Circumduction

I was walking behind someone in a coffee shop today who displayed a telltale sign that he had either a stroke or another neurological injury affecting the legs. Or just one leg. What I saw was that when this guy advanced forward with his right leg (took a step forward), his leg swung out to the side instead of following the normal gait pattern of flexing the hip, bending the knee, and lifting the foot. The right leg just stayed straight and swung out to the side. When the body does this, it’s called circumduction of the leg.

It did this for clearance of the foot so that he wouldn’t trip. The body automatically compensated with other muscles to make up for the muscles that were not being properly used. The foot couldn’t lift and the knee couldn’t bend which – if the leg was able to go straight forward, would cause the man to trip. The leg automatically swung out to the side in order to clear the foot from the ground and prevent tripping.

There are several things going on here. Starting at the top of the leg, the hip flexor muscle is not working properly. I’m assuming this is because of signals from his brain being messed up but of course I could be wrong not knowing this man.

Sit down with your knees bent. Raise your right knee. Can you do that? That’s number one. When you’re walking, you’re hip flexor must activate in order to raise the leg and move it forward a little. Next, your knee has to bend which also helps in clearance of the ground.

Lastly, and perhaps the most common issue here is at the ankle. Are you able to lift your foot? Not just lift it, but bend it at the ankle, bringing your toes up towards the shin. A lot of times, an AFO(ankle-foot-orthosis) will be issued in this case which is a hard, non-bendable orthotic placed on the back of your calf and is solid in a neutral position that lengthens to underneath the foot to keep it in proper positioning so tripping is minimized. This is great to use in the short term but the goal is to get those dorsiflexor muscles (muscles on the front of the lower leg responsible for flexing the foot upwards) working properly again.

If this sounds like your gait, the hip flexors, knee flexors and especially the dorsiflexors need to be focused on for strengthening.



Categories: Health, Recovery, Rehab, Stroke stuff

Tags: , , ,

7 replies

  1. If I had that detail of muscles involved from my therapists I could have figured out what to work on by getting bodybuilding books or doing the appropriate action observation. My occupational therapist gave me a DVD of muscle movements but I didn’t have a DVD drive at the time, muscles were either red or green depending on contraction or extension.

  2. From your description . . . it sounds like it might have been a prosthetic. Next thing you’re going to say is he had shorts on and there goes my theory 🙂

  3. I have emailed you regarding a cusomised home exercise program but am yet to receive a reply

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