Balance & Gait Problems: A Real Puzzler

Ray (@ray666)

Do you have pain anywhere other than where you mentioned … like pain in lower back or pain in inner thigh or in your leg?

I took care of my mom for awhile and her gait & balance was off. She would walk using her walker and it looked like her knees just buckled and went in a sit-down position that turned into a fall down. It is an unusual way to fall. It turned out to be her sacral joint. She was in her early 90s and just nothing they could do.

Then a couple of years later and I catch myself about to fall in the same manner. I have back pain from a previous surgery.. L-S joint ... the hardware seems to be rubbing me wrong. I started hurting a bit lower than my L-S joint and had some pain in my inner thigh. I went to my pain specialist and he said it was my sacral joint. He did a SI joint fusion and things got better. .. no sit-down incidences since. When the sacral joint causes problems the symptoms can be vague or pronounced. It can cause bladder and bowel problems… and can exist along side of pelvic disorders. I had bladder prolapse happening the same time.

It seems I never have just one physical problem to try to get a handle on. I have had neuroma surgery and another neuroma in my right foot and broke my little toe of my left foot right at the joint. I was diagnosed awhile back with bone on bone arthritis in my right foot across the pad.. effecting all toes and ball of foot. I suspect my left foot not far behind. I have a bum right knee .. many years ago the kneecap tilted off to the side and I had to have a release. I still do exercises for my knee. .. but still hurts. Even though I try not to I limp… I limp. Sometimes I feel like I waddle like my bowlegged grandma did. It does not seem like it takes much for the balance and gait to go off kilter.

Hopefully you will find the answer to your gait problem soon.
ZeeGee

Hello, ZeeGee (@fourof5zs)

Again, thank you for your great reply to my Mayo post!

You asked if I have pain anywhere other than where I mentioned. My left knee, the knee that has lots of arthritis (but the orthopedist tells me can still be treated with injections), can be painful, especially if I'm good about doing some daily exercise. My lower back too is sometimes, maybe not "painful," but "achy." But I spend a lot of time at my desk; even though I try very hard to get up and move about every 25-30 minutes, I can still have an achy lower back by the end of the day. Other than those two, no, I can't complain of any other pain. I'm lucky in that sense.

When I have fallen (and I haven't fallen that often, I'm sure because I have taught myself to be extra careful), it is sometimes when my attention is drawn to one side or the other and I turn too fast. As I believe I mentioned in my post, my falling is never because I'm dizzy. I believe my falling is all because of my lower body infirmities: bad feet, a bad knee, and (occasionally) a bad hip; those three, plus legs that feel weak. I say "feel weak," because when I've been tested for leg strength, I'm told my legs are strong, especially for a person of 77. So, that weakness puzzles me. That's definitely something I am going to ask my primary doctor about when I see her next week.

All of this adds up to my not walking properly. I try, but it can be difficult, on tile and hardwood floors walking properly is especially difficult, and outdoors on uneven ground it's virtually impossible.

Thanks again for responding! I look forward to us talking again.

Have an enjoyable weekend!
Ray (@ray666)

Hello, @ray666 and @fourof5zs as well as all of the others who have added to this conversation. I have found this very interesting because I too have had falls where my left leg will give out on me and I'll find myself on the ground (always a surprise). Fortunately, I'm quite short so I don't fall too far. So far, no broken bones just injured pride and feeling that I really should be able to walk better. Like you, @ray666, I've become much more aware of where and how I'm walking.

I had an EMG done recently that did show a slowing in the nerves of the left leg and a temperature change between the left and right leg showing the left side colder than the right.

I've also had MRIs of the lumbar spine which has been quite a mess for a long time. I also have a definite problem with the sacral joint that @fourof5zs mentioned. I'm now seeing an orthopedic specialist.

All of this to say, it sounds as if many of us are in the same boat. I do exercise my core to keep it as strong as possible. I have other exercises from previous PT experiences that I work with on a regular basis as well.

