (genu valgum, or valgus knee), the lower legs aren’t straight but bend outward. This can create a distinctive, awkward-looking walk where the knees are close together and the ankles are farther apart. Sometimes osteoarthritis can also result in knock-knees, depending which joints are affected.

Walking clue #9: A shortened stride on turns and when maneuvering around things

May reveal: Poor physical condition
Balance is a function of coordination between three systems: vision, the inner ear, and what’s called “proprioception,” which is the joints’ ability to tell you their position. The joints can do this because of receptors in the connective tissue around them. But the quality of the receptors is related to how much motion the joint experiences. “It’s the old use-it-or-lose-it,” Bailey says. “When you’re active, you lay down more receptors in the connective tissue, so your proprioception is better.”

That means you have better balance. And it’s why someone with balance problems is often frail or in poor physical condition. “If you have trouble balancing, you have a shorter stride, and it’s especially noticeable on turns or when you’re maneuvering around objects. You also have trouble going up steps, which requires balancing on one foot for a longer amount of time,” Bailey says. “You do much better on straightaways.”

Blitzer encourages frail patients who need canes and walkers but avoid them because they “don’t want to look old” to set aside their pride and use them. “Better to use adaptive devices and continue to be active than to be sedentary, which is a vicious cycle that makes you more sedentary,” he says.

Balance problems can be also be related to peripheral neuropathy, a kind of nerve damage caused by diabetes, Andersen says. Other common causes include alcohol abuse and vitamin deficiencies.

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Walking clue #10: A flat step without much lift

May reveal: Flat feet, bunions, neuromas
Flat feet are obvious at a glance: There’s almost no visible arch (hence one of the condition’s names, “fallen arches”). But other conditions can also cause a flat walk. When the person takes a step, the foot flattens even as the heel is lifting off the ground, when it would normally be going into an arched position. The heel may also shift slightly to the inside when it comes up, and the toes may flex upward.

These kind of movements are attempts to create better stability where there isn’t any because of a painful bunion (an abnormal enlargement of the bone or tissue around the base of the big toe) or a neuroma (a nerve condition) in the foot. The most common neuroma, called Morton’s neuroma, is extremely painful thickening of the nerve between the third and fourth toes. The stepping pattern changes in order to protect what hurts.

Walking clue #11: Shuffling

May reveal: Parkinson’s disease
Shuffling — bending forward and having difficulty lifting feet off the ground — isn’t an inevitable aspect of aging. It’s a distinct gait that may indicate that someone has Parkinson’s disease. The person’s steps may also be short and hesitant.

“Shuffling is one of the most common manifestations of Parkinson’s, a neuromotor dysfunction in a neuromuscular disease,” says Blitzer. Along with tremors, it can be an early sign of the disease.

People with advanced dementia, such as is caused by Alzheimer’s disease, may also shuffle as a result of cognitive trouble — the brain and musculature don’t communicate well. But by the time this happens, memory loss and problems with thinking skills are far more obvious.

Walking clue #12: Walking on tiptoes, both feet

May reveal: Cerebral palsy or spinal cord trauma
Another distinctive gait owing to an underlying condition is “toe-walking.” The toe reaches the ground before the heel, instead of the other way around. It’s related to overactive muscle tone, caused by stretch receptors that fire incorrectly in the brain. When the toe-walking happens on both sides, it’s almost always because of damage high in the spinal column or brain, such as cerebral palsy or spinal cord trauma.

Note: Sometimes toddlers walk on tiptoe for a while as they’re getting the hang of it, but this doesn’t mean they have a palsy. If you’re concerned, mention it to the child’s doctor, who will assess for other signs of a problem.

Walking clue #13: Walking on tiptoes, one foot

May reveal: Stroke
Doctors assessing toe-walking look for symmetry: Is it happening on both sides or only one? When a person toe-walks only on one side, it’s an indicator of stroke, which usually damages one side of the body. When polio was still a scourge in the U.S., affected people often had one withered extremity and one-sided toe-walking was more common.

Walking clue #14: A bouncing gait

May reveal: Unusually tight calf muscles
One unusual stride is a gait that causes the walker to literally bounce a bit. Specialists can see the heel-off, the first part of a normal step, happen a bit too quickly, because of tight calf muscles. Women are the most vulnerable, because of chronic high heel use, podiatrist Andersen says.

“I’ve seen women in their 60s who have been told to exercise — sometimes for the first time in her life because a doctor is ordering it for a health issue — and she can’t because she can’t comfortably wear a flat shoe,” she says. “The same thing can happen much earlier in life, too, such as with a 25-year-old who’s been wearing stilettos since she was a teenager.”

Walking clue #15: One higher arch and/or a pelvis that dips slightly

May reveal: One leg is shorter than the other
Limb (or leg) length discrepancy simply means that one leg is shorter than the other. Experts can spot this in several different ways. One is by looking at the foot while you take a step, says podiatrist Andersen; one foot will have a higher arch and the other will look flatter. The flatter foot usually corresponds to the longer leg, she says.

Also, because the shorter leg has to go a bit farther to get to the floor, the pelvis may drop down slightly in the stride, adds Bailey. “If you pull up the shirt you can often see changes to the lumbar spine — a horizontal crease along the spine on the side with the longer leg, because the spine is bending in that direction.”

You can be born with limb discrepancy or get it as the result of knee or hip replacements, if limbs don’t line up perfectly after healing. But unless the discrepancy is three-quarters of an inch or more, Blitzer says, studies indicate it probably won’t cause health problems. Shoe inserts usually can make up for a quarter-inch discrepancy; surgery is sometimes recommended for larger differences.


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