Walking is one of those movements we all take for granted. We don't regard this as an exercise, it is just something we all can do. But what happens if you have an accident, injury or suffer with some type of disease that affects your ability to walk correctly? What can you do about it? A severe loss of balance, strength, and confidence to do things that were previously easy and taken for granted can now completely change your way of life. A stretching program will help to some degree but will not be your answer for lack of strength. A strength program will help, but will not be your answer for lack of stability and mobility. What do you do? To answer this is more than just one secret exercise or a one size fits all approach. We have worked for many years in the rehabilitation field (16 years now) and work closely with many health therapists successfully helping people overcome all types of injury, from spinal injury and back pain to ACL reconstruction rehabilitation. But out of all these injuries, the loss of the ability to walk would be right up there with being the hardest and trickiest to work with to find a successful solution for the client. In this article I am going to share with you some of our most successful exercises, strategies, and methods for helping people learn to walk correctly, or in some cases getting out of the wheel chair and learning to walk again!
What Is Gait & Why You Must Train Patterns Of Movement
Some of you reading this may know of someone who has trouble with walking or you yourself have difficulty walking on a daily basis. In the health industry walking is known as Gait. What is Gait?
A gait cycle is a sequence of events in walking or running, beginning when one foot contacts the ground and ending when the same foot contacts the ground again.
The human gait cycle is a very complicated, coordinated series of movements. Which is one big reason why so many rehabilitation programs fail when they use simple methods to improve it!
In the book Movement by Gray Cook he says, "movement patterns are destroyed by reductionism." We have become so good at looking at things in such great detail we lose sight of how we really move. Focusing on single muscles and areas of weakness will do little to improve the ability to walk. I am not saying it is a waste of time, just that we must move to integrated complicated patterns of movement to make any significant change. Gray Cook says it best,
"Patterns are groups of singular movements linked in the brain like a single chunk of information. This chunk essentially resembles a mental motor program, the software that controls movement patterns. A pattern represents multiple single movements used together for a specific function."
Many of the clients we currently work with, have spent a lot of time working with other methods of training that were predominately isolated training techniques, or methods using machines or equipment to assist with their lack of stability. Just changing the strength or flexibility of a body part will not change a movement pattern unless the motor program is also changed. This is where we might use isolated exercises but with the purpose of instantly adding the movement pattern straight afterwards. To train balance you must be out of balance. And with this comes risk, however with us being there to support them and guide them we are able to enhance the movement faster than any other form of training. It is not easy, and can take some time to do. Mentally as much as physically the clients are tested with these patterns but it is exactly what the brain needs in order to reprogram a new sequence that is more efficient.
Read the article Movement Not Muscle for more detail on this.
Watch the video below that shows you several exercises to improve the gait pattern.
We currently have clients here who have goals of improving their walking ability after an accident or from a long-term neurological condition and throughout this article I will use REAL LIFE examples of what we have come across that works well and how YOU can improve your gait. As already mentioned we have found that this the typical “muscle” approach used by most health practitioners and rehab centres is very ineffective when it comes to this problem. Because the walking difficulty is caused by a “neurological” problem, in easy words, the problem is coming from your nerves; only a neurological solution or movement can solve this.
With neurological impairments like stroke, TBI (traumatic brain injury), MS (multiple sclerosis) and cerebral palsy the damage is done within the central nervous system.
If you can imagine an electrical system of a house: the meter box (being the brain & spinal cord) is the central nervous system, the wires leading out to the switch are the nerves leading towards the light globe (being the muscle). If there is a problem with the meter box (the brain, movement) you will never be able to fix it by changing the light globes (the muscle via stretching, the same floor exercises you’ve been doing for months). We are here to fix the meter box to help out the rest of the system. In order to improve this we need to put the body under a challenge in order to switch on more nerves.
We cannot ignore the role of the feet with this and this is the logical place to begin.
With over 100 various muscles, the feet and ankles encompass 15-20% of all the muscles in the body!
