This is one of my favourite exercises to work on with patients.
It is easy to test, and it gives me so much information about how a persons’ body is functioning.
By taking the test we can establish our baseline of performance in this simple task. Then by practicing increasingly challenging routines we can quickly improve.
Basically the test is to try and walk slowly on the spot, standing upright with hands down by your sides. Lift each knee in turn, taking 2-3 seconds from lifting the foot off the ground, to placing it back down again. If you have mobility or balance issues, start safely by holding onto the back of a chair, or close to a wall – it is easy to become unsteady.
Now add in your arms to the slow walk, lifting the left arm when the right knee comes up, and the right arm when the left knee lifts up. It is easy to get into a muddle at this point, and is more difficult the slower you go because that breaks up the movement pattern. So go as slow as you can. Can you maintain the correct left right arm and knee lift pattern? Can you stay stable on the one leg as the other lifts up and down – or do you topple over slightly? Are you stable, and in control?
If balancing this movement is a challenge keep one finger on a wall or chair to aid balance. The other thing to try is to do it looking in a mirror – this helps balance.
WHAT DOES THIS TELL US? – This simple movement tests a lot of basic functions – balance, co-ordination, pelvic and core strength and proprioception (The body’s ability to identify where it is in space). You may find that you’re quite good, but once you add in the arms it becomes more difficult. This might be because you are now using both sides of the brain – moving opposite arm/leg at the same time. The additional movement of the arms also means the body has to balance out differently, become more adaptive. Each person will have a different ability to do this movement, but importantly each person can improve or deteriorate depending on different factors. If you are tired or dehydrated ( or tipsy!) you won’t be as good. If you have had a recent injury, or become deconditioned through lack of exercise, or just as part of some peoples development/aging process it may become more challenging. The GOOD NEWS is that most people can improve easily and quickly with practice.
WHY IS THIS IMPORTANT? – This ability to slow walk is VERY IMPORTANT. When walking normally we spend a part of the gait cycle with both feet on the ground, but also partly with one foot at a time off the ground – balancing on the other foot. If our balance, strength or co-ordination gets worse for some reason, the body realises that it is not very steady in the ‘standing on one foot’ bit of the cycle, and rushes to put the foot down. This leads to a lack of control, and the person can feel that they are not really walking, but rather falling from one foot onto the other. Typically, this leads to the stride length shortening, and also as the person does not feel completely stable they can start to think about looking at the ground a bit more. Normally these changes happen very slowly, so slowly that we don’t notice. The TEST gives us nowhere to hide. We are forcing the body to show us how good we are at the gait cycle, how stable. Have you ever seen someone you know well ‘suddenly look like an old man/woman’ walking along the street if you hadn’t seen them for a while. This might happen due to an illness, or a period of reduced activity. Their gait has weakened – short steps, unsteady, looking down, anxious. We need to practice the slow walk on the spot to retrain our balance, co-ordination and strength. Unfortunately if left unchecked it becomes a vicious circle – we weaken, feel less steady, then shorten our stride more, spend less time on the one leg phase, get even weaker, even less steady etc. We start to walk looking at the ground, which can start us curving forwards in the upper back. The next step on from this is a greater risk of falling, and sustaining an injury – possibly a life changing injury in the case of hip fracture in the elderly.
If you are young and fit you might not think any of this applies to you. But practicing a slow walk on the spot can improve your balance and strength. It can improve your sporting performance…. think of the golf swing – transferring weight from one foot to other, maintaining balance through the swing, and finishing at the end of the follow through in a nice controlled posture, with no toppling!
Any sport with weight transfer from one foot to the other – football, tennis, bowls, badminton etc requires good stable balance on one leg, and when changing direction.
A special mention for dancing. My patients that dance are often very functionally able, particularly compared to their contemporaries, as they age. They are usually good at the slow walk, because their dancing improves the slow walk – and if they practicing the slow walk they will improve the dancing!
