Gait

Question 1

The gait cycle begins with and ends with

Answer 1

Begins with heel strike of one foot, ends with heel strike of the same foot again

Question 2

What is a stride?

Answer 2

Sequence of events between successive heel contacts of the same foot

Question 3

Gait cadence and walking speed

Answer 3

110 steps/min

3mph

Question 4

Stance phase occurs when

Answer 4

The foot is in contact with the ground from heel strike to toe off (60% of the cycle)

Question 5

Swing phase occurs when

Answer 5

The foot is not in contact with the ground from right after toe off until next heel strike (40 % of the cycle)

Question 6

What are the 2 period of double-limb support?

Answer 6

Between 0-10% and 50-60% of the gait cycle. The rest of the time only one foot is on the ground. Double-limb support decreases as speed increases, none during running.

Question 7

What are the 5 events of stance phase?

Answer 7

1. Heel strike
2. Foot flat (center of mass is behind the base of support), 3. Mid stance (body weight is completely over supporting LE, mid swing on the left)
3. Heel off
4. Toe off

Question 8

What are the 3 events of swing phase?

Answer 8

1. Early swing - right after toe off to mid swing
2. Mid swing - occurs during mid stance phase of opposite LE
3. Late swing - time from mid swing until heel hits the ground again

Question 9

Center of mass during walking vertically and horizontally

Answer 9

Goes up and down 5cm
Side to side 4 cm
Highest with single limb support, lowest with double-limb support

Question 10

Sagittal plane movement of the pelvis during gait

Answer 10

Described as anterior and posterior pelvic tilt.
Happens at the hip joint (pelvic-on-femoral flex/ext) and lumbosacral joint (pelvic-on-lumbar flex/ext).
Only 2-4 degrees - but important because without this you can change the way forces get dispersed up and down the kinetic chain

Question 11

Sagittal plane movement of the hip during gait

Answer 11

Hip flexion begins at pre-swing and is flexed 30 degrees at heel strike.
Hip extension of 10 degrees is achieved prior to toe off.
Only have 20 degrees total of hip extension and body does not tolerate losses of hip extension - becomes very problematic for entire LE, you would be loading SI joint and your lumbosacral spine way to much. Loss of hip extension is a predictor for falls in the elderly.

Question 12

Sagittal plane movement of the knee during gait

Answer 12

0 degrees of flexion at heel strike. Continues to flex another 10-15 degrees during first 15% of gait cycle.
Following flexion, knee will extend to approximately full extension until heel off.
Then the knee will reach 35 degrees of flexion by toe off.
Maximum knee flexion of 60 degrees is accomplished by the beginning of mid swing (need this 60 degrees for functional gait cycle)

Question 13

Knee flexion is controlled by

Answer 13

Eccentric control of the quadriceps. Without this, patients say that when they go to accept weight they feel like their knee is going to buckle and give out. Puts people at risk for falling on their face.

Question 14

Sagittal plane movement of the ankle during gait

Answer 14

At heel contact ankle joint is in slight PF.
After heel strike, the foot is placed flat on the ground by eccentric control of PF by the tibias anterior (loss of this is foot slap).
Then about 10 degrees of DF occurs as the tibia moves forward over the foot.
After heel off ankle starts to PF reaching its max of 15-20 degrees after toe off

Question 15

What primarily drives you forward during gait?

Answer 15

Momentum of toe coming off gets tibia vertically aligned. As it keeps coming forward you need eccentric control of the plantar flexors so it happens in a slow and controlled fashion.

Question 16

Sagittal plane movement of the 1st metatarsalphalangeal joint during gait

Answer 16

At heel strike the MTP joint is in slight hyperextension.
MTP joint is neutral between heel contact and heel off.
From heel off to toe off the MTP joint hyperextends to about 45-55 degrees.

Question 17

What should you do if patient has bunion?

Answer 17

Can’t just treat MTP joint. Have to remove restrictions in the first ray so that during push off the first ray can plantar flex and drop down (caused my concentric contraction of fibulas longus). If you don’t do this you will never get your MTP to do the extension it needs to do.

Question 18

Frontal plane movement of the pelvis during gait

Answer 18

Pelvis rotates 10-15 degrees as a result of pelvic on femoral hip abduction and adduction on the stance limb.
For weight acceptance of the right LE, the pelvis drops on the left swing side due to pelvic on femoral adduction on the right stance hip.
When we continue onto mid stance on the right, the left hip is adducted. right concentric/isometric glut med is keeping pelvis this way.
20-60% of the gait cycle the right stance hip will be abducted thereby elevating the left swing leg iliac crest.

Question 19

What controls the slight pelvic drop on the left swing side?

Answer 19

Eccentric contraction of right (stance side) gluteus medius

Question 20

Frontal plane movement of the hip during gait

Answer 20

During the stance phase of gait, hip frontal plane motion is a result of the pelvis moving on the femur.
During swing the femur is free to move along with the pelvis to give hip motion.

Question 21

Frontal plane movement of the knee during gait

Answer 21

Very little frontal plane motion exists at knee secondary to the stability of the collateral ligaments

Question 22

Frontal plane movement of the ankle during gait

Answer 22

Talocrural: very little frontal plane motion.
Subtalar: At heel strike supination occurs, after heel strike pronation occurs until heel off and toe off where supination will occur again to form a right lever to push yourself forward.

Question 23

Horizontal plane movement during gait

Answer 23

At right heel strike, the right ASIS is forward producing counterclockwise pelvic rotation (to the left). This produces left hip internal rotation and right hip external rotation.

Question 24

5 strategies to minimize energy during walking

Answer 24

Horizontal plane pelvic rotation
Frontal plane pelvic rotation
Frontal plane hip rotation (step width)
Stance phase knee flexion
Sagittal plane ankle rotation

Question 25

Foot drop

Answer 25

Concentric weakness of tibias anterior (swing phase gait deviation)

Question 26

Foot slap

Answer 26

Eccentric weakness of tibias anterior (stance phase gait deviation)

Question 27

Tibialis posterior

Answer 27

Primary concentric supinator during gait

Eccentrically controls pronation

Question 28

Fibularis longus

Answer 28

Primary pronator. Plantar flexes and pulls first ray down

Question 29

What happens if you lose strength in gastric and soleus?

Answer 29

Lose ability to plantar flex, so you lose push off during gait

Question 30

What happens if you have an UMN lesion from stroke or MS?

Answer 30

Spasticity in the plantar flexors - don’t have heel strike - walk on your toes

Question 31

Best predictor for who develops patellofemoral pain syndrome?

Answer 31

Loss of quad strength

Question 32

What gets you from sit to stand?

Answer 32

Hip extensors

Question 33

What helps prevent femoral IR and knee valgus?

Answer 33

External rotators of hip