Many years ago, when my gait problem began I felt like I walked with a stagger (to the right) I saw numerous neurologists. I was tentatively diagnosed with Parkinson's (PD). Since PD does not have a direct testing method, lots of other diagnoses were ruled out. Finally, after many years of staggering and falls a neurologist suggested a PD diagnosis. She told me that in situations like mine, trying a PD med (like Sinemet) is a way to find out if PD is the issue. Once I began Sinemet, the connection between my lower extremities and my brain became much stronger.

Now, however, many years later this left-sided weakness is causing falls again. It makes me feel like I'm starting at square one, however, I understand that I'm now dealing with another aspect of the aging dilemma that we are all experiencing.

@ray666 has an EMG been done for you yet?

Hello, Teresa! (@hopeful33250)

Thank you for your post! I'm finding this discussion to be fascinating. When I started it, I hadn't realized that so many of us had faced a similar dilemma when trying to put a name to what ails them. If I may jump right in …

I've not had any serious falls. In fact, for many years, I'd had none, even though a half dozen most every day, I'd feel like I was about to fall. In the past 12 months, I've had a few actual falls––no broken bones, but lots of dings and scraps. The increasing frequency is what's got me worried.

I've never had an EMG. From what you say, Teresa, it sounds like an EMG is a very revealing test. You probably noted in my earlier posts that I'm in the care of a neurosurgeon. Based on a cervical MRI, he's the fellow who diagnosed borderline cervical myelopathy––not requiring surgery (in his opinion); instead, some cervical PT and yearly checkups. Since my concern is uncomfortable walking, awkward gait, off-and-on wobbly balance, and a fear of falling, an EMG may be what's necessary for me to be able to put a name to my problem finally.

Also, as I am about to resume PT (on 4/20), I wonder if I should ask that our focus be less on my cervical back and more––far more!­­––on walking/gait rehabilitation (if there is such a focus).

One other thing you mention, Teresa, that has me thinking: Might I benefit from a PD exam? Some years ago, when I was already aware of my slowly deteriorating balance, I'd raised the question of PD with my primary doctor. She administered a few simple tests there in the exam room and concluded, No, Ray, you needn't worry about PD. But that was several years ago.

Again, Teresa, thank you for all of your insights!

Cheers!
Ray (@ray666)

Hi Ray, @ray666

I am glad that some of my thoughts were helpful to you. Yes, I agree that an EMG might be very helpful for you in understanding your situation better. I'm surprised that no one has suggested it, but often we do need to be our own advocates and this might be your case.

The best way to determine if you might have PD is to schedule an appointment with a movement disorder specialist. These doctors are neurologists who have special training in movement disorders and PD is one of those disorders. You might take a look at information about PD because there are a lot of symptoms that are overlooked in diagnosing PD. These are referred to as non-motor symptoms and include problems with sleep, constipation, voice problems (very soft voice usually), and often a lack of facial expressions. If you go to the Michael J. Fox website or the Davis Phinney website, you will learn more about the variety of symptoms of PD. I do not have tremors so I don't look the part of a typical PD patient. Here on Connect we also have a discussion about PD. Here is the link, https://connect.mayoclinic.org/group/parkinsons-disease/.

Just for your information: Movement disorder specialists are found at your larger medical facilities and/or teaching hospitals, you will not necessarily find them at a local hospital and/or community health center.

I look forward to hearing from you as you seek out an answer to your perplexing symptoms. Will you post again?

Hello, ZeeGee (@fourof5zs)

Again, thank you for your great reply to my Mayo post!

You asked if I have pain anywhere other than where I mentioned. My left knee, the knee that has lots of arthritis (but the orthopedist tells me can still be treated with injections), can be painful, especially if I'm good about doing some daily exercise. My lower back too is sometimes, maybe not "painful," but "achy." But I spend a lot of time at my desk; even though I try very hard to get up and move about every 25-30 minutes, I can still have an achy lower back by the end of the day. Other than those two, no, I can't complain of any other pain. I'm lucky in that sense.

When I have fallen (and I haven't fallen that often, I'm sure because I have taught myself to be extra careful), it is sometimes when my attention is drawn to one side or the other and I turn too fast. As I believe I mentioned in my post, my falling is never because I'm dizzy. I believe my falling is all because of my lower body infirmities: bad feet, a bad knee, and (occasionally) a bad hip; those three, plus legs that feel weak. I say "feel weak," because when I've been tested for leg strength, I'm told my legs are strong, especially for a person of 77. So, that weakness puzzles me. That's definitely something I am going to ask my primary doctor about when I see her next week.

