All right. So we're going to dive into the case study right here,
so let's check it out.
All right. So I think the first thing we want to do is pick a reference limb.
Will, which limb do you want to pick?
Uh, I'm going, I'm seeing more things on that left side.
So that seems to be more of the area of concern for me.
So that's going to be my reference limb there.
All right. Let's mark it. Perfect.
Okay. So now we're going to start from the bottom and go up.
So now we're looking at the ankle, particularly,
I'd like to start with like initial contact.
Okay.
Looking at that left leg and it's going to go into slow-mo and that's going to
give us a really nice, yeah.
So we've got to heel hit there on the left side. Yeah. But it's quick,
very quick.
Boom. Boom. All right, let's go ahead. Let's mark abbreviated heel contact.
Yeah. So toes aren't up for very long.
But then that one, it almost looked like it was a flat foot. Did you see that?
Yeah, it definitely varies a lot. Like there, she doesn't have the heel contact.
Gosh. Okay.
You're going to just kind of go between these two because it's like.
Let's put them both down and we'll just maybe kind of, you know,
say maybe inconsistent.
I'd also say that there's definitely not enough dorsiflexion as well.
So I'm going to call that inadequate dorsiflexion on there. I think that's fair.
I think that is fair.
That kind of makes sense with the abbreviated heel contact.
Yup. Okay. So let's move into single leg support still at the ankle here.
Still on that left side. Since we've got this lateral view,
boy. Yeah.
No.
That heeling is staying glued to the ground. So I'm going to say no heel off.
Yeah.
Cause even through terminal stance she really doesn't pick it up until she's
ready to swing the leg. Yeah.
Let's go back in here. Let's start at the start of that slow motion again.
So even here we are repeating it.
Yeah, definitely. That's where I want heel rise. Not getting it. Okay.
Okay. So then we let's go into the swing leg advancement. Yep. Okay.
So his left foot comes through here and the foot's almost plantarflexed there.
So definitely that's definitely inadequate dorsiflexion.
Would you call that a toe drag? I haven't seen it make contact with the ground.
So I'm going to say no.
Yeah.
You almost want to look at her shoe to make sure that that's not happening.
Cause you'd see some scuffing, but no, I don't see it. She's clearing it.
That that might be something we might check in an anterior-posterior view as
well. Okay.
Really quick. Since she has that inadequate dorsiflexion,
let's look at her right.
And see if she's doing a vault there to clear it or what is she doing in order
to clear it? Maybe we'll wait until we see the AP view.
Let's see. Yeah. Let's go and jump to the AP view really quick.
It's the nice thing about having video.
We can go through all of this stuff here.
So still looking at that left ankle.
Yeah.
So it does look like it's clearing the ground and I'm not seeing any vault on
that side.
Yep, me neither.
She's almost doing like a hip hike in order to clear it on the left side rather
than a vault. So I'm not going to mark that. Yeah.
So now that we're in this view,
this really sets us up well for looking at the calcaneus as well in this
particular, in this anterior posterior view.
And that's going to allow us to be able to see the inversion-eversion.
So let's see here, especially as you're making contact. Looking at that left.
Boom. Yep. Yeah. I don't really see it.
Like she makes contact like pretty neutral,
but then as soon as she like loads into it,
I'm seeing her go into that eversion where that heel's going out.
Yeah. Cause there is a natural,
like there is a natural kind of eversion that occurs, but this is.
Abrupt. Yeah, pretty dramatic there. And dramatic. And it,
she carries it through the whole single limb support.
So it's basically excess eversion,
I would say for loading response and then into that whole single limb support
eversion.
Yeah. I would, I would as well. Let's watch it one more time.
Yeah.
Yeah. And then moving over to the swing, uh,
let's see here.. I guess you can see excess
inversion on that one, it's kind of, it's sort of half and half.
It's just so inconsistent and more, it looks like a wobble. Like it's, it's not,
it's poor motor control. I don't really think it's like,
you can just see that wobble coming through swing. I don't know.
