Gait & Connections to MSK II Flashcards
Phases of Gait = ?
Phases of Gait:
- 1) Initial contact
- 2) Loading Response (foot flat)
- 3) Midstance
- 4) Terminal Stance (heel off)
- 5) Preswing (toe off)
- 6) Initial & Mid-swing
- 7) Terminal Swing
Compare and Contrast:
- “Bottom-up” or “Top-down” Control of the Global “Pronation” of the Lower Extremity.
Bottom-Up Theory: This theory suggests that issues start in the foot and affect everything above it.
- Pronation of the foot → internal rotation of the tibia → internal rotation of the femur.
- This perspective supports the use of specialized footwear or orthotics to correct and manage excessive pronation and associated discomfort/pain.
Top-Down Theory: This newer theory proposes that the problem starts higher up in the body.
- It suggests that excessive pronation is primarily caused by excessive internal rotation and adduction (movement toward the body’s midline) of the femur, due to weak or inactive hip external rotators and abductors.
- According to this view, improving the strength and control of the hip muscles can correct pronation issues and prevent medial collapse (inward movement) of the knee.
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Stance:
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Swing:
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Weight Acceptance:
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(1) Initial Contact:
(2) Loading Response:
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(3) Mid-Stance:
(4) Terminal Stance:
(5) Pre-Swing:
?
Limb Advancement:
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(6) Initial Swing:
(7) Mid Swing
(8) Terminal Swing
?
Single Limb Support:
Muscle activity during…
- Initial Contact = ?
- I) Iliopsoas = Inactive
- II) Glute Max. = Eccentric
- III) Glute Med. = Eccentric
- IV) Hamstrings = Eccentric
- V) Quadriceps = Eccentric
- VI) Pretibial Muscles = Eccentric
- VII) Calf Muscles = Inactive
Muscle activity during…
- Loading Response = ?
- I) Iliopsoas = Inactive
- II) Glute Max. = Inactive
- III) Glute Med. = Eccentric
- IV) Hamstrings = Eccentric
- V) Quadriceps = Eccentric
- VI) Pretibial Muscles = Eccentric
- VII) Calf Muscles = Inactive
Muscle activity during…
- Mid-Stance = ?
- I) Iliopsoas = Inactive
- II) Glute Max. = Inactive
- III) Glute Med. = Eccentric
- IV) Hamstrings = Inactive
- V) Quadriceps = Inactive
- VI) Pretibial Muscles = Inactive
- VII) Calf Muscles = Eccentric
Muscle activity during…
- Terminal Stance = ?
- I) Iliopsoas = Concentric
- II) Glute Max. = Inactive
- III) Glute Med. = Eccentric
- IV) Hamstrings = Inactive
- V) Quadriceps = Inactive
- VI) Pretibial Muscles = Inactive
- VII) Calf Muscles = Concentric / Eccentric
Muscle activity during…
- Pre-Swing = ?
- I) Iliopsoas = Concentric
- II) Glute Max. = Inactive
- III) Glute Med. = Inactive
- IV) Hamstrings = Inactive
- V) Quadriceps = Eccentric
- VI) Pretibial Muscles = Inactive
- VII) Calf Muscles = Concentric
Muscle activity during…
- Initial Swing = ?
- I) Iliopsoas = Concentric
- II) Glute Max. = Inactive
- III) Glute Med. = Inactive
- IV) Hamstrings = Eccentric
- V) Quadriceps = Concentric / Eccentric
- VI) Pretibial Muscles = Concentric
- VII) Calf Muscles = Inactive
Muscle activity during…
- Mid-Swing = ?
- I) Iliopsoas = Concentric
- II) Glute Max. = Inactive
- III) Glute Med. = Inactive
- IV) Hamstrings = Eccentric
- V) Quadriceps = Inactive
- VI) Pretibial Muscles = Concentric
- VII) Calf Muscles = Inactive
Muscle activity during…
- Terminal Swing = ?
- I) Iliopsoas = Inactive
- II) Glute Max. = Inactive / Eccentric
- III) Glute Med. = Inactive
- IV) Hamstrings = Eccentric
- V) Quadriceps = Inactive
- VI) Pretibial Muscles = Concentric
- VII) Calf Muscles = Inactive
Erector spinae function in gait = ?
Erector Spinae Function in Gait:
- Controls (braking force) the forward angular momentum of the trunk relative to the hip after heel contact (i.e., Eccentrically controls trunk flexion)
Rectus abdominis function in gait = ?
Rectus Abdominis Function in Gait:
- Stabilizes the pelvis and L-spine. Provides stability for the hip flexor muscles.
Hip extensors (Glut Max.) function in gait = ?