All of this adds up to my not walking properly. I try, but it can be difficult, on tile and hardwood floors walking properly is especially difficult, and outdoors on uneven ground it's virtually impossible.

Thanks again for responding! I look forward to us talking again.

Have an enjoyable weekend!
Ray (@ray666)

Hi, Teresa

I may have to keep this short because I have some shopping to do, but I want to thank you again for your additional thoughts, particularly the movement disorder specialist. I'd not heard of that specialty before. You say they're more easily found in large medical facilities. Luckily, my primary and the various specialists I've seen over the years are affiliated with Porter Adventist Hospital, one of Denver's better staffed and better equipped hospitals. I'd wager they've got a movement disorder specialist on their staff. And I'll be sure to ask.

As for PD symptoms, I've done a little snooping online, reading up on symptoms, and I don't seem to have any, at least what the various sites called the more prevalent symptoms. I did see, however, that there is such a thing as asymptomatic PD. I'll certainly not rule out PD as something to investigate. And now I'd best get started with that grocery shopping!

Best wishes,
Ray

I do not know if this is where I should post this, but thought someone could tell me of his/her experiences with cortisone injections in a knee. I had surgery that forced me to sit on a sitz bath to heal properly. Well, I ruined my knees doing this. I immediately quit the sitz baths when I awakened one morning to both knees hurting and found them not reliable. I "folded" several times but caught myself. I have been using my HurryCane to get around. I thought my knees would heal. Finally, I went to my PCP and he gave me a cortisone injection in my right knee. Not only did that not help, it made my knee worse. When I called about this I was told to go to an orthopedic health place. I have not begun this process. Have any of you had a similar bad experience with an injection that only made things worse? What did you do? I am just trying to keep moving but wonder if the knees are shot and I really will have to go to the orthopedic health place. What do they do at these places? I am certainly not looking for surgery. My PCP x-rayed both knees and said they looked better than his. He had a knee replacement. As many of you have mentioned, it is never just one thing wrong. My "What fresh hell is this?" this morning was my left index finger reminding me I had arthritis. At least I am right-handed. Any thoughts are welcome. @joybringer1

@ray666 Ray my pain withe the SI joint could be described as achy, dull pain. I'm sorry I did not get back to your message sooner. I went to see my son and his family on Thursday and was still exhausted from it yesterday.. and still a bit that way. I guess it is one of my symptoms.. fatigue.

@hopeful33250 Teresa,

With the Si joint my doctor said that it will relieve the pain by helping to put things back into alignment but can also cause more problems . That seems to be the case with any procedure or surgery .. a risk that you will not be worse off.

I now am having pain with my hip. My pain doctor does not know if it was from the fusion or not.. tests may tell. I have an MRI scheduled for Wednesday morning. I saw the doctor's P.A. this last time .. even thought I was scheduled with the doctor.. and he ordered the MRI of my lumbar region and not my hip. Hopefully it will also show my hip. I have to lay on my right side .. the left side my ribs are a mess from an open abdominal surgery and I have a a torn labrum in the left shoulder .. so the muscle that pressure is put on night after night in the hip is part of the pain and maybe arthritis. I am almost 71 years old. I really hate MRIs.. laying on my back for so long. I am also claustrophobic .. but at least my head does not go in first this time.

The past few weeks I have wet socks feeling in my feet and on right foot part way up my leg. So something is causing neuropathy. When I put in search engine wet socks feeling and not wearing socks it comes up that one thing it could be is multiple sclerosis. It is possible to contract late onset multiple sclerosis. Other causes can come from other places, but it did not name specific areas. I imagine when I see the doctor next.. in about 10 days .. he will probably set me up with a neurologist or the tests.

Aah the joys of aging .. so many diseases and not enough test or knowledge to quickly and definitively diagnose many of them.

We shall press on .. with dignity .. and a few tears.

ZeeGee