GAIT: Abnormal Flashcards
Tightness vs Weakness
Contracture will DEC in the ROM of OPP motion
- Ex. FLOP–> Hip flex contracture will lead to DEC hip EXT (same side) and==> DEC in step length on OPP side
Weakness will cause DEC in ROM of SAME motion (MMT scores)
- Ex. Weak hip flexors will cause DECd hip flex and dec in step length on same side—> COMPENSATIONS: ABDs, excessive knee flexion, Trunk lean
Magent Theory: Trunk leans towards WEAK mm’s
Tightness vs Weakness
Contracture will DEC in the ROM of OPP motion
- Ex. FLOP–> Hip flex contracture will lead to DEC hip EXT (same side) and==> DEC in step length on OPP side
Weakness will cause DEC in ROM of SAME motion (MMT scores)
- Ex. Weak hip flexors will cause DECd hip flex and dec in step length on same side—> COMPENSATIONS: ABDs, excessive knee flexion, Trunk lean
Magent Theory: Trunk leans towards WEAK mm’s
Practice!
PT notices pt experiencing early toe-off during TSt (EARLY==Limtd ROM somewhere). Which IDs a likely cause and intervention?
Hip Flex contracture, Prolonged stretch
*Stick to your plane! Here is SAGITTAL!
NOTE: if Gastroc is tight== early HEEL off in MSt
MM Activity in Gait Reminder
Group: Hip ABDs
Name: Glute med/min, TFL
Stance: ECCentric–> stab. pelvis
Hand/arm trick holding UP pelvis!
MM Activity in Gait Reminder:
Group: Hip ADDs
Name: Add longus/brevis, Gracilis, Add mag (horiz/vert heads)
Early and Late Stance: CONCentric–> Stab. pelvis
Practice!
PT eval 26yo female basketball player with vague dx of R. knee pain. Pt performs jump landing as shown–> Lands in EXCESSIVE R knee VALGUS. PT Tx should focus on?
Stick to your plane!! Asking about FRONTAL here bc watching from front
Strengthening R. Glute med
- Strengthen PROXIMAL BEFORE DISTAL
- Proximal stabilization CRUCIAL for knee pain
- NO VMO strengthening for PRO at ankle, valgum @ knee— DON’T DO IT!!!
Valgus @ knee usually d/t hip or ankle
MM Activity in Gait Cycle
Glute Max
Stance: ECCentric– decelerates forward momentum
PSw:– CONCentric– hip EXT
MM Activity in Gait Cycle: Erector Spinae
Think “Erect posture”
Heel strike thru Toe-off– All of stance
Maints trunk posture
Magnet Theory for Trunk lean
YOU CAN ONLY USE THIS FOR WHICH PHASE OF GAIT???
STANCE!!!!!
Practice!
74yo retired contractor walks w/ backward trunk LEAN (think MAGNET THEORY-STANCE) when in stance on LLE. MOST LIKELY cause?
Weak hip EXTs left side during stance.
Magnet Theory in STANCE:
- trunk goes toward WEAK mms
Magnet Theory: Stance
- Weak Muscle–> Trunk
- Anterior–> Anterior lean (sag plane)
- Posterior–> Post lean (sag plane)
- Lateral–> Lateral lean (frontal plane)
Causes of Backward Lean
(3):
- Weak hip EXTs (stance)
- Rigid hip flexion contracture (stance)== Hip flexors TIGHT which makes Exts WEAK
- WEAK hip flexors (swing)– therefore lean BACKWARDS to get more clearance== assists w/ PPT to advance limb in swing
see pics and READ!
Practice!
74yo contractor walks to tx room. Pt presents w/ backward trunk lean during SWING (think WEAK hip flexors–cheating to clear foot).
Hip flexor weakness
trying to cheat to clear foot d/t weak hip flexors
Backward Trunk Lean:
- Stance==> G. max weakness; Hip flexors tight (lordosis present bc APT bc hip flexors pulling into APT)
- Swing==> Hip flexors weak
Muscle Activity in Gait Cycle
Group: Ankle
Name: Peroneus longus and brevis
Stance:
- CONCentric contraction–> maint med/lat stability of foot; maintain arch
Muscle Activity in Gait Cycle
Group: Foot INtrinsics
Stance:
- CONCentric contraction–> support Plantar fascia
Practice!
PT checks A/PROM ankle ROM. Pt lacks 10degs of passive ankle DF. Same limitation of 10degs present whether knee extended OR flexed (=soleus mm is prob bc gastroc is 2jt mm). MOST likely contributing?
Soleus
1 jt mm so knee pos won’t matter**
HIP gait deviations:
(4):
- Inadequate EXT (IMPORTANT)–slide on this
- Excessive or Inad. flexion
- Excessive ADD.
