GAIT Flashcards
Describe the positions of joints when standing
Hips and Knees are extended
Contraction of calf muscles, intrinsic back muscles and hip abductors - to prevent sway
Muscles involved in standing
Erector spinae muscles
Iliopsoas muscle
Plantar flexor muscles (triceps surae)
Rotational axis of ankle joint
What ligament around the hip is most responsible for being able to stand upright with low expenditure of energy ?
Iliofemoral ligament (strongest ligament in the body)
What locks the knees ?
Knees are ‘locked’ by:
- Vastus medialis
- Gluteus maximus
- Tensor fascia lata (via ilio-tibial tract)
Feature of standing
Maximal contact of articular surfaces + minimum muscular activity
Where is the centre of gravity ?
Anterior to the ankle joint
Proprioception
The sense through which we perceive the position and movement of our body, including our sense of equilibrium and balance.
Describe Sway
Anterior
- centre of gravity is anterior to the ankle joint
- Regular small contractions of soleus and gastrocnemius
Lateral
- lateral splay of the feet helps
Anterior Sway (what muscles prevent anterior sway ?)
Centre of gravity is anterior to the ankle joint
Regular small contractions of soleus and gastrocnemius - prevent anterior sway
Lateral - sway
Hip abductors
Fibular collateral ligament, everters on one side
Hip adductors, tibial collateral lig. and inverters on the contralateral side
Describe the GAIT cycle
8 phases in one cycle
Each limb has a stance and swing phase and repeats
Muscle activity is essential but momentum and gravity are equally important.
State the 8 phases of the GAIT cycle
Heel strike
Loading response
Midstance
Terminal stance
Pre-swing
Initial & Mid-swing (2 parts)
Terminal swing
Stance phase
Heel strike
Loading response
Midstance
Terminal stance
Swing phase
Pre-swing
Initial & Mid-swing (2 parts)
Terminal swing
Describe heel strike
Flexion of thigh creates a momentum
The right thigh decelerates and drops the right LL and heel to the ground, the foot remains dorsiflexed.
What must be maintained in heel strike - for shock absorption and weight distribution ?
The spring and resilience of the right arches must be maintained in heel strike - for shock absorption and weight distribution.
Describe progression from heel strike to loading response
The right ankle is dorsiflexed and that dorsiflexion is also pulling the body forwards, over the right foot so that it can accept the body weight in the loading response phase.
What muscles are involved in the heel strike phase ?
Tibialis anterior
Glute muscles - decelerating flexion of hip
Describe loading response phase - flat foot
Foot rolls on heel - from lateral to medial
Foot starts to go flat and accepts the weight
Arches absorb weight/ shock.
Eccentric contraction - IMP
Muscle lengthens, but contracts - to decelerate an action
Concentric contraction
Muscle shortens - contracts
Why are inversion injuries more common than eversion injuries at the ankle ?
As the initial point of contact is on the lateral side of the foot.
You could possibly over invert the foot - leading to a sprained ankle/ broken ankle.
What happens when we are walking on uneven ground ?
(what movements are involved)
Inversion
Eversion
What happens when we are walking on uneven ground ?
