20. Gait Flashcards
Walking
Simple but complicated!
Simple – we can do it without having to think
Complicated – involves so many structures in the body
Musculoskeletal system = muscles, tendons, bones, joints,
Nervous system = sensory, motor, autonomic, proprioception
Cardiovascular system = heart, blood vessels
Special senses = vision, hearing
Problem(s) with any of the systems / structures can have an effect on our ability to walk
Stride
Straight line walking / running
Jumping (…back flip?)
Terrain adjustment
Turning
A combination of movements
Stride
made of stance and swing
Stance tasks:
weight acceptance then single limb support
Swing tasks:
limb advancement
Weight acceptance phases
Initial contact, loading response
Single limb support phases
mid stance
terminal stance
preswing (also limb advancement)
Limb advancement phases
preswing (continuing from single limb support)
Initial swing
mid swing
terminal swing
Joint positions during initial contact (0-2%)
Hip flexion Knee neutral/extension Ankle dorsiflexion/neutral 1st MTPJ dorsiflexion/neutral
Joint position during loading response (2-12%)
Hip flexion Knee flexion Ankle plantarflexion 1st MTPJ neutral
Muscle activities during initial contact
Hip extensors contract (eccentric) to control hip flexionvia momentum
Gracilis contracts (isometric) to control hip flexion and knee extension
Knee flexors contract (concentric) to start knee flexion
Knee extensors contract (eccentric) to control knee flexion
Ankle dorsiflexors contract (eccentric) to prevent foot slapping
Muscle activities during loading response
Hip extensors contract (concentric) to start hip extension
Knee flexors contract (concentric) to keep the knee in flexion
Knee extensors contract (eccentric) to control knee flexion
Gastroc contracts (concentric) to keep the knee in flexion
Ankle dorsiflexors contract (eccentric) to prevent foot slapping
Ankle plantarflexors contract (concentric) to bring the foot to the ground
Joint position mid stance (12-31%)
Hip neutral Knee extension Ankle neutral 1st MTPJ neutral
Joint position terminal stance (31-50%)
Hip extension Knee full extension Ankle dorsiflexion 1st MTPJ neutral/dorsiflexion
Muscle activities mid stance (12-31%)
Hip extensors contract (concentric) to keep the hip in extension
Knee flexors contract (eccentric) to control knee extension via momentum
Gastroc contracts (eccentric) to control knee extension via momentum
Ankle plantarflexors contract (eccentric) to stabilise the foot
Muscle activities terminal stance (31-50%)
Hip flexors contract (eccentric) to control hip extension via momentum
Gastroc contracts (eccentric) to control knee extension via momentum
Ankle plantarflexors contract (eccentric) to control ankle dorsiflexion via body weight
Joint position during preswing (50-62%)
Hip neutral Knee flexion Ankle plantarflexion 1st MTPJ dorsiflexion
joint position at initial swing (62-75%)
Hip neutral/flexion Knee flexion Ankle neutral/dorsiflexion 1st MTPJ dorsiflexion/neutral
muscle activities during preswing
Hip flexors contract (concentric) to start hip flexion
Gracilis contracts (concentric) to assist the knee in flexion
Gastroc contracts (concentric) to bring the knee into flexion
Ankle plantarflexors contract (concentric) to propels the body forward THEN Ankle dorsiflexors contract (concentric) to keep the foot off the ground
muscle activities during initial swing
Hip flexors contract (concentric) to keep the hip in flexion
Gracilis contracts (concentric) to keep the knee in flexion
Ankle dorsiflexors contract (concentric) to keep the foot off the ground
Joint position mid wswing (75-87%)
Hip flexion Knee flexion Ankle dorsiflexion 1st MTPJ dorsiflexion
Joint position terminal swing
Hip flexion Knee flexion/neutral Ankle dorsiflexion 1st MTPJ dorsiflexion
muscle activities mid swing
Hip extensors contract (eccentric) to control hip flexion
Gracilis contracts (concentric) to keep the hip and knee in flexion
Knee flexors contract (concentric) to keep the lower leg off the ground
Ankle dorsiflexors contract (concentric) to keep the foot off the ground
muscle activities terminal swing
Hip extensors contract (eccentric) to control hip flexion via momentum
Gracilis contracts (isometric) to control hip flexion and knee extension
Knee extensors contract (concentric) to bring the knee to extension
Ankle dorsiflexors contract (concentric) to keep the foot off the ground
Types of turning
step turn
ipsilateral pivot
ipsilateral cross over
Base of support
Defined as the area within an outline of all ground contact points
Centre of mass
COM = Centre of Mass
The average position of all the parts of the system, weighted according to their masses
Terrain adjustment
Stairs – up & down
Uneven surfaces
Various surface properties (e.g. soft/hard, slippery)
A complete picture of of gait analysis
If you want to get the complete picture, you need to take into account your patient’s movement routines:
Daily walking – to & from work / school?
Activities – sports? dance?
Surfaces – smooth? uneven? soft? hard?
Only straight-line walking in clinic is not always sufficient
? Compensatory mechanisms
Conditions causing disruptions in gait
Musculoskeletal conditions E.g. Arthritis, Tendinopathy, Ligament injury Neurological conditions E.g. Parkinson’s, Cerebral Palsy, CVA, Peripheral neuropathy Others Pain Behavioural issues Supply of energy
