Kinesiology Cont Flashcards
what produces an external torque during gait?
GRF
will cause movement at each joint of the LE
what produces an internal torque during gait?
primarily muscle activation
it is produced to match/overcome the external torque
when and why do concentric muscle contractions occur during gait?
they occur when the internal torque is moving the joint in the direction of the muscle’s activity
these provide stability and produce movement of a segment
when and why do eccentric muscle contractions occur during gait?
they occur when an internal torque is moving the joint in the direction opposite of the muscle’s action
these help with shock absorption and deceleration of a limb segment
what can cause muscular dysfunction and how will it impact gait?
Causes:
- weakness
- loss of power
- decreased endurance
- spasticity
- contracture
leads to altered gait patterns and compensations as the torque GRFV doesn’t change but the individual’s ability to counter it does
what muscles are activated at the hip in the sagittal plane during IC?
ALL hip extensors contract concentrically to prepare for LR
what muscles are activated at the knee in the sagittal plane during IC?
eccentric hamstring contraction to counteract extension torque
knee extensions transition from concentric to eccentric contraction in preparation for LR
what muscles are activated at the ankle in the sagittal plane during IC?
pretibials (tibialis anterior, big toe extensors) contract concentrically
what muscles are activated at the hip in the sagittal plane during LR?
concentric contraction of hip extensors
(Glute max, adductor magnus, TFL, Glute med peak)
what muscles are activated at the knee in the sagittal plane during LR?
eccentric contraction of knee extensors
(quad activity peaks)
what muscles are activated at the ankle in the sagittal plane during LR?
eccentric contraction of ankle DF (tibialis anterior peaks)
Transition to eccentric contraction of ankle PF in late LR
what muscles are activated at the hip in the sagittal plane during MSt?
no hip muscular activity requried in the sagittal plane
what muscles are activated at the knee in the sagittal plane during MSt?
quads eccentric to no activity
what muscles are activated at the ankle in the sagittal plane during MSt?
eccentric contraction of the gastroc/soleus
what muscles are activated at the hip in the sagittal plane during TSt?
minimal activity in the sagittal plane
what muscles are activated at the knee in the sagittal plane during TSt?
no quad or HS activity
tibial position maintained by gastroc
what muscles are activated at the ankle in the sagittal plane during TSt?
concentric contraction of ankle PF to prevent tibial collapse with heel rise
Gastroc/Soleus activity peaks
what muscles are activated at the hip in the sagittal plane during PSw?
concentric contraction of hip flexors
adductor longus peaks
what muscles are activated at the knee in the sagittal plane during PSw?
knee flexion is mainly passive
slight concentric contraction of knee flexors and eccentric rectus
what muscles are activated at the ankle in the sagittal plane during PSw?
ankle PF activity ceases in early PSw and passive tension contributes to ankle moving in PF
ankle DF concentric initiated at the end of PSw
what muscles are activated at the hip in the sagittal plane during ISw?
continued concentric contraction of hip flexors
Iliacus peaks
what muscles are activated at the knee in the sagittal plane during ISw?
concentric contraction of knee flexors
(biceps femoris SH, sartorius, gracilis peak)
flexion continues to be aided by flexion at the hip
what muscles are activated at the ankle in the sagittal plane during ISw?
concentric contraction of tibialis anterior
toe extensor activity peaks
what muscles are activated at the hip in the sagittal plane during MSw?
continued concentric contraction of hip flexors
initation of eccentric hip extensors (HS) to control hip flexors
what muscles are activated at the knee in the sagittal plane during MSw?
knee extension created by momentum
knee flexors contract eccentrically at the end of MSw to control extension
what muscles are activated at the ankle in the sagittal plane during MSw?
continued concentric contraction of DF
what muscles are activated at the hip in the sagittal plane during TSw?
concentric contraction of hip extensors
what muscles are activated at the knee in the sagittal plane during TSw?
concentric contraction of knee extensors to insure full extension
peak hamstring eccentric contraction to decelerate thigh
what muscles are activated at the ankle in the sagittal plane during TSw?
continued concentric contraction of DF
Describe the relative joint position and muscle activity at the hip in the sagittal plane during gait
use the chart
describe the relative joint position and muscle activity at the knee in the sagittal plane during gait
use the chart
describe the relative joint position and muscle activity at the ankle in the sagittal plane during gait
use the chart
what muscles are activated at the hip in the frontal plane during LR and MSt?