Hip Extensors (Glut Max) Function in Gait:
- Initiates hip extension (concentric), prepares for weight acceptance at the beginning of stance (isometric).
- Brakes/slows forward translation of the trunk and thigh at late swing (eccentric).
Hip flexors function in gait = ?
Hip Flexors Function in Gait:
- Eccentrically controls hip extension.
- Before toe off iliopsoas activates to concentrically pull the leg through first 50% of swing phase.
Hip abductors function in gait = ?
Hip Ab-ductors Function in Gait:
- Stabilizes the pelvis in frontal plain. Active during single leg stance to eccentrically control the lowering of the pelvis on opposite side.
- Some concentric action at last to control adduction of the hip.
Hip adductors function in gait = ?
Hip Ad-ductors Function in Gait:
- Two burst of activity, initially at heel contact and just after toe off.
- At heel contact it co-activates to stabilize hip.
- At toe off it is helping to extend the already flexed hip.
Hip internal rotators function in gait = ?
Hip Internal Rotators Function in Gait:
- Stance phase control hip alignment in horizontal plane by controlling pelvis while hip is in contact with the ground.
Hip external rotators function in gait = ?
Hip External Rotators Function in Gait:
- Control alignment of the hip in horizontal plane especially IR during early stance.
- Helps control pronation of the foot.
Knee extensors functions in gait = ?
Knee Extensors Functions in Gait:
- Quads active in late swing to prepare for heel contact. Major burst at heel contact to eccentrically control knee flexion which cushions the weight acceptance.
- Primary function of the rectus femoris in gait occurs in the transition from stance to swing phase and appears directed at assisting with initiating hip flexion as well as controlling knee flexion.
Knee flexors functions in gait = ?
Knee Extensors Functions in Gait:
- Hamstrings most active just before heel contact to decelerating knee extension.
- Concentrically help to initially hip extension during initial 10 % of stance.
- Short head of biceps femoris assist with knee flexion during the swing phase.
- Most knee flexion occurs passively due to hip flexor and gastrocnemius action
Gastrocnemius
Integrated function in gait = ?
Gastrocnemius:
- Decelerates dorsiflexion during terminal phase of leg swing (prior to foot hitting the ground)
Soleus
Integrated function in gait = ?
Soleus:
- Works with gastroc to decelerate dorsiflexion during leg swing.
Tibialis Posterior
Integrated function in gait = ?
Tibialis Posterior:
- Helps soleus and peroneus longus slow down dorsiflexion of the lower leg when the foot is fixed on the ground.
Peroneus Longus
Integrated function in gait = ?
Peroneus Longus:
- Assists with inversion and supination of the forefoot to create a stable lever for the heel-off to toe-off phases of gait.
These forces are of equal magnitude but = ?
These forces are of equal magnitude but opposite direction.
Moment = ?
Moment = Tendency for a movement
Ground reaction force at…
Ground reaction force at initial contact = ?
Initial Contact:
- This is the moment when the foot first makes contact with the ground, typically with the heel.
- The GRF starts low as the foot just touches the ground.
Ground reaction force at loading response = ?
Loading Response:
- This phase follows initial contact and represents the beginning of weight bearing.
- The body begins to absorb shock, and the GRF increases as the body weight shifts over the standing foot.
Ground reaction force at mid-stance = ?
Midstance:
- Occurs when the body weight is directly over the stance limb, and the foot is flat on the ground.
- GRF is generally upward through the center of mass, as the body is supported by the limb.
Ground reaction force at terminal-stance = ?
Terminal Stance:
- This is the final phase of the stance where the heel starts to lift off the ground, and the body prepares to transition to the swing phase.
- The GRF moves anteriorly, and there’s an increase as the body propels forward.
Ground reaction force at pre-swing = ?
Pre-swing:
- Marks the transition from stance to swing phase.
- It starts with initial contact of the contralateral foot and ends with toe-off of the ipsilateral foot.
- GRF decreases as the foot lifts off.
Ground reaction force at initial swing = ?
Initial Swing:
- The foot is off the ground, and the leg starts to move forward.
- There’s no GRF acting on the swinging leg, as the image shows.
Ground reaction force at mid-swing = ?
Mid-Swing:
- The leg continues to move forward, and the foot clears the ground.
- The GRF is not present in the swinging limb, as indicated in the diagram.
Ground reaction force at terminal swing = ?
Terminal Swing:
- This phase completes the swing, with the leg decelerating in preparation for the next initial contact.
- No GRF is acting on the leg in swing.
Gait Evaluation, what period = ?
- Eccentric anterior tib/long toe extensors
- Concentric quad
- Eccentric hamstrings
- Eccentric Glute max.