For any movement you do standing up, neural signalling begins at the feet as they are the first part of the body to feel the ground and tell the system what to do. They tell the brain where you are, if you are balanced enough to move yet and basically instigate movement before it even begins. The better the feet and ankles are functioning, the better the signal all they way up the kinetic chain.
Our feet and ankles are meant to withstand incredibly high forces and should provide more in terms of shock absorption than perhaps any other body part.
Unfortunately, we begin to gradually lose this ability once we start wearing shoes. Over time, the feet, ankles, and toes become inhibited. And as we expose our feet to some trendy shoes with all types of padding and support, this only make matters worse and exacerbates the lazy and weak feet muscles..
Besides minimizing the ability to withstand intense ground reactive forces, the body gradually begins sending fewer and fewer signals to the feet, leading to distortions in pro-prioception and loss of innervation all the way up the kinetic chain. This is where injuries are born!
Ultimately, this creates foot and ankle dysfunction that leads to inefficient movement in the body that over time leads to chronic pain. Shortly I will explain a great way to overcome this problem but for now I suggest to watch the 2 videos below for more detail on just how important the feet are for providing stability when we move, and some simple exercises you can use to improve this.
Now that we have defined the gait pattern for you and explained how important foot stability is it is time to look at some of the best exercises for improving your ability to walk.
Just remember there is no one magical exercise on its own that will "fix you". You have to use a combination of all these ideas and apply what works best for you. And you also need to be very patient as you will make many mistakes and become easily frustrated. While it may seem you are getting nowhere as you continually mess things up, keep at it, for the mistakes are exactly what the brain needs to see in order to make some adjustments. Make sure you keep things safe and you may need someone to assist you in the early stages to overcome the fear that some of these movements create.
Okay, let's get into it.
1. The Line Drill
Watch the video above to see how to complete this exercise. I also use this a test with older adults to predict a fall as you can see in the video to the right with an older adult performing it.
For such a simple exercise this is extremely effective at enhancing the entire body to fire an instant reflex to react to sudden stability challenges.
When you are in your 30's or 40's and you slip or trip your reactions are extremely fast. Your brain sends a very rapid response to adjust your centre of gravity, step forward, grab something and prepare your body into a safer position for impact with the ground. This all happens in the blink of an eye and is not a conscious thought. We do not need to train this skill when we are younger as we very active and constantly exposing our bodies to this ability in daily life.
However an older adult that has gradually become less active and is losing muscle mass, or someone who may have suffered an extreme lower limb injury and has lost their walking ability will have a much slower firing speed. As their brain recognizes this weaker signal it compensates by making several changes to how we move and adopts a stiffening approach to stabilizing.
People with poor balance often apply a rigid and stiffening strategy of locking the knees and straightening their legs and stiffening all their muscles to prepare for impact. This strategy makes falling inevitable and the consequences of one much more severe.
This exercise has 5 levels to the test as each one narrows the base of support and mimics the feeling of falling! In the early stages you may require the use of a stick or cane to learn how to move the feet in the right position and make this exercise safer until you develop more confidence.
The hips may also require mobilizing and some additional exercises for strengthening the legs will help. But really this will come down to how well your body coordinates the gait cycle with large steps.
Read this article to see more about these tests - 2 simple gait assessments to determine the risk of a fall
2. Walking On The Sensa Mat
I would go as far to say that this piece of equipment is the "BEST" thing I have added to our programs in the past 10 years, it is that good!
This exercise can be very painful and daunting to begin with but the rewards are so worth it! The purpose of walking on the Sensa mat is to fire more sensory nerves within your feet, by doing so this has been shown to improve motor nerve function within your feet and up through the rest of the leg.
In a recent study conducted by the Oregon Research Institute (ORI), textured surface for the feet exercise has demonstrated an improvement in physical function and reduction in blood pressure to a greater extent than conventional walking in older adults. This was mainly due to the effect the mat has on what are known as mechanoreceptors in the sole of the feet in the skin. These mechanoreceptors have a large impact on balance and postural control. As we age, we experience DECREASED information from foot sole skin input. One solution is to enhance skin information with the intent of improving balance.
