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Medicine Year 1 - Semester 2 - Part 2 > GAIT > Flashcards

GAIT Flashcards

1
Q

Describe the positions of joints when standing

A

Hips and Knees are extended

Contraction of calf muscles, intrinsic back muscles and hip abductors - to prevent sway

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2
Q

Muscles involved in standing

A

Erector spinae muscles
Iliopsoas muscle

Plantar flexor muscles (triceps surae)

Rotational axis of ankle joint

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3
Q

What ligament around the hip is most responsible for being able to stand upright with low expenditure of energy ?

A

Iliofemoral ligament (strongest ligament in the body)

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4
Q

What locks the knees ?

A

Knees are ‘locked’ by:

  • Vastus medialis
  • Gluteus maximus
  • Tensor fascia lata (via ilio-tibial tract)
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5
Q

Feature of standing

A

Maximal contact of articular surfaces + minimum muscular activity

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6
Q

Where is the centre of gravity ?

A

Anterior to the ankle joint

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7
Q

Proprioception

A

The sense through which we perceive the position and movement of our body, including our sense of equilibrium and balance.

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8
Q

Describe Sway

A

Anterior
- centre of gravity is anterior to the ankle joint
- Regular small contractions of soleus and gastrocnemius

Lateral
- lateral splay of the feet helps

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9
Q

Anterior Sway (what muscles prevent anterior sway ?)

A

Centre of gravity is anterior to the ankle joint

Regular small contractions of soleus and gastrocnemius - prevent anterior sway

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10
Q

Lateral - sway

A

Hip abductors

Fibular collateral ligament, everters on one side

Hip adductors, tibial collateral lig. and inverters on the contralateral side

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11
Q

Describe the GAIT cycle

A

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.

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12
Q

State the 8 phases of the GAIT cycle

A

Heel strike
Loading response
Midstance
Terminal stance

Pre-swing
Initial & Mid-swing (2 parts)
Terminal swing

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13
Q

Stance phase

A

Heel strike
Loading response
Midstance
Terminal stance

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14
Q

Swing phase

A

Pre-swing
Initial & Mid-swing (2 parts)
Terminal swing

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15
Q

Describe heel strike

A

Flexion of thigh creates a momentum

The right thigh decelerates and drops the right LL and heel to the ground, the foot remains dorsiflexed.

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16
Q

What must be maintained in heel strike - for shock absorption and weight distribution ?

A

The spring and resilience of the right arches must be maintained in heel strike - for shock absorption and weight distribution.

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17
Q

Describe progression from heel strike to loading response

A

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.

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18
Q

What muscles are involved in the heel strike phase ?

A

Tibialis anterior
Glute muscles - decelerating flexion of hip

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19
Q

Describe loading response phase - flat foot

A

Foot rolls on heel - from lateral to medial

Foot starts to go flat and accepts the weight

Arches absorb weight/ shock.

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20
Q

Eccentric contraction - IMP

A

Muscle lengthens, but contracts - to decelerate an action

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21
Q

Concentric contraction

A

Muscle shortens - contracts

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22
Q

Why are inversion injuries more common than eversion injuries at the ankle ?

A

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.

23
Q

What happens when we are walking on uneven ground ?
(what movements are involved)

A

Inversion
Eversion

24
Q

What happens when we are walking on uneven ground ?
(what joints are involved)

A

Subtalar and Transverse Tarsal joints

25
Q

State the muscles involved in loading response

A

Inversion
- tibialis anterior
- tibialis posterior

Eversion
- fibularis longus
- fibularis brevis

26
Q

State the muscles involved in inversion - loading response and their innervation

A

Tibialis anterior - deep fibular nerve
Tibialis posterior - tibial nerve

27
Q

State the muscles involved in eversion - loading response and their innervation

A

Fibularis longus
Fibularis brevis
(both superficial fibular nerve)

28
Q

Describe mid stance

A

One limb carries the entire body weight, whilst the other limb is lifted

Eccentric contraction of plantar flexors - controls dorsiflexion

Hip abductors - stabilises pelvis

29
Q

State the muscles involved in mid stance, and their innervation (hip abductors)