(what joints are involved)
Subtalar and Transverse Tarsal joints
State the muscles involved in loading response
Inversion
- tibialis anterior
- tibialis posterior
Eversion
- fibularis longus
- fibularis brevis
State the muscles involved in inversion - loading response and their innervation
Tibialis anterior - deep fibular nerve
Tibialis posterior - tibial nerve
State the muscles involved in eversion - loading response and their innervation
Fibularis longus
Fibularis brevis
(both superficial fibular nerve)
Describe mid stance
One limb carries the entire body weight, whilst the other limb is lifted
Eccentric contraction of plantar flexors - controls dorsiflexion
Hip abductors - stabilises pelvis
State the muscles involved in mid stance, and their innervation (hip abductors)
Gluteus medius
Gluteus minimus
Superior gluteal nerve
Describe terminal stance
Start to push off
Heel is off the ground
Foot rocks on forefoot
Momentum must be created by drawing the body forwards over the ankle
Forefoot starts to push off
State the muscles involved in terminal stance
Gastrocnemius
Soleus
(Triceps surae)
Gluteus medius
Gluteus minimus
Hip abductors
Features of terminal stance
Right ankle is plantar flexed
Left foot is off the ground -> pelvis is stabilised
Plantar arch is heightened
Muscles involved in plantar flexion of the ankle
Gastrocnemius
Soleus
(Triceps surae)
Muscles involved in stabilising the pelvis
Gluteus medius
Gluteus minimus
Hip abductors
Plantar aponeurosis
Calcaneus to Fibrous flexor sheaths
State the muscles involved in heightening the arches
Flexor hallucis/ digitorum longus
Tibialis anterior
Tibialis posterior
Fibularis longus
Intrinsic muscles of the foot
Describe the pre-swing phase
The right lower limb is about to enter the swing phase
Right ankle:
- plantar flexion
- powerful push-off
Right toes
- flexion
- powerful push off
Right hip
- extends slightly to help forward momentum
State the muscles involved in the pre-swing phase and their innervation
Plantar flexors:
- gastrocnemius
- soleus
- (tibialis posterior)
TIBIAL NERVE
Toes:
- flexor hallucis longus
- flexor digitorum longus
- flexor hallucis brevis
- flexor digitorum brevis
- quadratus plantae
TIBIAL NERVE
MEDIAL BRANCH OF TIBIAL NERVE
Hip:
- biceps femoris
- semitendinosus
- semimembranosus
- gluteus maximus
SCIATIC NERVE
INFERIOR GLUTEAL NERVE
State the plantar flexors involved in pre-swing phase
Plantar flexors:
- gastrocnemius
- soleus
- (tibialis posterior)
TIBIAL NERVE
State the toe muscles involved in pre-swing phase
Toes:
- flexor hallucis longus
- flexor digitorum longus
- flexor hallucis brevis
- flexor digitorum brevis
- quadratus plantae
TIBIAL NERVE
MEDIAL BRANCH OF TIBIAL NERVE
State the thigh muscles involved in pre-swing phase
- biceps femoris
- semitendinosus
- semimembranosus
- gluteus maximus
SCIATIC NERVE
INFERIOR GLUTEAL NERVE
Describe initial and mid-swing phase
Right LL enters initial -> mid swing
Left LL takes all the body weight
Right LL is lifted up, toes must clear the ground
State the movements of the joints in initial and mid swing
Right hip - flexion
Right knee - flexion
Right ankle & toes - dorsiflexion
State the right hip flexors involved in initial and mid swing and their innervation
Iliopsoas
Rectus femoris
Sartorius
Femoral nerve
L1-3 (psoas major)- iliopsoas
State the right knee flexors involved in initial and mid swing and their innervation
Hamstrings
(popliteus)
Gastrocnemius, Sartorius
Sciatic nerve (hamstrings)
Tibial nerve (popliteus)
State the right ankle and toe dorsiflexors involved in initial and mid swing and their innervation
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
DEEP FIBULAR NERVE
How is balance maintained during initial and mid swing phase ?
Plantar-flexion - plantar muscles as well
Dorsiflexion
Inversion - tibialis posterior and anterior
Eversion - fibularis longus and brevis
Dorsal column / cerebellar injury
Problems with GAIT
- walking is mostly an unconscious action
- if you loose proprioceptive feedback: gait ataxia
Ataxia
Loss of proprioceptive feedback from a muscle
OR
Motor problem (loss of nerve supply to a muscle)
Describe terminal swing
Right lower limb is thrown further forwards
The right side of the pelvis moves anteriorly, using momentum to internally rotate at the left hip.
Describe movement of joints during terminal swing
Right hip
- further flexion
- lateral rotation to keep the foot positioning forwards
State the lateral rotators of the hip and their innervation
Piriformis
Obturator Internus + Superior Gemellus
Quadratus Femoris + Inferior Gemellus
State the innervation of the lateral rotators of the hip
L5 — S1-2