The image above shows me using this and also one of our clients who has been improving the control aspect of her walking after suffering from a severe car accident that left her with symptoms similar to a stroke. Since adding this type of training she has demonstrated significantly better stability and walking patterns. Her improvement in just a few short weeks was nothing short of incredible! Her gait and overall foot stability progressed so fast she was able to begin walking over high objects, and is now walking down stairs without holding the rails! You can read her full story by clicking here
For more detail on the Sensa Mat make sure you read our full article Improve Your Foot Stability Using The Sensa Mat
A great video of this in action is below.
3. Progress Your Walking Difficulty
This exercise seems obvious, however, in giving you most improvements through your current gait it is viable to increase the intensity of your walking and not just the distance and amount of your current walking ability.
Increasing the intensity of your gait will recruit more nerves through shocking the body, therefore recruiting more muscles and making you stronger etc. In here we provide the safety supervision in order to perform this. An example here we have one of our clients walking using a frame through a distance of 10 meter bursts, this is harder than what he currently uses; holding his parallel bars. Another example is steeping over objects, adding this object will initiate the nervous system to have no choice but to try and act upon it and therefore lift the leg up.
See examples below of where we use an obstacle course using mini hurdles and various heights of objects in all directions.
Want Proof That This Type Of Training Works Then Make Sure You Read The Stories Below
The two clients pictured above suffer from serious neurological injuries. The client in picture on the left and middle (Frank Cannizzo) has a spinal cord injury affecting his balance and motor control on his left leg. The client on the right Steve Nikolovski has Multiple Sclerosis. Both of these clients have been using many of the drills featured in this article and to see just how much impact it has made on their life here is their stories.
"My journey started some 18 months ago. After a couple of years of trying to find a cause for my back pain, the doctors found that I had a 65mm long tumour growing inside my spinal cord between T4 – T7 vertebrae. I never would have expected anything like that! Doing nothing was not an option, so I was booked in and had the tumour surgically removed. Doctors did say there was a chance of paraplegia, but I thought that would never happen to me. “Lucky Frank” ! The tumour was benign, but it did leave me numb from the waist down and with no motor function in my left leg and impaired sensory function in both legs. I had never been in a wheelchair before but soon mastered it, as it was the only way I could get around. I spent hours just doing laps of my ward at Cabrini. Determined to regain some sort of mobility.
I then proceeded to endure a couple of months in Rehab at Caulfield Hospital. Great staff and facilities, but the accommodation and food are a good reason to get well as soon as possible and get the hell out of there. I was doing rehab at the Angliss when my wife asked me to consider coming down to No Regrets. Nella was doing the cancer patients program and was really loving her time with Elley and the crew. She told me about some of the different people that No Regrets had worked with, and how they had some amazing results. I came on down and had a chat with Nick and have never looked back. I have gone from barely being able to struggle from the street into the Gym, to now being able get around the garden, mow the lawn, wash the car and do all those things we take for granted when you are able bodied. Although still reliant on my faithful crutch, I am moving with some confidence and a lot more stability than months gone by. With the structured exercise programs developing core and targeted areas, we have been working towards getting up and down stairs, up and down off the ground, bending , stretching, and all movements which are part of every day life. Challenging the body to re learn and find new ways of getting these legs working again
Elley and Dylan are always encouraging and supporting me, and with Nick Nathan and Mel all putting their two bobs worth in, how can you go wrong? There is a wealth of knowledge and experience there, and they always have the day’s workout prepared and ready for me. It was pretty sedate in the past, but as I improve, the buggers are starting to make me sweat!!
I have found it a great environment to be in at No Regrets, and find encouragement from fellow clients like Dave and Laurie a great help to make sure you never miss a session. No excuses , No Regrets!
I have heard about good personal trainers, but I think this place is pretty special.