Gait Evaluation - Stance Phase:
- Initial Contact :
- Eccentric anterior tib/long toe extensors, concentric quad, eccentric hamstrings, glut maximus eccentric activity
Gait Evaluation, what period = ?
- Controlled decent of the foot to the ground
- Pretibial regulates ankle PF
- Quads regulated knee flexion
- Eccentrically the glutes, hamstring and adductor magnus prevent hip flexion via eccentric actions
- Highest ground force reactions seen at this stage
Gait Evaluation - Stance Phase:
- Loading Response (heel rocker):
- Controlled decent of the foot to the ground via pretibial regulates ankle PF, Quads regulated knee flexion eccentrically, Gluts, hamstring and adductor magnus prevent hip flexion via eccentric actions. Highest ground force reactions seen at this stage.
Gait Evaluation, what period = ?
- Eccentric soleus and gastroc control tibial advancement over the foot and provide stabile foot and limb stability
- Glut max decreases in late mid stance due to vertical alignment of pelvis over the femur
Gait Evaluation - Stance Phase:
- Mid Stance (Ankle Rocker):
- Eccentric soleus and gastroc (lesser degree) control tibial advancement over the foot and provide stabile foot and limb stability. Glut max decreases in late mid stance due to vertical alignment of pelvis over the femur.
Gait Evaluation, what period = ?
- BW vector approaches MTP’s
- Highest demands on the triceps surae (eccentrically) due to large dorsiflexion moment at ankle.
- TFL restrains posterior forces at the hip.
- GRF reaches second peak similar to Loading response.
Gait Evaluation - Stance Phase:
- Terminal Stance (toe rocker):
- Body weight vector approaches MTP’s, Highest demands on the triceps surae (eccentrically) due to large dorsiflexion moment at ankle.
- TFL restrains posterior forces at the hip. GRF reaches second peak similar to Loading response.
Gait Evaluation, what period = ?
- Plantar flexors muscle activity decreases.
- In walking no muscle activity required for push off.
- Hip flexion produced concentrically with rectus femoris and Adductor longus.
Gait Evaluation - Stance Phase:
- Preswing:
- Plantar flexors muscle activity decreases. In walking no muscle activity required for push off.
- Hip flexion produced concentrically with rectus femoris and Adductor longus (which is also decelerates passive abduction created by weight shifting
Gait Evaluation, what period = ?
- Concentric pretibial muscle activity for foot clearance.
- Short head of biceps femoris flexes knee concentricallty
- Iliacus advances hip to 20d of flexion.
- Gracilis and Sartorius assist hip & knee flexion concentrically
Gait Evaluation - Swing Phase:
- Initial Swing:
- Concentric pretibial muscle activity for foot clearance.
- Short head of biceps femoris flexes knee concentrically, iliacus advances hip to 20d of flexion.
- Gracilis and Sartorius assist hip and knee flexion concentrically
Gait Evaluation, what period = ?
- Max knee flexion to the point the tibia is vertical.
- Knee extension and foot dorsiflexion advance tibia and clear the foot.
- Momentum creates an extensor movement so quad is not active.
- Mild contraction of hip flexors preserves the hip flexion position
Gait Evaluation - Swing Phase:
- Mid Swing: (max knee flexion to the point the tibia is vertical). Knee extension and foot dorsiflexion advance tibia and clear the foot. Momentum creates an extensor movement so quad is not active. Mild contraction of hip flexors preserves the hip flexion position
Gait Evaluation, what period = ?
- Eccentric contraction of the hamstrings and gluteus maximus decelerates the thigh and restrains further hip flexion.
- Activity of the pretibial muscles maintains the ankle at neutral to prepare for heel contact.
- In the second half, the rectus femoris is inactive but the rest of the quadriceps vasti become active to facilitate full knee extension.
Gait Evaluation - Swing Phase:
- Terminal Swing:
- Eccentric contraction of the hamstrings and gluteus maximus decelerates the thigh and restrains further hip flexion.
- Activity of the pretibial muscles maintains the ankle at neutral to prepare for heel contact.
- In the second half of TSw, the rectus femoris is inactive but the rest of the quadriceps vasti become active to facilitate full knee extension.
Key areas to observe during gait cycle = ?
Following key areas to observe during gait cycle:
- Calcaneal eversion
- Mid-tarsal pronation
- Great toe extension
- Dorsiflexion
- Tibial varum/valgum, rotation
- Knee flex/ext
- Patellar movement
- Hip extension
- Pelvic sway
- Arm swing
- Should be noted whether these areas are normal, excessive or inadequate
Compensated Trendelenburg:
Uncompensated Trendelenburg:
Steppage gait:
??
Foot slap/drop foot:
