AGM2013: Promoting Walking Ability (Alison Clarke)

This post is the fourth and final post about the UK HSP Support Group AGM. Alison Clarke is a physiotherapist from the Northern General Hospital in Sheffield.

Alison began her presentation by giving the four things which a person needs to be able to walk:
1) Each leg must be able to support the whole weight of the body.
2) You must be able to balance on one leg
3) You must have sufficient muscle power to be able to swing the leg & trunk forwards
4) You must have the ability to swing the leg forwards.

Alison observed that for HSP the main problem is not being able to swing the leg forwards, there are problems bending the leg, with swinging it forward, and with heel strike. People with HSP bring their weight forward, with excessive trunk lean. As a result people with HSP have short steps, walking is slow, requires lots of effort, and various compensations are made. Several people end up falling over backwards.

HSP affects the gait because the condition affects the muscle tone. This can cause pain, bring on joint stiffness and reduce balance. When muscles are not used they become shorter and become weak.

When you have some walking issues, this is the time to have a review with a physiotherapist.

Alison then went on to discuss walking aids. These include:
Sticks/poles
Crutches/gutter crutches
Walking frame
Rollator/gutter rollator
Wheelchair
FES

'Gutter' refers to the type where you would put your forearm into a 'gutter' rather than hold just with the hand. Alison observed that with frames and rollators it is important to consider choices of seats, handles and ferrules.

Sticks and poles are used to aid balance rather than support weight. For HSP Nordic walking poles can be useful as they keep your body upright and increase your momentum. Having two of these aids is better than having one as two aids will keep you more upright.

It is preferable to use your own muscles and balance to walk and move, but considering using aids is not negative.

It is important to choose your aids carefully, they should put less stress on your posture, give you less pain and give you more endurance.  More importantly, perhaps, is that aids improve your aesthetics - people who use aids look more like an average walker than those who don't use aids.

Aids also give you more access to places, can help you at work or at leisure, and give you confidence. They can be a positive thing.

If you move with your own muscles you will maintain the quality of your muscles and balance, and using aids will reduce this.

Conversely you need to use aids when you cannot do what you want to, perhaps because you are falling or tripping.

Therefore, its a balance - you will need to spend some time maintaining your muscles and balance, but also use appropriate aids when you are looking to enjoy yourself. Elbow crutches can be a good choice.

There was quite a bit of discussion around this balance between aids and self moving after the presentation. Generally people in the room felt they should have started to use aids earlier.

I asked when someone should make their first appointment at the physiotherapist. Alison advised that you should if you are showing any small signs. If you leave it too long it can be hard to reverse any habits that you've picked up.