My goal with sharing information on this blog is to touch on some of the things I see, over and over, as issues that many Stroke Survivors have that get in the way of improving walking. Today’s topic is very high on the list of problems that I see over and over again that Stroke Survivors are not aware of. Hip Hiking is one of those problems.
First, let me describe hip hiking. It is when a Stroke Survivor initiates moving their more affected leg by raising their hip up. Another way to describe it is like this: the person brings their waist up toward their arm pit. (You can look at the picture that accompanies this blog for an example).
What occurs naturally, is that we initiate our step with our foot being active. The toes are lifting and the foot is already picking up before we start to bend our leg to take a step forward. Now, this occurs almost all at the same time, but the foot is definitely active and a part of the step from the very start.
When a Stroke Survivor starts the step “from the top” at the hip, lots of unwanted things can occur. First, engaging muscles up in the trunk to “hike the hip” can cause increased arm tightness. Also, many times when the brain engages the “hip hiking” as the first move to take a step, the knee stays straight or stiff. When a person is having trouble with their knee bending when walking, I will look to see if they rely on the strategy of hip hiking to step the more affected leg forward. Another problem that can arise with “hip hiking” is that the foot is not encouraged to become active, and this can contribute to more tightness.
Now, I will say that the strategy of hip hiking is not necessarily something that a Stroke Survivor chooses as a way of moving. Often, if the foot is not lifting and a person does not have an orthotic that helps the foot lift, the brain just automatically uses the strategy of lifting the hip. Hip hiking is not a way of moving that can be rehabilitated into more natural walking. Hip Hiking has to be replaced with ways of moving that are more natural.
To do this, I generally employ the following strategies with clients I work with. First, we find an orthotic that will help with the foot lifting if they do not already have one. Second, I assess to determine what areas of the body need increased flexibility- there are always places that need stretching. Third, we work on the parts of walking that are not natural and come up with drills and exercises to help more natural movements to become automatic. Then we combine that in walking forward, slowly on level ground. Then we add in walking backward, side ways and finally turns. Then we change the speed and surfaces a person walks on.
But before we can go through any of that process, we want to change the strategy of using hip hiking to move the leg forward to one that has the whole leg more active in the movement.
If you are interested in more strategies and instructions for how to use them, sign up for the Walking and Balance Boot Camp. In this online program I teach you exercises and strategies that can help you with lots of the common problems that Stroke Survivors deal with when trying to improve their walking and balance after Stroke. Click Here to sign up