- LR → hip abductors contracting eccentrically
- Glute med and adductor magnus at peak
- MSt → hip abductors contracting eccentrically then concentrically
what muscles are activated at the ankle in the frontal plane during LR and MSt?
invertors contracting eccentrically during both phases
what muscles are activated at the hip in the frontal plane during TSt and PSw?
hip abductors contracting concentrically
what muscles are activated at the ankle in the frontal plane during TSt and PSw?
invertors contracting concentrically
what muscles are activated at the hip in the frontal plane during the entire swing phase?
hip adductors contract concentrically
what muscles are activated at the ankle in the frontal plane during the entire swing phase?
evertors contract concentrically
describe the relative joint position and muscle activity at the hip in the frontal plane during all of gait
use the diagram
describe the relative joint position and muscle activity at the ankle in the frontal plane during all of gait?
use the diagram below
what are the key roles of the ankle dorsiflexors during gait?
eccentric activation to control plantarflexion of the ankle at IC until foot flat
what are the key roles of the ankle plantarflexors during gait?
- eccentric contraction moving into MSt to control tibial advancement
- concentric contractions at TSt assists with forward propulsion
what are the key roles of the ankle invertors during gait?
- eccentrically contracts to control pronation until MSt
- concentrically contracts to supinate the foot for push off in TSt/PSw
what are the key roles of the ankle evertors during gait?
also active as co-contraction to counter strong inversion effect occuring during LR/MSt
what are the key roles of the knee extensors during gait?
- eccentrically control knee flexion in LR
- Concentrically to extend the knee and support the body in MSt
what are the key roles of the knee flexors during gait?
Decelerate knee extensors in preparation for placement of the foot on the ground
what are the key roles for the hip extensors during gait?
activated in TSw prior to IC to initiate hip extension and prepare LE for weight acceptance at the beginning of stance
what are the key roles for the hip flexors during gait?
advance LE forward during ISw
Concentrically lift LE to allow for toe clearance during swing
what are the roles of the hip abductors during gait?
Control the slight lowering of the contralateral pelvis on the side of the swing limb then provide pelvic stability in stance
what are the key roles of the hip adductors during gait?
assist with the initation of hip flexion after toe off
List some gait deviations
- Trendelenburg gait
- compensated trendelenburg gait
- foot slap
- knee extension thrust
what phase of gait is Trendelenburg gait observed?
LR → PSw
(observed best in frontal plane)
what does Trendelenburg gait look like?
excessive downward drop of the contralateral pelvis during stance
what is the cause of both Trendelenburg and compensated Trendelenburg gait?
glute medius weakness
what is the result of Trendelenburg gait?
a functionally longer swing limb resulting in decreased efficiency and possibly decreased stance time
what differentiates Trendelenburg from compensated Trendelenburg gait?
compensated Trendelenburg gait utilizes a trunk lean over the stance leg to try and maintain a level pelvis
what does a foot slap gait look like? what phase of gait is it most noticed and in what plane?
PF torque goes unchecked by anterior tib
occurs during IC → LR
best observed in the sagittal plane
what are some potential causes of a foot slap gait?
tib anterior weakness
(from a peroneal nerve palsy or peripheral neuropathy)
what is the result/impact of “foot slap” on gait?
rapid PF after heel contact which can be audible
usually can clear foot during swing
what does a knee extension thrust during gait look like? what phases does it typically occur in and what plane is the best to view it?
knee snapping back into extension early in stance phase
phase → IC
plane → sagittal
what are some potential causes of a knee extension thrust gait deviation?
quad spasiticy from UMN lesion
what is the result/impact of a knee extension thrust gait deviation?
rapid and often excessive knee extension during LR, can occur w/cause knee hyperextension over time
describe the positioning of the foot and ankle in the sagittal plane during IC
neutral to slight PF position
(heel rocker (1st rocker) is initated here)
describe the positioning of the foot and ankle in the sagittal plane during LR
5º of rapid PF to get foot flat on the floor
describe the positioning of the foot and ankle in the sagittal plane during the transition from MSt to TSt
this transition is a period of CKC DF to about 10º and MTP to 30º
(ankle and forefoot rocker occurs here)
describe the positioning of the foot and ankle in the sagittal plane during PSw
there is a transition from time of max DF position toward max PF position
max MTP extension to 60º
heel lift off is occuring
describe the positioning of the foot and ankle in the sagittal plane during ISw
DF to move the ankle away from max PF to about 5º of PF
describe the positioning of the foot and ankle in the sagittal plane during the transition of MSw to TSw
ankle continues to DF until it reaches a neutral position in preparation for heel strike during IC
what critical events must occur at the ankle during gait and at what phases?