I'm not gonna mark it, but you can. I just feel like it's too,
too wobbly through there.
Yeah. Alright. Let's look at toes. And for this one,
I'm going to choose a lateral view to talk about this one here. Okay.
So let's see here. A big thing we're looking for the clawed (toes),
obviously she's wearing shoes right now,
so we're not going to be able to see that one. Right.
But here we should be able to see if she's getting the,
in the metatarsal phalangeal extension.
Cause get that little crease in her, um, in her shoe.
Yeah. That's a great place to look for it.
It's looking for like a crease basically where the toes would be
and I'm not seeing it.
Boy. That's tough. Well, let's uh,
let's mark it down. Uh, and maybe we can just say like, just, you know,
need barefoot, let's say.
Yeah, that would give us a better sense of what's going on. Okay. All right.
So I'm going to bring it back to the start of our slow motion here.
So now we're going to jump into the knee now. So here's the left,
as it comes in,
things looking fine as far as like the initial to me.
Yeah. You want a little bit of flexion in that knee,
upon loading response and she's got that. That looks great. All right.
But then she comes into stance. Yeah.
Her stance is kind of carrying,
just a little bit of flexion into it, honestly. Like she's not fully extending.
Oh. And then, ah.
I think it's not that you're seeing the flexion upon loading response.
I think we're seeing boom and well, let's see it on the way back,
but I think she's going into that extensor thrust and that's what you're seeing
more than anything that was not too bad. No.
See what this one.
Oh, she's not. Okay. Well maybe there's a little bit there.
There's a little bit there. It almost happened late.
Yeah. Kind of... Let's look at this in real time.
Oh yeah. Oh, okay. Big one there. Yeah.
So we saw that knee popping back into that extent, like that hyperextension.
Yeah. You can kind of see it here as well. Boom. Pop pop. Okay. So yeah,
definitely an extensor thrust there. So there was that difference.
So you had actually that knee kind of forcefully moving back,
especially as she got more towards that terminal stance. Yep.
Yeah. You could just see it. Doesn't look, doesn't look good?
Yeah. This is one of the things that's important.
I think to see actually in true normal motion there.
All right. Can we take a look at the AP view?
I just wanna make sure we're not missing any valgus, varus, anything like that.
Let's see here. So this is hard to see.
This is like one of those cases. It would probably be good.
It would have been really helpful if we had pulled up the pant leg above the
knee there. So we're kind of missing a little bit.
Yeah, it sounds like she's got a little bit of a valgus positioning there,
but then she also so much calcaneal eversion that...
Is it coming from the foot position? Do you know what I mean?
Yeah. I don't see anything in there that I could really reliably say. Like, yes,
that's what I saw. So for me, I wouldn't put anything there as of right now.
So maybe something you would look at again. Okay.
All right. Let's look at that thigh as best we can. Um,
so starting kind of in the sagittal plan,
looking flexion and extension here again, we're looking at that left side
here comes through. That looks good. Yep. Here it comes back.
That looks pretty good. I see, I see 20 degrees of extension that yeah,
I think that looks good.
So now as we're getting into like abduction, adduction, internal rotation,
external rotation, this is going to be best to be seen in that AP view.
So we're going to get here,
especially in this slow motion it's going to be easier to see. Alright.
Taking a peek here. Okay.
Alright.
I am seeing medial rotation and maybe that's why I thought it was valgus.
And it's actually like we talked about earlier more medial rotation from the
hip. That's true. Yeah. Yeah.
You can just see where the seam of her pants almost.
You can see that lateral seam of her pants because she's medially rotated.
All right. Are you seeing that in swing as well? Or just.
I'm seeing it primarily in stance right now? I would say, yeah,
I would actually argue. I see a little bit of that in swing as well.
Good.
I think also one other thing I'm seeing here is occasionally is abduction.
It's one of those things that it's not coming through every single time,
but like, like right there, like her left foot cross right in front of her.
Right? No, that's true. There's almost kind of like a,
like what you might call a scissoring.
