A post-stroke patient with hip hiking during gait; Which activity would be MOST beneficial to improve motor control during swing?

• A. Marching in place when standing
• B. Stretching of the gastrocnemius
• C. Slow rotation of the leg to reduce extensor spasticity
• D. Prone knee bends

Answer: (A)

Gait during swing relies on coordinated hip and knee flexion with ankle dorsiflexion to achieve toe clearance. When hip hiking is present, the person often uses a compensatory pelvic elevation to clear the foot because the swing phase pattern isn’t being activated effectively. Practicing a functional, upright stepping pattern helps re-educate that swing motion.

Marching in place while standing provides a safe, weight-bearing environment to repeatedly practice the actual swing mechanics: initiating hip flexion and knee flexion, coordinating with ankle dorsiflexion for toe clearance, and maintaining trunk and pelvis stability. This repetitive, rhythmic activity trains the neuromuscular system to produce the proper swing phase movements rather than relying on compensatory hip hiking, improving motor control during swing.

Stretching the gastrocnemius targets ankle length and can help if plantarflexor tightness limits reach, but it doesn’t directly retrain the coordinated swing pattern. Slow rotation of the leg to reduce extensor spasticity addresses tone and alignment in a nonfunctional arc and isn’t as targeted to practicing the active swing mechanism. Prone knee bends strengthen knee flexors in a non-swing, non-weight-bearing position and don’t replicate the upright, dynamic control needed for swing in gait.

So marching in place in standing best promotes the coordinated, functional swing movement needed to reduce hip hiking and improve step clearance.