- IC = heel first contact
- LR = ankle PF
- MSt = controlled tibial advancement
- TSt = controlled ankle DF with heel rise
- PSw = ankle PF
- MSw = foot clearance
what are the foot and ankle rockers?
3 different positions/movement sequences that all aim to move the foot and ankle through gait
List the 3 different foot and ankle rockers
- heel rocker (1st rocker)
- ankle rocker (2nd rocker)
- forefoot rocker (3rd rocker)
what occurs during heel rocker (1st rocker)?
motion of the foot from a DF to PF position during LR to achieve a flat foot
what occurs during the ankle rocker (2nd rocker)?
closed chain advancement of the tibia into a DF position over a fixed foot during MSt
what occurs during the forefoot rocker (3rd rocker)?
begins when COP is over the Metatarsals and heel lift occurs in TSt/PSw
what is the purpose of the rockers?
they allow for an efficient and smooth gait pattern
describe the positioning of the knee in the sagittal plane during IC
neutral to 5º of flexion
describe the positioning of the knee in the sagittal plane during LR
flexing to 15º (allows for shock absorption)
describe the positioning of the knee in the sagittal plane during MSt to TSt
extension back to 5º flexion/neutral
describe the positioning of the knee in the sagittal plane during PSw
rapid flexion to 40º
describe the positioning of the knee in the sagittal plane during ISw
more flexion to 60º
needed for limb clearance
describe the positioning of the knee in the sagittal plane during MSw
Rapid extension to 25º flexion
determines step length
describe the positioning of the knee in the sagittal plane during TSw
further extension to 5º/neutral
what are the critical events that must occur at the knee and which phases do they occur at?
- LR = controlled knee flexion
- PSw = passive knee flexion
- ISw = knee flexion
- TSw = knee extension
describe the positioning of the hip in the sagittal plane during IC → LR
20º flexion
(considered “leftover” from TSw)
describe the positioning of the hip in the sagittal plane during MSt
extension into a neutral hip position as the body progresses forward
describe the positioning of the hip in the sagittal plane during TSt
maximum (20º) hip extension occurs
the body is past the foot at this point as it begins to transition into PSw
describe the position of the hip in the sagittal plane during PSw
flexion (from 20º extension) to about 10º of hip extension
(this is when there is a reversal from extension into flexion)
describe the positioning of the hip in the sagittal plane during ISw
continued flexion to 15º
describe the positioning of the hip in the sagittal plane during MSw → TSw
continued flexion to 25-30º
what are the critical events that occur at the hip during gait? What phases do they occur at?
- LR = hip stability
- ISw = hip flexion
- MSw = hip flexion
how much ROM is needed at the hip, knee and ankle for normal gait?
- hip = ~40º
- flexion = 25
- extension = 20
- knee = ~60º
- flexion = 60
- extension = 0
- ankle = 30º
- DF = 10
- PF = 20
how is the COM displaced in the sagittal plane during gait?
vertically (~5 cm)
it is at it’s lowest during the halfway point of both double limb support stages
it is at it’s highest during the halfway point of both single limb support stages
describe the position of the ankle in the frontal plane during IC
slight inversion of the hindfoot
describe the positioning of the ankle in the frontal plane during LR → MSt
eversion of the hindfoot
pronation initially and then the forefoot follows hindfoot position
describe the positioning of the foot and ankle in the frontal plane during TSt → PSw
inversion
allows for resupination and the foot becoming a rigid lever so that we can push off of it
describe the positioning of the foot and ankle in the frontal plane during swing phase
really variable
can’t really ascribe normal positioning
describe the positioning of the knee in the frontal plane during gait
not much movement with normal gait
(total = ~5-10º)
some genu varum/valgum may be observed
describe the positioning of the hip in the frontal plane during IC
neutral ab/adduction
describe the positioning of the hip in the frontal plane during LR → MSt
adduction during weight acceptance
a contalateral hip drop may be observed
describe the positioning of the hips in the frontal plane during MSt → TSt
increased adduction (up to 15º)
weight shifts over to stance leg resulting in relative hip adduction (due to hip hike of swing leg)
describe the horizontal plane motions of the trunk during gait
opposite rotation from pelvic motion
total excursion 7-9º
describe the horizontal plane motions that occur at the hips during gait
forward rotation of the pelvis on the stnace limb occurs with hip flexion during swing
increases greater step length than that of hip flexion alone
describe the horizontal plane motions that occur at the shoulder during gait
opposite sagittal plane motion from ipsilateral hip
motion is partially active and is mostly shoulder extension
the motion balances out rotational forces of the trunk
how is the COM displaced in the horizontal plane during gait?
shifts from R to L crossing a midline point to stay over BOS
max shift towards the reference limb occurs at the end of mistance of the reference limb
the max shift away from the reference limb occurs during midswing of the reference limb
List several possible gait deviations
- decreased great toe extension
- steppage gait/increased knee flexion
- foot flat contact
- circumduction
- increased lumbar lordosis
what phases of the gait cycle is decreased great toe extension primarily impacting and what would it look like?
