Pain and Walking: an Often Ignored Connection?

Some antalgic gaits are well-known, almost caricatural: obvious limping, fleeting support, protective posture… But others are more discreet, more subtle. And when pain is not expressed, the connection between gait modification and a painful origin becomes difficult to establish.

And yet, this connection is essential to identify.

When Pain is not Spoken, but Seen

Faced with pain — or the fear of feeling it — the body reacts. It adapts. The patient naturally modifies their posture, their support, their way of walking. They set up antalgic compensations.

These adaptations are sometimes so effective that the pain disappears. Or at least, it is no longer perceived. In some cases, the patient has never complained of pain… and yet, their gait is altered.

Result: during consultation, we observe a gait modification without complaint or memory of pain. The connection becomes blurred. And with it, our clinical reasoning.

The Appearance Trap

If we don’t consider pain as a possible origin, we risk:

• Looking for another cause: motor deficiency, balance disorder, joint stiffness…
• Prescribing exercises aimed at correcting the gait… without effect, because the cause is not treated.
• Unintentionally reinforcing the compensatory pattern, by acting beside the real problem.

Physical Therapists, Let’s Stay Vigilant

As movement professionals, our role is also to be detectives. A modified gait without pain complaint does not mean the absence of pain.

Staying attentive to weak signals, exploring the patient’s history, questioning their apprehensions, observing triggering contexts: all of this can reveal masked pain.

And above all: treating the cause to remove the compensation.

Key points:

• Pain can profoundly modify gait, even without complaint.
• Some antalgic gaits are difficult to detect.
• Identifying pain (or the memory of it) is essential to guide rehabilitation.

The compensation is sometimes so successful… that it makes us overlook the cause.

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