Thanks No Regrets". Frank Cannizzo.
Here is a picture of Frank doing a trap bar deadlift in June 2017!
And here is Steve's story.
"When I was around 16 years old I was really into going to the gym. I'd go 6 days a week with my mates and always reach new heights in strength and muscle size. One day when I came home from gym I felt numbness in my face and I could barely walk. I didn't think it was anything serious, as my mates and I would joke about it after a heavy gym session. Then, a few months before my 18th birthday I was diagnosed with MS and the specialists said it was an unknown cause.
From then on I was getting medicated for my condition as the neuro-specialists were saying it was the best thing for MS, however, I felt it was making things worse. I was losing mobility in my legs and losing some strength in my arms, then, about 7 years later I couldn't walk. From then on I have been doing some rehabilitation with occupational therapists and physio's who have helped me gain function with certain tasks and getting around places in everyday life, although, there were some stages where I felt like I wasn't getting pushed hard enough, having my typical gym mentality haha.
Now that I have found No Regrets I feel like I am getting pushed to my limits. Since I have been here I have had two operations on my toe that they had to take the toenail off from the ongoing MS symptoms, however, that isn't stopping me from trying to get back into things that I need my toes to help me walk and work my leg shard. Nathan has been getting me to walk with my walking frames, doing squats up and down the chair holding on sticks instead of using the frame, and now to the point of standing up without holding on! (see picture) I wish I would have found these guys earlier as I feel like I am getting closer to achieving my goal to being able to walk again. " - Steven Nikolovski.
Here is a picture of Steve standing completely unassisted for the first time in years!
4. The Toe Touch Drill
This exercise is used to improve your static balance on one leg as well as transferring weight into different directions which is important for gait. This exercise would be one of the best to do as it brings into play stability on one leg.
I like to use this as an assessment tool with every client I meet on their first day, and especially with people suffering lower limb injuries or walking impairments. The reason for this is, it exposes mobility restrictions and weaknesses that are often hidden in other tests, helping me to design a corrective program that addresses these faults. It predicts future injuries in the lower limb without the risk of increasing pain.
And the other reason I like it is that it is a great core exercise. In reality it is so much more than just a simple core exercise as it influences many joints and muscles all within the blink of an eye. It is unique in that it has the ability to change the way a person walks for it shares the same relative timing used by all the joints of the stance leg in the gait cycle. It is for this reason we use it extensively with older adults who are at risk of falling and with people suffering various injuries in their lower limbs.
Below are some great videos to watch of this exercise. The video on the right shows me completing this drill on the Sensa Mat!
Also make sure you read the article - Why I love the Toe Touch Drill for improving hip and pelvic stability
5. Squats & Deadlifts
Learning to squat is actually a primitive skill you learn as a toddler, and it is where your body first finds the skill to be able to stand. Without this ability we would have great difficulty in performing even the simplest everyday tasks and be reverted back to a toddler and forced to crawl! For this reason we do not refer to the squat as an exercise, we refer to it as a pattern of movement.
The squat is a great way to build functional strength within the legs, no matter what level you are at there is a way we can perform this exercise. Obviously, if you have a walking impairment it may take considerable time to develop your strength with this movement and you may need to get very creative with the methods you use to improve this.
By holding your walking frame or gait aid is a great start to get the nervous system fired up to help recruit more muscles, therefore, assisting you in improving your walking speed and endurance. Other progressions from squatting up from a chair with your aid is holding sticks to enhance the stability requirement needed for you to balance yourself up, needing more strength to squat up and to lower yourself down with control.
The image above below one of our clients with Cerebral Paulsy performing squats. The harder version, instead of using his frame, we use two unstable sticks, therefore increasing the strength and balance requirement needed to perform the squat. Even though he may not be perfect and there are many things we cannot change, this type of activity has a profound effect on the rest of this body.
For more detail on the squat you will find a stack of information in our article 7 Best Squats For Stronger Legs & Bulletproof Knees.
