Gait For Healthy Aging, Part II: Understanding and Preventing How Gait Degrades With Aging

Gait For Healthy Aging, Part II: Understanding and Preventing How Gait Degrades With Aging

There is a detailed discussion of how gait can become worse with age in [1], such as “increased gait variability, shorter stride/step length, slower walking speed, increased percentage of the gait cycle spent in double support and stance, decreased stride width with increased stride width variability, and less accurate tandem walking”. Some reasons for shorter stride I was unaware of include loss of strength in the calf muscles so there is less of the “toe off” in a normal stride I described previously, and overly tight hip flexors preventing sufficient hip extension [2]. A lot of the other factors are also attributable to balance issues and less confidence (fear of falling).

If your gait already shows signs of degradation I’d highly recommend getting referred to physical therapy. I saw some impressive improvements in patients coming to my PT while I was rehabbing after rotator cuff surgery. I also had a friend Ray who was rehabbing after a stroke. On the affected side he had a bad case of “drop foot” where you have trouble dorsiflexing the foot when walking:

This can cause you to trip over the toe of that foot, so he compensated by doing an exaggerated lift of the foot, resulting in an uncomfortable gait with a pronounced limp. He was referred to a trainer at the gym we were going to for remedial exercises, and was remarkably improved after a few weeks.

For those of use that are getting older but still have normal gaits, what can we do to keep it that way? It is critical to keep strength and range of motion in all three rotational directions of the hip (flexion/extension, abduction/adduction, and internal and external rotation), in flexion/extension of the knee, and in plantarflexion/dorsiflexion of the ankle. I lot of this is covered by this short video of walking exercises I referred to previously. That video is also good for working on balance, and for balance I’d also recommend the heel-toe and one leg exercises I mentioned in my gait evaluation. Stairs, and the “sit-to-stand” exercise, are both great for quad strength for you knee joint.

For the hips, it is straightforward to work all 3 directions with a resistance band shaped like a loop:

You can find these in sporting goods departments or on Amazon, or you can get custom ones like the one on the right from a PT. They have these by the roll, and can cut and tie them to a custom length. Just by having it around the knees or ankles you can to flexion/extension, external and internal rotation (with the clamshell and reverse clamshell), and abduction. For adduction I just use a band attached to an eye hook in a wall. Here is abduction, adduction, and flexion/extension with the band:

For rotation you can do the clamshell and reverse clamshell:

You should check with you doctor or PT before doing any of these if you have any limitations. For example, I believe the “clamshell” exercise, shown in the hip rotation video, is not recommended if you’ve had hip replacement via the posterior approach.


  1. Osoba, M, et al, Balance and gait in the elderly: A contemporary review, Laryngoscope Investig Otolaryngol. 2019.
  2. Kerrigan, D, et al, Biomechanical gait alterations independent of speed in the healthy elderly: evidence for specific limiting impairments, Arch Phys Med Rehabil. 1998.

March 19, 2021March 18, 2021

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