Yeah. But that one didn't look like it.
Let's see what happens here again. No, that one's good.
That one looks all right. And how did we come in?
Next one? That was fine too? So yeah, this is kind of one of those ones. That's
so you come here, there's close. Not bad.
That was very adducted there. Adducted there. Adducted there.
I would mark that one. I think it's happening with enough frequency to,
to warrant doing that. Cause if it's happening here.
It's definitely gonna be happening out in the quote unquote real world.
Yeah, no. Alright. Okay. Alright. Fine. Fine, Will.
This is one of those ones that I it's so inconsistent.
And I wonder if it's true adduction or just again,
such poor motor control, but either way. Um,
I know we go ahead and mark it. Okay.
Alright. And now we're going to go up to the...
Inconsistent... Pelvis. Yes. All right. Now moving into the pelvis.
Um, so for this one, I'm going to capture a little bit from the side here.
So especially looking for that forward rotation or backward rotation, um,
let me fast forward it so we can actually see that left side here. Here we go.
Kind of stays back there. You can almost see her,
her thigh come forward in flexion right there, thighs forward.
But I can't really see if.
Not a dramatic movement of the pelvis overall. Seems kind of stiff.
Can you see it from an AP view?
Here it should should come through here. Yeah.
That doesn't really look like a forward, much of it.
There's just not, it's more from the hip isn't it? Like that, yeah.
You can really see it there it's way back there. Okay. All right.
So let's put maybe inadequate forward rotation.
Yes. That would be occurring in the swing limb advancement there.
How about... Now, remember I said that she wasn't vaulting on the other side,
but she's hiking to clear it. Um,
so I'm gonna put a hip hike for sure. Cause,
look at that that's that she doesn't have that dorsiflexion
how's she clearing it? Boom.
There's a little hip hike. That does seem to be where it's coming from. Yeah.
Because with the inadequate dorsiflexion,
it makes you think that something's gotta be happening in there.
So it looks like.
I think it's more of a, a hip hike. Maybe,
maybe even a little circumduction and that's what we're seeing with that
adduction.
Alright. I'm going to take a look from the side.
I want to kind of see from an anterior tilt versus posterior tilt and yeah,
pretty clearly I'm seeing pretty much an anterior's right there very much so.
Yeah. Those hips or pelvis is very much rocked forward.
So kind of like what we're talking about,
that's probably like weak glutes that we're seeing. Weak glutes, weak abs Yeah.
Yeah. At least something for us to investigate further. Right.
Is that pretty much it for the pelvis? I think...
I think that's it. Yeah. Good. Okay.
All right. So then we move on to the trunk.
So let's start off with the forward and the backward leans.
That's what we can see in this particular thing here. Um.
Not bad, not bad. Yeah.
I think that anterior pelvic tilt kind of keeps her more upright, to be honest,
you know, you'd expect to almost see her flopped forward. Uh, but.
From a more general standpoint, I mean, she's got like forward head,
but like overall looking at like thoracic spine,
especially it's not that far forward. Not enough for me to mark it. Yeah.
I'm actually pretty happy with this. So let's look at it from this AP view.
And so now we're looking at left versus right.
And we're going to come here on this little motion here in just a second.
Let's see here. Okay.
So she... Look at the left leg in stance. So when she's in stance,
what's her trunk doing a little bit of a, what was that left lean
in stance? I see a left trunk lean.
I see that left shoulder drop. Definitely. Yeah.
I kind of look at her shoulders. There's a drop.
Well is definitely a difference.
Wasn't it trying to like if we were looking at shoulders,
if we'd ideally like to see them to be level,
you can definitely see them tilt towards the left as she goes over there.
So it's not like the most dramatic one that we can see,
but I would definitely say that it's certainly there.
Yeah. Okay. How about in swing?
She's got a little bit of a slight, you know,
and I think it's because she's hiking her hip to get that hip hike.
She kind of leans to the right in swing.
Yeah, I guess that, so it's kind of combination between.
