Who’s driving the compensation, anyway?

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We often look at folks gait and see a pelvic drift or lean to the weak side and think “I should help them strengthen their gluteus medius”, which is often needed, but we need to think of what is driving that compensation.

Take a look at this gent that presented to the office with low back pain and watch his gait. 

Some things we hope you see are:

  • lean to the right during right stance phase
  • increased arm swing on the left
  • increased progression angle of the foot on the left
  • increased arm abduction on the left, adduction on the right
  • increased finger flexion on the left
  • slight head tilt to the left
  • tibial varum
  • crossover gait

Perhaps you are thinking, in the same order as above:

  • weak glute medius on left or QL on right or compensating for LLD on L
  • using L arm to try and help propel himself forward
  • increased balance requirements on the left so the “kickstand” foot
  • moving center of gravity the left
  • increased flexor tone to try and compensate for a weakness
  • moving center of gravity to the left, the brain needs to help keep the eyes parallel to the horizon
  • tibial varum and perhaps a more supinated foot posture, or increased forefoot pronation requirements
  • crossover

..or maybe you are thinking of something else?

The truth of the matter is that what is driving the largest part of his compensation is in fact a disc herniation, but not for what you may be thinking. The herniation is on the LEFT SIDE and at L3-L4. Take a look at the MRI Image. Yes, there is also a small herniation that L5-S1 but it DOES NOT occlude the foarmen nor hit the individual nerve roots and is on the LEFT (which you are hopefully thinking would cause left sided weakness)

Hmmm...

So what is driving his compensation is actually a LEFT SIDED quad/adductor weakness (the femoral and obturator nerves are from L2-4). Go back and watch the video again. Can you see it?

Someone needs to be driving the bus. Don’t be too quick to jump on it until you know who is driving it and where it is going.