RSM-DPA-012
Written by Hironori Ikeda, MSc Sports Medicine
RSM International Academy · Chiang Mai, Thailand
When in the Step Does the Body Shift?
A client may lean over one leg to avoid pain, move the pelvis sideways during weight transfer, or change foot placement when feeling unsteady. Those patterns can look similar in a frozen image.
I start with the phase of the step and the client's complaint. Hip-abductor support, forward movement over the ankle and trunk rotation answer different questions, so I compare them separately.
This guide connects those regional findings to a repeatable walking trial and explains when a new gait change needs medical assessment rather than a posture cue.
In This Article
- When in the Step Does the Body Shift?
- In This Article
- 1. Loading Response and Single-Leg Support: Locate the Shift
- 2. Gluteus Medius: Compare Hip Support With and Without Help
- 3. Ankle Progression and Toe Clearance: Distinguish Calf From Dorsiflexor Function
- 4. Trunk Counter-Rotation: Change One Walking Condition
- 5. Re-test Walking and Recognise a New Neurological Change
- Related RSM Clinical Blogs
- Study Dynamic Posture Assessment at RSM
1. Loading Response and Single-Leg Support: Locate the Shift
I record several passes from the front and side at a comfortable documented pace. I distinguish sideways movement of the pelvis from angling of the trunk, then identify whether it occurs while accepting weight, standing over one leg or preparing the next step.
Pain can shorten the time spent on the affected leg. A person may also move the trunk toward a painful hip during stance. These observations suggest different examination questions, but the outline alone cannot identify the painful structure.
I ask about walking distance, rests, footwear, recent changes and falls. A stable painless variation does not need an automatic symmetry correction. A new or progressive loss of walking ability needs a broader history and examination before a technique is selected.
2. Gluteus Medius: Compare Hip Support With and Without Help
Gluteus medius attaches from the outer ilium to the greater trochanter, lying above gluteus minimus and partly beneath gluteus maximus posteriorly. It abducts the femur when the pelvis is fixed and contributes to pelvic support over a weight-bearing leg.
Anatomy note: In cadaver measurements, posterior gluteus medius fibres changed from external- to internal-rotation leverage as hip flexion increased; “hip abductor” alone misses this position-dependent role.
If the shift is clearest in right single-leg stance, I compare the left side using the same stance duration and knee position. Fingertip support is a separate condition. I record pelvic drop, trunk lean, pain and confidence rather than calling every lean a weak right gluteus medius.
A comfortable resisted-abduction comparison adds information about force and symptoms; it is not the same test as balance. If assistance changes the stance more than local muscle testing does, support demand remains part of the explanation. I then return to walking to see whether that finding is relevant there. If local tenderness is relevant, broad supported side-lying contact between the iliac crest and greater trochanter helps distinguish the muscle belly from its bony attachment before selecting a tissue trial.
3. Ankle Progression and Toe Clearance: Distinguish Calf From Dorsiflexor Function
As the body progresses over the stance foot, the ankle moves into dorsiflexion; later plantarflexion contributes to leaving the ground. Gastrocnemius crosses the knee and ankle, while soleus lies deeper and does not cross the knee. Both transmit force through the Achilles tendon to the heel.
When the shift appears during forward progression, I compare comfortable weight-bearing dorsiflexion with the heel down and the same foot direction. A supported heel rise asks a different question about plantarflexor performance. Neither observation proves that an isolated calf muscle causes the gait shift.
During swing, tibialis anterior in the anterior leg compartment helps lift the front of the foot. Repeated toe catching or a new inability to lift it should not be addressed only by a calf stretch. I arrange assessment of the weakness or sensory findings before making the walking task harder.
4. Trunk Counter-Rotation: Change One Walking Condition
The external and internal obliques occupy different abdominal-wall layers. With the pelvis relatively fixed, external oblique contributes to opposite-side trunk rotation and internal oblique to same-side rotation. During walking they participate in a broader system; visible shoulder motion cannot measure an individual muscle's activity.
I note whether the chest turns with or against the pelvis and whether that relation changes with pace or carrying a bag. I do not demand an exaggerated opposite rotation. If the shift appears with a very narrow foot path, a modest comfortable change in step width is one possible trial.
I keep the walkway and footwear constant and record the resulting speed and cadence. Pain, steadiness and effort matter more than creating a rigid marching pattern. If the trial feels awkward or worsens symptoms, I abandon it and revisit the phase or regional finding.
5. Re-test Walking and Recognise a New Neurological Change
I repeat the original walking condition and compare the familiar symptom, stance timing and shift over several passes. A useful step-width modification remains labelled as that modified condition. I also record whether the change helps the distance or activity the client actually needs.
Sudden imbalance or gait change accompanied by one-sided weakness, facial droop, speech difficulty or vision change needs emergency assessment. Stroke symptoms may stop briefly and still require urgent help. I stop the assessment and contact local emergency services when stroke is suspected.
Persistent difficulty lifting the foot or toes, repeated falls or progressive weakness also warrants medical assessment, even when it did not begin suddenly. Severe post-injury pain with inability to bear weight changes the pathway as well. An easier walking pass does not cancel these concerns.
Related RSM Clinical Blogs
Browse all Dynamic Posture Assessment clinical guides
▷ Pelvic Rotation Asymmetry: Hip Rotation, Gait & Trunk — Dynamic Posture Assessment · Separate hip rotation from pelvic orientation and chest counter-rotation.
▷ Hip Drops on One Leg: Gluteal Capacity & Trunk Strategy — Dynamic Posture Assessment · Examine hip-abductor capacity and trunk strategy when the shift occurs during single-leg support.
▷ Hip Drop on One Leg: Gluteals, QL & Pelvic Control — Deep Tissue Massage · Choose local gluteal or QL assessment when regional symptoms agree with the walking finding.
Study Dynamic Posture Assessment at RSM
In Dynamic Posture Assessment & Kinetic Chain Training, practise locating a gait change within stance or swing and comparing a single modification at a documented pace. Completion of Trigger Point Therapy supplies a palpation foundation.
Deep Tissue Massage adds supported gluteal, calf and trunk tissue choices when a local examination supports their relevance.
View the course schedule and entry requirements · Ask about course suitability and registration
About the Author
Hironori Ikeda, MSc Sports Medicine
Hironori leads RSM International Academy in Chiang Mai, Thailand. His teaching connects functional anatomy, clinical palpation and kinetic-chain assessment with practical massage decisions.
Read Hironori’s professional background and teaching approach