Video and Transcript: How to Get Rid of a Persistent Limp

Hi, everyone! Dr. Orit Hickman here from Pain Science Physical Therapy. 

I am redoing a video that I’ve done before where the sound quality was pretty crappy. And so, this video is about how to correct a limp if you’re experiencing a limp. And so, if you’ve-if you’ve checked out that video before, this is going to be probably the same information, but you’ll probably be able to hear it now. So, I apologize for that. [I] hope this works out better.

So, it’s one of the most common things that we’ll see in the clinical setting is a patient coming in after they’ve had some sort of lower extremity or even low back injury. And, as a result of the pain, it’s very normal for you to want to move away from that area that hurts. And so, a limp is a very common way that we’ll compensate for any kind of pain that we experience in the lower body. Totally normal. It’s what we would expect when you first start-when you first have pain, [and] you have an injury. But what can happen is that limp can continue and for sometimes months and even years afterwards. 

There’s a lot that goes into treating that and correcting that. We’re going to talk about the mechanics of a limp and how to correct it from a movement standpoint. But, oftentimes, there’s underlying neurobiology. So, the brain has put new programming, new movement patterning in. And, that’s a big part of what needs to be corrected as well. 

So, today, again, we’re going to just talk about the movements and the mechanics and how to correct the limp from a movement standpoint. But, if you find that you do these activities and it really doesn’t change things when you’re trying to retrain your movement patterning, then there may be-it may be that that program has gotten very hardwired in your brain, and we have to do other things to get the brain to let go of that program. And, when I say programming, I want you to think about most everything that you do that’s well practiced and automatic is a program in your brain: how you brush your teeth, how you get dressed, and even how you walk. And so, if you’ve experienced pretty significant pain in the lower extremity or in the low back area, then you might have started limping just to protect, and then it becomes a habit. And, it’s very challenging to break that habit once it’s there because the brain is going to prioritize protection well over anything else in the body. And so, that’s probably for another video. So, we’re just going to talk today about the mechanics.

So, a lot of times what happens is that-we’re going to use my right leg as an example. So, let’s say I have right leg pain, and when I walk, I’m going to want to keep my weight off that right leg. So, I’ll bring the right leg to the front, and then I’m going to shift maybe and do something kind of funky with my movement patterning just so that I can lift and bring my left leg forward but prevent putting too much weight on the right side. So, [you] really have to train the brain to weight shift and for you to accept weight back onto that side that’s painful or that was painful. Hopefully, it’s not still painful. 

Ok. So, let’s say it’s my right side. First thing that I’ll do with patients is I’ll work on what’s called a weight shift. So, if you saw my walk, this was how I was walking. Right? When I shifted my weight over to the right, I was hiking my hip on the left side to get over to that right side. So, we want to start from the very beginning of teaching you how to shift your weight over to the right without that hike in your-in your pelvis or without doing something else weird and funky in your body. So, you’re just trying to shift the weight side to side. 

And, if you can see, my hands are up in this position. I’m imagining that I’m holding a tray of glasses. So, if I shift my weight over to that right side, if I were to do something like this, I would tip the tray. All the glasses would fall over. So, I’m trying to imagine keeping that tray really nice and steady. And, if you need to, you can practice this with an actual tray. I wouldn’t put any glasses on there, maybe-maybe paper cups or plastic cups, something that won’t break.

So, I’m just shifting my weight side to side until I get comfortable with this, and I get used to this. And, you should be able to shift far enough over that you can then start to lift the opposite leg. So, you can see I’m bringing my weight over to the right, and now I’m lifting my left foot. And then, I’m bringing my weight over to the left, and I’m lifting my right foot. Right? So, you just practice. 

So, [the] first thing is practicing the weight shift and just getting that weight over. And, what you-I don’t know if you notice, but my hip height-my hip sort of [clicking sound] went out to the side on the left side. I’m correcting that now. And, I’m bringing my shoulder over. And, my shoulder-so my shoulders and my hips are aligned. So, my trunk is fully upright versus [honking sound], which is okay too. But, right now, for this training exercise, I’m just trying to keep everything as symmetrical as possible. So, I’m just bringing my shift over. And then, once I get comfortable with that, I’m going to lift the weight off the opposite leg. Right? So, shift and lift. Shift and lift. 

Once that’s pretty easy, and when I-when we talk about something like this-you know-the question that always comes up is, “How long should I practice each of the phases?” It really comes to-down to you individually. You practice as long as you need to practice until it’s automatic. And, that could be several days. That could be several weeks. Sometimes it’s several months. [It] depends on how long you’ve been limping and using these changes and these movement patterns, so compensatory movement patterns. 

So, you shift side to side. You do that as long as you need to, again, however many days, weeks, months it needs to be practiced. This is a great thing to do while you’re brushing your teeth. Right? You could just kind of shift side to side. And then, from the shift, you move to the shift-lift. Right? Shift, lift. Shift, lift. 

Once that gets comfortable and you can lift that opposite leg and hold it for a few seconds, the next step is shift-lift-step and then come back. Shift, lift, step. Okay? Shift, lift, step. So, again, you’re practicing this as many times as you need to side to side until this becomes automatic. 

And, a great place to practice this is also in front of a mirror so that you can really see: am I [creaking sound] doing this, am I like hiking and using my whole trunk, or am I just keeping my shoulders above my hips and [am] able to advance the opposite leg? Right? Shift, lift, step. Okay. 

So, then once that gets good… Right. We’ve gone shifting side to side, lifting the opposite leg, and then stepping. And, the next piece is shifting forward and lifting. Right? So, we’ve got shift, lift, step, shift, lift, step, shift, lift, step. Okay? Let’s try that again together. So, we shift, lift, and step. Shift… Right? [It’s] no different now except that we’re shifting a little in a diagonal position, but we’re still shifting over to the left side. [We’re] lifting the right foot [and] stepping with the right foot. Okay? Do that one more time. Shift to the right. Lift the left foot. Step with the left foot. Shift forward into the left. Lift the right foot and step with the right foot. 

And, you practice doing that until, again, these component pieces are automatic. Then, you can work on adding more and more steps. You can go forward. You can step backwards. If you think about it, we don’t only just go forwards when we’re walking. We-we step to the side when we’re changing positions in our kitchen. We might step backwards. And so, we’re going to be stepping in all these different directions. So, for now, we’re just working on this movement coming forward. But, eventually, we do the same thing. You-if you’re going to the right, for example, we shift to the right, turn, lift the left foot, and then step. Right? And then, maybe we shift back to the right, lift the left foot, turn, and step as we rotate. So, you’re going to build on these movements so that you can continue to work on improving that pattern.

So, this is just-this is just practice over and over and over again. And, like I said, in terms of how long this is going to take, it varies from patient to patient. And, it really does partly depend on a few things: 

1. How long have you been limping for? 

And 2. Is it still painful? 

And, you have to retrain your brain to know that this is no longer a dangerous activity. These are things that just make it more challenging. The longer you’ve had to limp or if you continue to experience pain, these things are going to be challenges that you might have to work through. And, honestly, you may not be able to do that by yourself. You could probably do that more successfully while working with a physical therapist. 

So, I hope this helps. Let me know how it goes. If you have any questions, please feel free to put them down below. If you thought this video was helpful, I would love it if you gave it a thumbs-up. Also, feel free to subscribe for more videos. And, I hope you have a great day!