If you live with Parkinson’s disease, multiple sclerosis, stroke or cerebral palsy, poor gait often becomes the first visible sign. Steps are shorter on one side. Toes catch. Stairs need a plan. Over years, this poor gait pattern adds up in your joints, your balance, and how much energy a normal day takes. A lot of that build-up can be slowed, and some of it eased. Here is how that works, and where to start.
01 . Why poor gait develops
How a poor gait and balance issues develop when the nervous system is injured
Walking looks simple, but it is one of the hardest things the nervous system does. The brain plans the step. The spinal cord lines up the muscles. The nerves carry the message. Sensors in your joints, feet and inner ear send feedback the whole time. Disturb any part of that loop and poor gait is often the first place it shows.
Each condition gets there a different way. In Parkinson’s, the brain stops setting the size and timing of a movement the way it should, so steps shorten and the rhythm turns uneven. Multiple sclerosis slows the signal to the muscles that lift the foot, so the toe catches. A stroke takes some of the brain’s control over one side of the body, so one leg ends up slower and weaker than the other. Cerebral palsy is different again. The pattern has been there since childhood, so the muscles, joints and bones have grown up around it.
When walking speed is measured across stroke, Parkinson’s and multiple sclerosis, every group comes in below the pace used to mark comfortable community walking, and each condition slows it in its own way. The change is real, and it can be measured. That is exactly why a proper assessment is worth the time. Our Physiotherapy team starts by working out which part of the loop is holding you back, because that is what decides which approach will help.
02 . Musculoskeletal cost
How altered gait issues reshape your musculoskeletal system
The nervous system starts the problem. The muscles, joints and bones finish it. The body adapts to whatever pattern of movement it is given, and poor gait patterns teach it to lean on parts that were never built to take that load.
The gait pattern usually plays out across four systems:
- Muscle. Muscles that get used less grow weak. Muscles that get overused grow tight. Tight calves, tight hip flexors and weak glutes are the usual trio. Over time a muscle can shorten and stiffen so far (a contracture) that the joint gets stuck in one spot.
- Joints. Uneven loading means uneven wear. Over years, that one-sided load is one of the things linked with joint wear and osteoarthritis. Hips, knees and ankles tend to take the brunt.
- Spine. A leg that swings less, or a hip that drops on every step, makes the spine pick up the slack. Postural change, ongoing low back pain and a stiffer back can follow.
- Feet. A foot that does not clear the ground cleanly, or lands at an odd angle, slowly changes shape. Flattening, claw toes and bunions are common after years of an altered walking pattern.
They look like separate problems. They are one chain, from the nervous system down to the joints and muscles. Treating it means working both ends at once: retraining the movement, and easing the load the body is carrying.
The neurological injury starts the problem. The musculoskeletal system finishes it.
03 . Falls and fractures
Falls, fractures and the cost over time
Of all the things that follow, falls matter most. A fall on an ordinary day can become a hip fracture, a wrist fracture, a head injury or a hospital stay, and each one of those can reset how independent you are.
The Australian numbers are sobering. Falls caused 248,211 hospital admissions in 2023-24, which was 43% of all injury admissions. Adults aged 65 and over were close to 12 times more likely to be admitted after a fall than adults aged 25 to 44. For someone with a chronic neurological condition, the risk sits higher again.
The way falls happen also differs by condition:
- Parkinson’s disease. The step-to-step consistency of someone’s walking can flag fall risk earlier than walking speed on its own. Freezing, a sudden moment where the feet feel stuck to the floor, is another high-risk point.
- Stroke. How much the hips can shift sideways during walking is one of the clearest signs of post-stroke fall risk, because it shows how well the standing leg can hold your weight while the other leg swings through.
- Multiple sclerosis. People with MS who fall tend to show more step-to-step variation in how they walk than those who do not.
- Cerebral palsy. Adults with cerebral palsy can face earlier wear on the muscles and joints, and rising fall risk from their forties on, often from the tightness and joint changes built up over decades.
Identifying which falls pattern connects to poor gait in your case is part of the assessment. It changes what the plan looks like.
04 . What can be done
What Physiotherapy and Exercise Physiology can do
The good news is that poor gait responds to focused work. There is enough evidence across these four conditions now that a team can match an approach to your condition rather than running the same generic program for everyone.
A useful plan usually covers five things:
1. Physiotherapy gait retraining. A Physiotherapist trained in neurological rehabilitation works on the exact part that has changed: the length and rhythm of your steps in Parkinson’s (often using a beat or a visual marker to walk to), lifting the foot clear in multiple sclerosis, shifting weight evenly in stroke, and posture and balance in cerebral palsy. In Parkinson’s, walking and balance respond well to steady, repeated practice. In stroke, what tends to help most is practising real walking tasks, made a little harder over time, rather than passive or hands-on-only treatment.
2. Exercise Physiology strength and conditioning. Exercise Physiology builds the strength and stamina that walking leans on: hip strength to keep you level, calf strength to push off, and the fitness to keep going for a real outing, not just across the room. For people who tire quickly, this is often where the biggest gains come from.
3. Assistive equipment and orthotic review. A stick, a frame or an ankle brace buys you safe distance and saves energy for what you actually want to spend it on. It is a tool, the same as glasses or a hearing aid. A clinician checks the fit and the situation, because the wrong stick on the wrong side undoes the work.
4. Falls-prevention home check. Most falls happen at home. Clearing rugs, adding light, putting a rail in the bathroom and matching shoes to the floor surface cuts risk before any clinical work is added. Hydrotherapy is another option for anyone who finds land-based exercise too tiring.
5. A team that talks to each other. Your Doctor manages the medications. Your Physiotherapist works on the movement. Your Exercise Physiologist works on the conditioning. An Occupational Therapist may work on the day-to-day tasks. The plan works when the team actually works as a team.
The order matters less than the consistency. A small, regular program beats an intense one that stops after six weeks.
05 . When to start
When to start and what good progress looks like
The single biggest predictor of how much function you keep is how early you start active management. Waiting for poor gait to get worse before booking an assessment is the most common mistake, because the chain of changes described earlier is hardest to unwind once it has been laid down.
A reasonable starting point looks like this:
- If you have a new neurological diagnosis (recent stroke, recent MS diagnosis, recent Parkinson’s diagnosis): book a Physiotherapy assessment within the first three months. Early-stage gait retraining is when the nervous system has the most plasticity to learn new patterns.
- If you have lived with a neurological condition for years and your gait has gradually changed: book an assessment now. There is almost always useful work to do on the musculoskeletal layer (strength, flexibility, balance) even when the neurological substrate is stable.
- If you have had a fall, or had a near-fall in the last six months: book an assessment this month. The window for active prevention is shorter once the fall pattern has started.
What good progress looks like depends on the starting point. Realistic markers in the first 6 to 12 weeks include longer time on your feet without fatigue, fewer near-falls per week, better foot clearance on stairs, and confidence to walk further from home. The big functional outcomes tend to follow: returning to the shops, going back to a community group, walking with a grandchild.
If you are not sure where to start, the easiest step is to book an assessment with one of our Physiotherapy or Exercise Physiology teams, or refer in through the referrer hub.
