Talking about Walking

Its the most common goal I can think of for a PT. "The patient will be able to walk..." without pain; independently; community distances; without falling; up and down stairs. Walking is the real deal. My Apple watch counts my steps and asks me to stand at least 12 hours per day. So walking must be important if Apple cares about it. But even before Apple, PT students spent many hours learning about walking. So hears some of what I know...

Walking is a controlled mode of mobility where you alternate standing on one leg while the other leg advances. Then weight is shifted to the other side for single leg standing while the first leg advances. I know, I'm about to nerd out about this stuff but I hope you'll stick with me. What's important to know is the whole process is very controlled. You don't fall forward and quickly catch yourself. That's called tripping and is very uncontrolled. We should be able to stop at any part of the walking cycle and balance, then start again. We are never totally off the ground - that's running.

A lot of muscles have to work to walk. Hip muscles stabilize our pelvis during the single leg standing phase. Ankle muscles lift the toes so they don't drag. Our quads stabilize our knees so they don't buckle. That's just the basics, the tip of the iceberg. We don't really have to get into more specifics because that's not what's so exciting about walking, especially with babies.

Babies start to learn to walk around 10-11 months when they pull up and begin to cruise around the house holding onto furniture or other stable surfaces. They bounce up and down while standing at the couch to get their heels down on the ground and begin to get control of the hips, knees and ankles. Cruising is a bit easier because its sidestepping. The baby practices taking steps but doesn't have to worry about tripping over his toes. I like to set up a train of different surfaces (couches, ottomans, chairs) with gaps in between to help the baby shift and reach and begin to let go of the surface.

So I bet you're asking - Do I use baby walkers and push toys? As a therapist I don't. I don't even like to hold the baby's hands when I work on walking. I like to hold the baby at the hips so I can help with the shifting back and forth. This also leaves the arms open to help the baby learn to balance on their own and allows her to catch herself if she falls. By holding the baby at the hips I can gauge how much help I'm giving and what muscles are working. When a hand or finger is offered, the baby controls how much help she is getting. So back to walkers and push toys. I don't ever recommend a walker that the baby sits inside of because the seat puts the hips in an odd position and if they aren't the right height it can leave baby on her toes. Push walkers are great and help babies start to move in the forward direction. (And a little secret... a large box of diapers or Amazon box works just as well!)

First independent steps are the most exciting part of my job! Teaching children to be independent, so they can keep up with peers or siblings is the most important thing I can do. First steps occur any time from 11 months to 18 months. I highly recommend you seek an evaluation if your little one isn't cruising by 12-13 months or they haven't made significant progress to walk by 14-15 months. It's often the little tricks like handling at the hips and working on progressing cruising that will help a child gain confidence. A PT will also evaluate your child's feet to determine if orthotics might give them a little stability.

Just remember... toddlers are NOT lazy. They would walk if they could and often times they just need a little help to get going. You'll be baby proofing the house and chasing them down the hall in no time.