Spinal Exam

Assessment of Gait



  • Assessing a patient's gait can be a useful screening tool for identifying pathology affecting mobility. Impairment of gait may be due to pain, weakness, deformity or joint instability.
  • Gait involves many different systems - vision, proprioception, upper motor neurons, lower motor neurons, basal ganglia, cerebellum and higher planning centres. Full neurological assessment is required to correlate gait disturbances.
    • How to Assess

    • Ask the patient to walk ~5m and return to their starting point.
    • Look For

    • Posture - position of the head, shoulders and spine.
    • Symmetry - symmetrical rise and fall of the shoulders, hips, knees and feet.
    • Rhythm - natural movement through the stance and swing phases.
    • Coordination - steadiness of the gait and amount of sway. Dyscoordination may indicate an ataxic or spastic gait.
    • Foot separation - wide-based or narrow-based. A wide base  is used to compensate for poor coordination.
    • Stride length - the distance between heel placements of one foot over one gait cycle.
    • Cadence - the number of steps per minute.
    • Causes of Abnormal Gait

    • Pain - inflammation, infection, malignancy, trauma
    • Weakness - muscular, neuromuscular or neurological
    • Deformity - arthritis, surgery, shortening post fracture, congenital malformations
    • Instability - peripheral neuropathy, cerebellar or brainstem pathology

Antalgic Gait

  • The presence of an antalgic gait indicates injury or other pathology causing pain on weightbearing.
    • Look For

    • A painful gait, with quick stance on the affected lower limb.

Ataxic Gait

  • An ataxic gait occurs with cerebellar lesions or with loss of proprioception.
    • Look For

    • An unsteady, staggering, wide-based gait.

Apraxic Gait

  • An apraxic gait is common with frontal lobe pathology.
    • Look For

    • A wide-based gait with short, shuffling steps.

Trendelenburg Gait

  • The Trendelenburg gait is indicative of proximal myopathy.
    • Look For

    • Dropping of the affected side during the stance phase and the unaffected side during the swing phase.

Spastic Gait

  • Spastic gait may occur with cerebral palsy or hemiplegia.
    • Look For

    • A poorly coordinated gait with short steps and jerky movement.

Festinating Gait

  • Festinating gait may be caused by Parkinson's disease or other causes of parkinsonism.
    • Look For

    • Quick, shuffling steps with the torso held rigid.

Short Leg Gait

  • A short leg gait may occur in the context of any condition in which one leg is shorter than the other.
    • Look For

    • Dipping of the affected leg.
    • Causes of Short Leg Gait

    • Congenital short leg
    • Fracture
    • Joint disease
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 Chakraverty R, Pynsent P, Isaacs K. Which spinal levels are identified by palpation of the iliac crests and the posterior superior iliac spines? J Anat. 2007;210:232-236. Christodoulides AN. Ipsilateral sciatica on femoral nerve stretch test is pathognomonic of an L4/5 disc protrusion. The Journal of bone and joint surgery.British volume. 1989;71:88. Devereaux MW. Anatomy and Examination of the Spine. Neurol Clin. 2007; 25: 331-351. Dreischarf M, Albiol L, Rohlmann A, et al. Age-related loss of lumbar spinal lordosis and mobility--a study of 323 asymptomatic volunteers. PloS one. 2014;9:e116186. Epstein NL. Benztropine for Acute Muscle Spasm in the Emergency Department. CMAJ. 2001 Jan; 164(2): 203-204. Fon GT, Pitt MJ, Thies AC, Jr. Thoracic kyphosis: range in normal subjects. American Journal of Roentgenology 1980; 134 (5): 979–983. Glasziou PP, Purdie J, Yelland MJ. The Interobserver Reliability of the Thoracic Spinal Examination. Australiasian Musculoskeletal Medicine. 2002 May; 7(1): 16-22.
Ibrahim SI, Lo S, Tay SY. Loss of Cervical Lordosis and Foreign Body Ingestion. Otolaryngology–Head and Neck Surgery. 2011;145:P152-P152.
 Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE. Age-related hyperkyphosis: its causes, consequences, and management. J Orthop Sports Phys Ther. 2010;40:352.
Kim H, Scheer J, Lafage V, et al. Cervical Lordosis Increases with Age in Adult Spinal Deformity: A Cross-Sectional Study of Nonoperative Patients. Global Spine Journal. 2015;5.
 Kim HJ, Lenke LG, Oshima Y, et al. Cervical Lordosis Actually Increases With Aging and Progressive Degeneration in Spinal Deformity Patients. Spine Deformity. 2014;2:410-414.
Kostuik JP. Flat back deformity with loss of lumbar lordosis. Current Opinion in Orthopaedics. 1998;9:25-38.
 Ohry A. Dr Jacob Mackiewicz (1887-1966) and his sign. J Med Biogr. 2007;15:102. Perriman DM, Scarvell JM, Hughes AR, Lueck CJ, Dear KBG, Smith PN. Thoracic Hyperkyphosis: A Survey of Australian Physiotherapists. Physiotherapy Research International. 2012;17:167-178. Pool JJ, Hoving JL, De Vet HC, Van Mameren H, Bouter LM. The interexaminer reproducibility of physical examination of the cervical spine. Journal of Manipulative and Physiological Therapeutics. 2004 Feb; 27(2): 84-90. Sparrey CJ, Bailey JF, Safaee M, et al. Etiology of lumbar lordosis and its pathophysiology: a review of the evolution of lumbar lordosis, and the mechanics and biology of lumbar degeneration. Neurosurgical focus. 2014;36:E1.