Does Walking Cause You Pain?
….it shouldn’t
Does walking hurt? One of the first things I try to observe with a patient is how they walk. This seemingly simple movement tells me a lot about a person’s movement patterns and I can often correlate their symptoms to the patterns I observe. While we generally walk in a straight line, walking involves a series of coordinated rotations in the shoulders, spine, hips and ankles. Unfortunately, injuries, habits, shoes, etc. can alter those rotations creating patterns that feed into our sore back, hips, shoulder, neck, feet, etc. Walking should be an unconscious and painless effort. However, being intentional with three aspects of walking, head position, arm-swing and foot placement can loosen up those sore joints and increase your tolerance to walking and standing.
When we walk, we are actually rotating reciprocal parts of our body to create forward motion. As we step forward with our right foot, the pelvis rotates towards the left. Continuing up the chain, the lumbar spine follows the pelvis and rotates left. At this point our left arm swings forward, counterbalancing the pelvis and lumbar spine, rotating the ribs and thoracic spine to the right. Just before our right foot hits the ground the ankle rotates allowing the foot to supinate (fancy word for external rotation), such that we land on the outside of our heel. As we continue with the step, the foot then pronates (fancy word for internal rotation) such that pressure should be biased to the inside of the sole of the foot, and then back to supination such that we are able to push off with the right big toe to transfer ourselves over to the left foot. Then the whole process repeats itself. Again, this process should be completely automatic and pain-free. However, if walking is painful for you there are a few aspects of walking that you can occasionally pay attention to, to improve this series of rotations.
The first thing to notice is where is your gaze or head position. Our brain always wants our gaze on the horizon, straight ahead of you. This is the most efficient head position for walking. What happens when we look down? Our body automatically stiffens up in anticipation of unstable footing. The muscles throughout your body tense up and limit the rotations of gait in order to provide you with the stability it will need to navigate uncertain steps. The problems arise when you habitual cast your gaze to the ground regardless of the footing. A couple miles walking around looking at the ground just in front of you can leave you stiff and sore. There is an easy fix to this, but it is a hard habit to acquire. Just be intentional with your gaze and look at the horizon while walking. This signals your musculoskeletal system that you are not concerned about your footing, allowing your neck, spine and hip musculature to loosen up.
The next aspect of gait to pay attention to is your arm swing. Do both arms move while you walk? I often observe patients who will move one arm, but not the other while walking. If either arm does not swing forward and backwards symmetrically you are likely using your shoulder girdle for stability and this will lead to stiffness and pain. For pain free walking the arms must swing and they must move in unison with the opposite leg to provide a counter rotation to pelvis. That is to say, when your right leg swings forward for a step, the left arm must swing forward to balance the rotation. A larger and/or faster step with your foot requires a larger and/or faster swing with your opposite arm. Again, the fix is to be intentional, if only for a minute or two, with your arm swing.
Perhaps the most difficult aspect of gait to describe and coach is at the ankle-foot complex. Generally speaking, this complex must perform three rotations with each individual step. To simplify things, it is best to pay attention to where you feel pressure through your foot when in contact with the ground. First, be sure that when your foot first makes contact with the ground, it is with the heel and slightly biased towards the outside of that heel. Don’t exaggerate this and land way out on the outside of the heel. As the step progresses and your weight is directly over your foot, the pressure should transition to a bias towards the inside of your heel and the ball of your big toe. As your body moves in front of your stance foot, you should push off the ground with your big toe facing straight ahead of you. For a simple visualization, imagine a diagonal line on the bottom of your foot from the outside of the heel to the tip of the big toe. This is the line of pressure your should feel from the ground as your step progresses. Please note that your feet may not be oriented directly forward and more often than not this compensation takes place up the the hip. Forcing your foot to remain pointed straight ahead can create a tug-of-war war between your foot and your hip with the knee suffering the consequences. If you tend to point your toes in or out, try to gently orient them a little more straight ahead, but don’t force it.
Focusing on your gaze, arm swing and foot pressure will make you will feel like you are walking like a robot at first and that is to be expected, as your body has been unconsciously walking for a long time. Furthermore, after a minute or two of conscious walking you will quickly find yourself zoning out and thinking of more important tasks and that is ok. Just check in daily and for short periods of time on your head position, arm swing and foot placement while walking. With a small amount of daily practice you can improve your gait and reduce those nagging pains associated with walking.