A

Gluteus medius
Gluteus minimus

Superior gluteal nerve

30
Q

Describe terminal stance

A

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

31
Q

State the muscles involved in terminal stance

A

Gastrocnemius
Soleus
(Triceps surae)

Gluteus medius
Gluteus minimus
Hip abductors

32
Q

Features of terminal stance

A

Right ankle is plantar flexed

Left foot is off the ground -> pelvis is stabilised

Plantar arch is heightened

33
Q

Muscles involved in plantar flexion of the ankle

A

Gastrocnemius
Soleus
(Triceps surae)

34
Q

Muscles involved in stabilising the pelvis

A

Gluteus medius
Gluteus minimus
Hip abductors

35
Q

Plantar aponeurosis

A

Calcaneus to Fibrous flexor sheaths

36
Q

State the muscles involved in heightening the arches

A

Flexor hallucis/ digitorum longus

Tibialis anterior
Tibialis posterior

Fibularis longus

Intrinsic muscles of the foot

37
Q

Describe the pre-swing phase

A

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

38
Q

State the muscles involved in the pre-swing phase and their innervation

A

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

39
Q

State the plantar flexors involved in pre-swing phase

A

Plantar flexors:
- gastrocnemius
- soleus
- (tibialis posterior)

TIBIAL NERVE

40
Q

State the toe muscles involved in pre-swing phase

A

Toes:
- flexor hallucis longus
- flexor digitorum longus
- flexor hallucis brevis
- flexor digitorum brevis
- quadratus plantae

TIBIAL NERVE
MEDIAL BRANCH OF TIBIAL NERVE

41
Q

State the thigh muscles involved in pre-swing phase

A
  • biceps femoris
  • semitendinosus
  • semimembranosus
  • gluteus maximus

SCIATIC NERVE
INFERIOR GLUTEAL NERVE

42
Q

Describe initial and mid-swing phase

A

Right LL enters initial -> mid swing
Left LL takes all the body weight

Right LL is lifted up, toes must clear the ground

43
Q

State the movements of the joints in initial and mid swing

A

Right hip - flexion
Right knee - flexion
Right ankle & toes - dorsiflexion

44
Q

State the right hip flexors involved in initial and mid swing and their innervation

A

Iliopsoas
Rectus femoris
Sartorius

Femoral nerve
L1-3 (psoas major)- iliopsoas

45
Q

State the right knee flexors involved in initial and mid swing and their innervation

A

Hamstrings
(popliteus)
Gastrocnemius, Sartorius

Sciatic nerve (hamstrings)
Tibial nerve (popliteus)

46
Q

State the right ankle and toe dorsiflexors involved in initial and mid swing and their innervation

A

Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus

DEEP FIBULAR NERVE

47
Q

How is balance maintained during initial and mid swing phase ?

A

Plantar-flexion - plantar muscles as well

Dorsiflexion

Inversion - tibialis posterior and anterior

Eversion - fibularis longus and brevis

48
Q

Dorsal column / cerebellar injury

A

Problems with GAIT
- walking is mostly an unconscious action
- if you loose proprioceptive feedback: gait ataxia

49
Q

Ataxia

A

Loss of proprioceptive feedback from a muscle

OR

Motor problem (loss of nerve supply to a muscle)

50
Q

Describe terminal swing

A

Right lower limb is thrown further forwards

The right side of the pelvis moves anteriorly, using momentum to internally rotate at the left hip.

51
Q

Describe movement of joints during terminal swing

A

Right hip
- further flexion
- lateral rotation to keep the foot positioning forwards

52
Q

State the lateral rotators of the hip and their innervation

A

Piriformis
Obturator Internus + Superior Gemellus
Quadratus Femoris + Inferior Gemellus

53
Q

State the innervation of the lateral rotators of the hip

A

L5 — S1-2

Medicine Year 1 - Semester 2 - Part 2 (53 decks)

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