Two Main Reasons WHY Your Child Might Navigate Stairs UNSAFELY

December 4, 2018

Stair Navigation

Stair Navigation

I was inspired to write about navigating stairs after one of my recent marathon runs but specifically my one in Corning, NY. The day after my 26.2 miles, I decided it would be a great idea to hike…😃

So…that’s where this leads me. I was sore, my muscles didn’t want to work properly and I compensated significantly. When I noticed how I was walking down steps of the trail, I realized it was just like how I see these children walk down steps when they don’t trust their legs or are weak on one side over the other.

Watch this video to demonstrate:




What Causes That?

Typically when you see this stepping pattern its due to one of two really common reasons that we see here in the clinic.

1. Limited Range of Motion in Their Leg:

For example, if a child has a lack of range of motion and mobility in their ankle joint (to move toes up/down: press down the gas pedal, lift foot off of the gas pedal) whether that be from surgery or contractures.

***Side note to this one … Ankle orthotics could also cause this compensatory movement pattern. Depending on which type of orthotics they have, it could limit the range in their ankle to move up or down, causing a different navigation pattern. For example, if your child has SOLID AFOs (meaning there is no hinge or movement at the ankle joint), this completely limits the child’s ability to move their ankle and adjust to different positions. Having trouble picturing it? Well imagine your ankle was fixed at a 90 degree ankle, you can’t move it up or down. Now step down with the other leg – what compensations do you notice? The child might have difficulty leaning forward or bending their knee, solely because its a blocked movement for their ankle.

Those are the same reasons that you see compensatory strategies without braces but a different cause (i.e. contracture or surgical history).

2. Weakness and Poor Eccentric Control of Their Leg Muscles:

Let’s flash back to that really cool video I made… If I have weakness in my quadriceps (my front upper leg muscles), then what do I do to compensate? I turn my body and sort of go down sideways. Why? Because it takes the pressure off of my quadriceps.

Here are some fun facts…There are THREE types of muscle contractions:

  • A. Concentric: The one you likely think of when you think of a contraction. The muscle shortens. For example, you lift a dumbbell up to curl - your biceps are concentrically contracting (getting shorter as it contracts).
  • B. Isometric: The muscle length stays the same. For example: you push against a wall. Unless you are Superwoman or Superman, you are not moving that wall and your muscle is contracting but not getting shorter like it did in the bicep curl.
  • C. ECCENTRIC: The muscle LENGTHENS while it contracts - weird, right? It is also referred to as a ‘braking contraction’, meaning it slows the movement down. So let’s take that bicep curl from earlier and slowly lower the weight - your biceps is eccentrically contracting as you slowly lengthen the muscle.

This one is tricky, but it is why stairs are harder to come down than they are to go up. It’s also why it’s a little scary watching someone go down the stairs without muscle control because it almost seems as if they may fall. When you eccentrically contract your quadriceps, they ideally will slow the movement down and prevent your knee from collapsing too fast.

Bringing this back to my lovely stair navigation while hiking post marathon …. It HURT to eccentrically contract my muscles because they were so sore. So what did I do? I turned to the side to use different muscles and BOTH arms on the rail. Same reason why we see some clients turn to the side or even just rotate their leg while stepping down.

Let’s say we have a client who is hemiplegic (on their right side) – meaning their left side is significantly weaker -They will either NOT lead with their right leg to spare the left from having to control the movement down OR they will demonstrate a very uncontrolled and fast step down due to the weakness of the left leg. Make sense?

Now – let’s be clear that there are many more reasons why stair navigation can be unsafe…another large reason being poor balance or coordination…but we can save that for another post. We wanted to focus on lacking eccentric muscle control for poor stair navigation because this relates to more movements than just stairs and is something we see every day here in the clinic. It is a large reason why we try to focus on these types of movement during our strengthening activities, so that it can account for more muscle control in their every day activities and promote more independence.

Questions? LET US KNOW!

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Christine Astarita
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