Are You Having Problems With Walking or Balance?
It may be time to evaluate your gait for better health and long-term fitness
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Maybe you used to love walking in the park, but now that you’re getting older, you’re moving a little slower or worried about falling. These are among the signs that you may want to have your gait, or walking pattern, evaluated by a medical professional.
You are not alone. At least 30 percent of people ages 65 and older report difficulty walking three city blocks or climbing one flight of stairs, and about 20 percent require the use of a mobility aid — like a walker or cane — to walk, one study reported. Gait disorders have been detected in approximately 25 percent of people ages 70 to 74, and in nearly 60 percent of those ages 80 to 84.
Aging muscles and nerves
In the absence of an injury or medical condition causing difficulties, gait changes typically appear during our late 60s to 70s, says Kevin Vincent, M.D., chair of the Department of Physical Medicine and Rehabilitation at the University of Florida College of Medicine in Gainesville. In most people who develop them, it’s part of the natural process of aging and a slow decline of the nerves and muscles, along with a degeneration in the sharpness of vision. Conditions like diabetes or obesity can cause more rapid declines, especially if they cause neuropathy, or pain and numbness, in the feet.
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“Our fear with somebody with gait issues is (a) falling but (b) the impact it’s going to have since they start to get less and less functional,” Vincent says.
A classic misconception older adults have is that falling is normal, and there’s nothing anybody can do because they’re getting older, says Levi Atanelov, M.D., a physical medicine and rehabilitation doctor who runs an Owings Mills, Maryland, practice called Steady Strides. In truth, a rehabilitation program designed by a physiatrist, a doctor trained in physical medicine and rehabilitation, can help people make substantial improvements.
Police detective Larry Armwood, age 52, sought help from Atanelov’s office after suffering a stroke in 2019. At the time, he had very little function on his whole right side, from his eye and ear all the way down to his foot.
“My right side was almost like it was frozen,” he says. He had difficulties with walking, standing and balance, and couldn’t pick things up. Armwood engaged in a comprehensive rehabilitation program including several sessions a week of physical and occupational therapy. Besides physical exercises, he received an injection of Botox to relax the muscles, stood on a vibration board to help with neuropathy, and used a therapy brush to stimulate nerve sensations, among other treatments.
“They nursed me back to probably 98 percent,” says Armwood, who lives in Parkville, Maryland. He returned to work a year ago, rides his motorcycle, and can run two miles and do 50 push-ups. “I’m laser-focused,” he says.
Keep an eye on balance and falls
If you notice you’re shuffling along, your friends are waiting for you to catch up, or you’re starting to trip or catch your feet on the carpet or other surfaces it may be time for you to get evaluated, Vincent says.
Balance offers another clue, says Atanelov. If you’ve had two falls in a year, or one fall with a trauma, that’s a sign. So is walking with a cane or walker. “If you think — or better yet, if your spouse, friends or family think — you have trouble with balance, that means you have trouble with balance.”
Don’t be shy when it comes to seeking help, he advises. “There is a stigma for the patients psychologically,” Atanelov says. “They do not want to face the reality they actually have trouble with their balance. ... They’re scared: ‘Now my kids are going to think I’m old, or they’re going to put me in a nursing home, or make me get a walker.’ ”
A physiatrist is the first place to turn to evaluate gait and design a program to help you improve, Vincent and Atanelov say. If you’re not sure where to find one, tell your primary care physician you are noticing a decline, and ask for a referral.
During an evaluation, a physiatrist will observe your walking pattern, including your speed, the length and width of your stride, and how you transfer weight between your legs. They also will check your balance, ask you to rise up from a chair, walk up and down stairs, or observe how you can step over small obstacles.
If you’re not observing gait issues yet, or you’re in your 50s, now is the time to try to slow the decline, say Atanelov and Vincent. Maintain a good weight and level of fitness, keep your blood sugar in check if you have diabetes, and have your eyes checked yearly. Improve lighting in your house and remove things you could trip over. Wear shoes with good traction and support. Have your hearing checked if you are noticing issues, and take care of medical concerns promptly.
The good news, Vincent says, is that it’s never too late to make improvements. In fact, a study of frail nursing home residents up to age 96 found that a program of high-resistance weight training helped improve average gait speed by 48 percent in just eight weeks.
In a recent community talk, Vincent said, “Grandma needs a treadmill, not a rocking chair. We need her to keep moving, so that she doesn’t decline.”
“The body is a wonderfully resilient and adaptive mechanism that responds to the activity and the stress,” he says. “Yes, it might be a little bit achy at first if you’re moving and you hadn’t been, and yes, it will take time to adapt. ... But it will adapt. You’re never too old.”
Karen Blum is a contributing writer and award-winning health and science reporter in the Baltimore area. Her work has appeared in the Baltimore Sun and numerous magazines for physicians and other allied health professionals.
Step It Up
What are some exercises you can do to preserve or improve your gait? Key muscles to strengthen include those in the calves, thighs and hips, says Joseph Everhart, a physical therapist with the University of Pittsburgh Medical Center. (If you already have trouble balancing, talk to your doctor first.) Everhart recommends the following:
- Walk: Walk continuously for at least 20 minutes daily, even if you just walk loops around or inside your house.
- Calf raises: Stand with your feet shoulder-width apart. Hold on to the back of a chair, table or counter for balance, then rise up onto the balls of the feet. Or, sit in a chair and lift your heels, pointing your toes down.
- Knee extensions: Sit in a chair and take turns extending your leg out straight, parallel to the floor. You can add an ankle weight if you like.
- Mini-squats: Stand with your feet shoulder-width apart. Hold on to the back of a chair, table or counter for balance, then bend your knees until they are over your toes.
- Hip abductions: Sit in a chair and loop a resistance band around your thighs. Spread your legs apart and then back together. Or, stand and hold on to the back of a chair, table or counter for balance. Lift your leg out to the side, away from your body, while keeping your toe pointed forward. Alternate legs.
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