When we talk about deadlifts the first thing that comes to mind is some beast of a guy lifting 200kg off the floor. While it is undoubtedly a great strength exercise it is very much like the squat in that it is a foundational movement first. And when it comes to improving the gait cycle it is VITAL.
Why?
For it targets the powerful muscles of the posterior chain that provide the ability to move our leg during walking. Almost every lower limb injury will have a weakness with the posterior chain as an underlying problem so it makes sense to have an exercise to improve this movement.
In Gray Cook’s book called “Movement”, he states several times it is best to train the deadlift first.
He says, “Deadlifting should be the first exercise taught to anyone interested in weight training because it meets all the criteria of a great fundamental exercise. It can be modified, it promotes core stabilization, it demands good posture, it promotes shoulder stability and it forces the hips to be the driving force.”
The best version of the deadlift to learn is the Romanian Deadlift shown in the video below. This video shows you several key elements to getting this right and also some progressions to try.
You will also find this article a great resource to refer to - Why the Romanian Deadlift is the best exercise for treating back and hip pain
6. The Lunge
This is another foundational movement pattern like the squat and deadlift although this one has some unique characteristics.
This exercise is one of the more difficult patterns of movement needed to learn in order to get program your walking on automatic reflex. Like the squat it will improve your strength, however, because this exercise is placing your legs in a split stance it simulates the action of walking much greater, and therefore correlates with walking more closely than the squat. The lunge is superior to most other patterns with relation to walking for it brings into play what is known as the Slings Of The Body. These slings are like chains or cross wires that integrate our lower body with our upper body to produce movement. This is why our left leg moves with our right arm.
To read more about the slings read these two articles
The split stance position also requires more balance required to keep your body in the upright stance.
Prior to using this exercise and also in conjunction with the standing version we will use a kneeling version that enhances the stability component of the core and the hips working together. This is one of those exercises that looks really easy until you try it. The best part about this exercise is it gives the same feeling as falling but without the danger of falling as you are already on the floor. There is three levels you need to master.
- Hands by your side
- Hand on your head
- Hands on your head and eyes shut!
If you can master level three with you will be making great progress with your reflex stability.
Below is the video of how to do this.
Once you have mastered the kneeling version it is time to build the strength into the standing version. Once again you may need to "cheat" on this at first to allow your body time to adapt. If you are working on your squat and deadlift already you will be making some good progress to improving this one as well.
Below is some pictures of us helping Frank to improve his lunge using sticks.
Do You Need More Help?
The two FREE reports shown below will help you to put together your exercise program to strengthen your body for walking. The glutes checklist is an invaluable tool I use a lot with clients suffering knee or hip pain trying to restore their movement.
Conclusion
I know it’s a lot of information, so in summary for you to take in the difficulty of walking resulting from a neurological condition is the nervous system shutting down, not the muscles individually! Therefore, to improve your walking you must put your body under the stimulus to improve it through complex tasks and movements as seen in a few of the exercises shown above. These will work well in conjunction with your current stretching, nutrition, pharmaceutical or other therapies you are already undertaking. Just remember that you will only change according to the level of challenge you subject your body to.
For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 300 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily. You can also subscribe to our FREE fortnightly newsletter by clicking here.
If you do need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 15 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References:
- Barefoot Strong - By Dr Emily Splichal
- Whole Body Barefoot - By Katy Bowman
- Born To Run - Chris McDougal
- The Vital Glutes - By John Gibbons
- Movement - By Gray Cook
- Corrective Exercise Solutions - by Evan Osar
- Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
- Core Stability - by Peak Performance
- Athletic Body in Balance - by Gray Cook
- Anatomy Trains - by Thomas Meyers
- Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
- Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
- How To Eat, Move & Be Healthy by Paul Chek
- Scientific Core Conditioning Correspondence Course - By Paul Chek
- Advanced Program Design - By Paul Chek
- Twist Conditioning Sports Movement - By Peter Twist