- Excessive ABD.
HIP gait deviations:
IMPORTANT ONE:
Inadequate EXTENSION
- Hip flexion contracture aka tight hip flexors– FLOP– Opp side short step length
- +Thomas test, APT= Lordosis= Ext spine= Counternutation sacrum–> LACES–> Lordosis- APT- Counternutation- Ext spine
Practice!
55 yo pt referred after MVA lesioning L. INF gluteal nerve (G. max innervation, so G. max will be WEAK). Gait deviation?
MAGNET THEORY IN STANCE!
POSTERIOR lean of trunk occurs @ L. foot IC
Magnet theory!–stance only
Excessive Knee EXT causes:
(2):
- Quad Weakness (bc quads supposed to control that EXT)
- Excessive Ankle PF (remember excess. ankle PF assocd with Knee hyperEXT (“PE class”)
Remembe Red High Heels David!
- Ankle PF–> Knees lock out–> Pelvis anterior–> LS lordosis–> TS kyphosis–> FHP
Pelvis & Ankle alignment FOLLOW ea.other!
Ex. High heels== Ankle PF & forward trunk lean– APT– knee goes into hyperEXT and kyphotic posture
Practice!
Pt presents w/ knee pain. PT notices pt has excessive ankle PF w/ excessive APT (go TOGETHER!!!). Correlated motion @ knee jt?
HyperEXT
PE class
- HyperEXT + APT + LS lordosis
- Think David in Red High Heels****
Ankle Deviations
Foot
All first, listed
- Excessive INversion
- Excessive Eversion
- Premature Heel-off
- Delayed Heel contact
- Toe drag
- Foot Slap
Ankle Deviations in Gait
Foot
Excessive INversion
SUPINATION
IPAD
Ankle Deviations in Gait
Foot
Excessive Eversion
Pronation
- P. DEAB
Ankle Deviations in Gait
Foot
- Premature Heel-Off
Premature ALWAYS ==TIGHTNESS
MSt
- Tight gastroc
End of stance
- Tight hip flexors
Ankle Deviations in Gait
Foot
- Delayed Heel Contact
Land toes FIRST, THEN heel
- Tight PFs OR Weak DFs
Ankle Deviations in Gait
Foot
- Toe Drag
Too much PF or Weak DFs
Ankle Deviations in Gait
Foot
- Foot Slap
Weak DFs (ECCentrically)
Ankle Deviations in Gait
Ankle
Excessive PF
Excessive DF
Excessive PlantarFlexion
Think David in High Heels== HIGHER heel==> SLOWER walk
- Causes loss of progression== shortened stride length/reduced velocity (higher heel==slower walk)
- LOW heel contact @ IC and forefoot contact instead
- 3 Substitutions:
- Premature heel off (premature=weak)
- Knee hyperEXT (PE class)
- Forward trunk lean**
Practice!
PT observes 67yo female walk–notes forward trunk lean w/ knee hyperEXT (2 dead giveaways). LIKELY contributing cause?
Ankle PF contracture (just think EXCESS PF)
PE class= excess PF assocd w/ knee hyperEXT==APT==LS lordosis==TS kyphosis==FHP
Other answers:
- excessive DF== excess knee flexion
- quad spasticity== NO bc knee hyperEXT usually WEAK QUADS
- Ankle PF weakness== weak toe-off
AD placement (SPC ex.)
OPP OF BAD SIDE–> so GOOD SIDE
The Hip– DJD
Adding Cane on OPP side (aka if its R. hip DJD)
Review Foundations!
see pics
Note: L. side cane balances out effort from R. hip (bad side)
Practice!
58yo underwent THA on LEFT side w/ posterolat approach (no IR, ADD, trunk/hip flex >90deg). Gait training program. Cane/crutch what side?
OPP OF BAD SIDE—> GOOD SIDE!
R. hand to DEC activity in L. hip ABDs
- We want to DEC force of L. ABDs–> “Assistive device” to HELP (assist)– dec force of activity in mm’s on BAD side
Hold cane on R. side– C/L side in order to DEC mm activation on IL side
DEC torque/stress/demands on I/L (bad) side
Practice!
58yo underwent THA on LEFT side w/ posterolat approach (no IR, ADD, trunk/hip flex >90deg). Gait training program. Cane/crutch what side?
OPP OF BAD SIDE—> GOOD SIDE!
R. hand to DEC activity in L. hip ABDs
- We want to DEC force of L. ABDs–> “Assistive device” to HELP (assist)– dec force of activity in mm’s on BAD side
Hold cane on R. side– C/L side in order to DEC mm activation on IL side
DEC torque/stress/demands on I/L (bad) side
