1/4 Hour Neuro #40: "Duck Walking": Is It Really the Cause of My Hip Pain?

Introduction

Hello everyone and welcome to the neuro quarter hour! Today, we will tackle a common question: is duck walking the cause of hip pain? We will explore the connection between this walking style and potential body imbalances, drawing on principles of neurology and postural studies.

It is important to highlight that hip pain is a vast topic. This is why it is crucial to conduct a thorough assessment with healthcare professionals, such as doctors and physiotherapists, to understand the issue.

Duck Walking and Primitive Reflexes

Duck walking, characterized by feet turned outward, can be an indicator of several dysfunctions. In our neuro approach, we often link it to the immaturity of certain brain structures, particularly in the brainstem and reticular information.

A structure called the pontobulbar area, if immature, could lead to an abnormal opening of the foot, explaining the duck walking. This same structure is also essential for pain inhibition. An imbalance at this level could therefore not only cause duck walking but also bilateral hip pain.

The Role of the Babinski Reflex

A primitive reflex often associated with duck walking is the Babinski reflex. This reflex, typically present in newborns and expected to be integrated later, is manifested by a fan-like opening of the toes when the outer edge of the foot is stroked. If it is still present and there is an opening of the feet (greater than 45 degrees), it may be a cause of this gait.

To identify it, even when lying down and relaxed, a person with duck walking will often struggle to perform internal hip rotation to bring their big toes together. This is a common sign in individuals suffering from hip pain.

The Complexity of Hip Pain: Beyond Duck Walking

A General Body Imbalance

It is rare for a single aspect to explain all pain. Duck walking is a symptom that may reveal a more general imbalance of the central nervous system and motor control. For instance, a clinical case showed the presence of almost all non-integrated primitive reflexes in a young girl exhibiting this type of gait and cerebellar dysfunctions. The cerebellum, being crucial for balance and coordination, when dysfunctional, can impact proprioception and body mapping, making natural gait difficult.

Connection with Other Joints

The hip is not isolated. Duck walking has repercussions on the knees, which also turn outward, creating ongoing strains and tensions. Asymmetries are often observed where one foot is more open than the other, or one foot turns in while the other turns out, leading to overall postural imbalances, including in the shoulders and lower back.

Approach and Possible Solutions

The Importance of Evaluation and Multidisciplinarity

When facing hip pain, it is fundamental to consult a doctor. At the same time, a postural approach by professionals such as osteopaths, posturologists, or physical trainers can provide complementary insights. There will always be a link between the mechanical aspect and the neurological aspect; one does not exclude the other.

If pain returns after osteopathic manipulation, it suggests a strong link with biomechanical tensions. However, if nothing changes, a deeper cause should be sought, potentially related to issues at the foot level itself or non-integrated primitive reflexes.

The Steps Before "Amnesic" Glutes

We often hear about "amnesic" or "weak" glutes. While it is important to strengthen the glutes, it is crucial to address underlying issues first. Before diving into intense strengthening exercises with bands or weights, one should first check and reintegrate primitive reflexes and ensure proper activation of the posterior chain, for example, by practicing crawling or creeping. These preliminary steps can prepare the body for more effective and lasting strengthening.