A hip hike slash a right lateral lean. Just to kind of clear that foot.
Again, not the hugest one, but definitely there.
Yeah. Want to mark it. Okay. Alright,
good. Any global, uh,
kind of big picture things that we want to write down here.
Let's look at that in real time speed really quick.
So definitely a decreased gait speed.
For sure. And looking down,
like we were saying that forehead and her arms aren't really swinging that much.
They're kind of just held down by her side.
So it's a little bit abnormal there.
Speed. Forward head. Decreased arm
swing? Yeah, probably,
probably not the most efficient.
Alright. And so we're gonna stop there.
And so that is our analysis of our reference limb.
And so we spent quite a good amount of time there, but we wanted to be thorough.
We wanted to spend time and kind of talk about why we're seeing different
things.
And already you can see that we actually differ on kind of our interpretation of
things that should be pretty clear cut. Um,
this is why you can kind of see that reliability is not the highest for this
particular assessment,
but everything that we're saying is definitely worthy of talking about. So like,
you know,
where we might Differentiate on something where we might check it versus not
that doesn't mean that it's not a concern that there's not, you know,
certainly issues that are going on there.
It's just that I think oftentimes our definitions of what we might be seeing,
I don't think are well-represented in standardized forms like this.
You also saw how, how heavily we relied on the video.
We would have been in trouble if we hadn't had that video in order to kind of go
back to say, Oh, I want to see that in AP.
I want to see that in the lateral view.
And so you could really see just how great it was to have that video versus
asking this, uh, particular person to walk.
However many times we needed in order to perform that full analysis.
So a great way to practice, it slows it down. You can see that slow-mo um,
and then also if you can, with the patient, videotape them, uh,
to give you that, um, allowance to go back and forth and,
and really make sure you're seeing everything that you want to put down that
form. All right. So we just did, um,
the analysis of the left limb. So let's go ahead and let's quickly, uh,
change out our forms and let's do one on the right.
Yep. So now we've got a clean form ready to go. And again, now, you know,
our reference limb was that left side, but we're now looking at the right side,
kind of in the context of the other opposite side.
So this one should go a lot faster because we've already hopefully gotten most
of the big issues out of the way we've already done our global assessment as
well. So those things we don't have to necessarily look at. Alright, so again,
here,
we're taking a look at the right leg and let's go ahead and dive in.
Good [elevator-style
music
].
So there we go. We've done our assessment. Now. Now we have all of this tool,
which has a list of deviations that we're able to use.
And these are all things that you can document on as well. Um,
and one way that you can use this is that as you do treat a patient, um,
you can kind of use these different areas of the body that we're seeing
dysfunctions in order to guide your treatment or guide your interventions that
you select. And over time,
you could also potentially use this to go back and check over and see if you're
still seeing those impairments that you saw on that first day,
when you did the analysis.
Like we talked about before,
the nice thing about this form is that it does break it into the weight
acceptance, single leg,
single limb support and swing limit advancement sections.
And the nice thing about that is you can really see, boy,
she's really struggling on this left side.
You can see how many places we marked in this weight acceptance down here at the
ankle and calcaneus.
You can really see how many things we marked at the swing limb.
It just kind of helps guide where we're going to focus our treatment.
Absolutely.
Thanks for following along with our gait observational analysis series, we, uh,
hope that this was informative and that, you know,
what the next thing to do is print off more of these forms and go practice with
the case series that we've got.
Yeah,
we've got a number of different case studies that you can use as part with,
with these different forms. You can find those on our YouTube channel at
youtube.com/missiongait. And we've got a number of different pathologies.
And even for some of the cases, we have, uh, multiple cases,
multiple videos of the individual as they progressed along.
Actually the video you watched today,
we actually have an example of this patient with an orthotic and with a cane as
well.
And so you can kind of observe the differences in her gait pattern once you add
those things back into the mix. So highly recommend you check those things out.
And if you have any questions, comments, or concerns,
let us know down in the comment section below and thanks for tuning in.