IMPROVE, IMPROVE –So we can all get better at the slow walk on the spot. We can move on from the most basic walk, adding in components to challenge, to start to really test our systems. I HAVE NEVER COME ACROSS A PATIENT WHO DID NOT IMPROVE THROUGH PRACTICE!!
THE BASIC SLOW WALK ON THE SPOT.
1/ Start this exercise holding onto a chair or table or by a wall to check that your balance is good enough to try it safely. Try these exercises in a quiet place, no distractions. Make sure there is nothing sharp or hard around the first time you try – in case you topple. BUT PLEASE TAKE CARE and don’t topple!!!
Start the slow walk on the spot by lifting one leg up, bending at the knee as the leg lifts up, then placing it down, then repeat with the other leg. Count 1 second for each leg raise cycle. Practice until you can move smoothly and controlled, left and then right, for a count of 20 – ie 10 knee raises of each side. Move to 2 seconds for each knee to come up and then down, then try 3. If you can’t manage this try it in front of a mirror. This visual cue will improve your balance through the movement. Concentrate on keeping your body in the midline, placing the foot down with control each time. Don’t sway to the side as you place your foot down. Keep strong in the middle. If you feel you are falling out of the posture try and resist, but put your foot down and balance with hand/finger to avoid a fall. If you need to balance using a hand on a chair, or wall, the progression is to go from using two hands to just one hand, or just a finger. Keep the hand near the wall, but try not to use it until you need to.
2/ Add in the arms, lift the opposite arm to the knee that you are raising, bending it at the elbow. Some will find this no problem, others will have to concentrate. Some people start with opposite left and right arms, but after a few steps this deteriorates to lifting left arm/left knee then right arm/right knee. We do not want this, it must be opposites – to get both sides of the brain working.
3/ Now, if your comfortable doing 3 seconds up, 3 seconds down with good control, no ‘falling out to the side’, and you’ve got the arm movements working ok –just bring those knees an inch or two higher – it gets harder. Remember to keep your breath slowly in and out, no breath holding. Lift the knees high.
4/ Try and do the slow walk with one eye closed, and then the other eye. You may find that you are better with one eye closed than the other. You may also have found that you are better doing the slow raise on one leg or other. These are peculiarities of your system, everyone is different. Try and get better on the weak side. Now the BIG ONE – try with both eyes closed. You will have to rely on your proprioception and balance mechanisms much more. Remember, we are training the neurological systems, as well as the musculo-skeletal strength and stability system.
At each progression of these exercises try and improve to the point that the progression becomes easy – nice slow controlled steps, high knees no ‘falling out’. If you struggle at any point, this is where the work starts. Practice this difficult progression. Concentrate, contract your core muscles, breathe.
5/ Add in a few ‘holds’ – keep the knee up at the top of the step for a count of 5, or 8, or move onto 10. This will build up the strength in the hip stabilising muscles.
6/ Try the slow walk with your head held in different postures – slightly to the side, slightly rotated one way or the other. Remember you can always put a hand or finger onto the chair/wall/table that’s close by if you feel unsteady.
7/ Add in accessory movements – perhaps when your right knee is raised, do a slight squat with your left knee – and vice versa. Or when the knee is up, tip forwards and back on the leg you are standing on..
You can mix up this progression, experiment and play around – but in general I would suggest that you try and add them in order, but perhaps read through all seven first so that you know what’s coming.
Perhaps play around with the slow walk on the spot for 3 minutes here, 5 minutes there, during the day. Little and often is better. Notice whether you are better/worse at certain times of the day, or if you’re tired, or dehydrated. Try before a walk, and then afterwards.
It is like playing the piano or riding a bike. If you haven’t done it for ages you might not be as good as you expect, but practice and you will get better.
So, you can build in lots of other variations to challenge further, but that is basically it.
GIVE IT A GO
I have seen patients whose balance, confidence and walking has improved amazingly doing this simple exercise progression. Please pass it on to anyone that you think might benefit.
If you have any questions please contact us at the clinic