- phases = TSt and PSw
- patient does not complete forefoot rocker and ends stance phase noticeably early
what is the cause of decreased great toe extension?
- joint hypomobility
- pain
- bone spur
- gouty arthritis
- plantar fasciitis
what is the end result of a gait deviation like decreased great toe extension?
decreased push off
shortened stance time
what phases of the gait cycle is steppage gait impacting and what does it look like?
- swing phase
- looks like increased hip and knee flexion with loss of ankle DF
what are some potential causes of a gait deviation like steppage gait?
- foot drop/nerve disorder
- polyneuropathy
- equinus deformity
what is the end result of a gait deviation like steppage gait?
prolonged swing phase
fall risk
decreased efficiency
what phases of the gait cycle is foot flat contact primarily impacting and what would it look like?
- IC
- looks like the mid foot or forefoot make first contact with ground instead of the heel
what are some potential causes of foot flat contact gait deviations?
- excessive knee flexion in late swing
- weak/impaired DF
what is the end result of a gait deviation like foot flat contact?
absent heel rocker
(can have normal ankle rocker)
what phases of the gait cycle are primarily impacted by the gait deviation: circumduction? What does it look like?
- phases = swing
- looks like a lateral whipping motion of the limb during swing at the hip
what are some potential causes of the gait deviation circumduction?
- impaired knee flexion ROM
- impaired ankle DF ROM
what is the end result of the gait deviation circumduction?
compensation for failure to functionally shorten the limb during swing = increased fall risk
what phases of the gait cycle are primarily impacted by the gait deviation increased lumbar lordosis? What does it look like?
- TSt
- looks like increased lumbar lordosis during late stance phase
what are some potential causes of the gait devaition of increased lumbar lordosis?
- hip flexor contracture
- Hip OA
what is the end result of the gait deviation of increased lumbar lordosis?
lack of hip extension in terminal stance is compensated for increased lordosis in the spine
Define Base of Support
area bounded posteriorly by the tips of the heels and anteriorly by a line joining the tips of the toes
Define Center of Gravity
also called COM
point where mass of body is centered
Define postural control
maintenance of COM over BOS to control body’s orientation in space and stabilize head w/respect to vertical to orient gaze
what 2 responses enable postural control?
reactive (compensatory) response
proactice (anticipatory) response
what are reactive (compensatory) responses?
responses that occur as reactions to external forces that displace the body’s COM
what are proactive (anticipatory) responses?
responses that occur in anticipation of internally generated destabilizing forces
how much postural sway is normal?
7 mm during quiet stance
COP can be mapped to determine sway
what is the clinical relevance of postural sway?
increased sway = increase fall risk due to COM nearing/getting outside of BOS
what is the difference between sensory and mechanical perturbations?
sensory = may be caused by altering visual input
mechanical = displacement causing changes in the relationship of the body’s COM to BOS
what are muscle synergies/strategies (pertaining to postural control)?
centerally organized patterns of muscle activity that occur in response to perturbations of standing postures
what is the pattern for an ankle strategy? Hip strategy?
ankle = distal-to-proximal pattern
hip = proximal-to-distal pattern
what are 2 changes in support stategies?
- stepping strategies
- grasping strategies
what is the goal of changes in support strategies?
move/enlarge the body’s BOS so that it remains under the COM
it is the only strategy that is successful with large perturbations
how can you define equilibrium with respect to internal/external forces?
sum of internal and external forces equal to zero
what occurs if the line of gravity (LoG) passes through a joint axis?
no torque is created around the joint
what occurs if the LoG passes at a distance from the joint axis?
external gravitation moment
this results in rotation around the joint axis unless it is opposed by a counterbalancing internal moment/muscle contraction
Direction depends on the ________ of the ________ in relation to the ___________
location
LoG
joint axis
if the LoG is anterior to the joint axis, the external moment will cause what?
anterior motion of the proximal segment supported by that joint
what are 3 keys to a successful postural assessment?
- assess from multiple angles
- remove obstructive clothing
- observe more than the area of complaint
Long-term deviation of the LoG passing through/around joint axis will result in __________
structural changes
Describe the Ideal Standing Posture
ideal alignment palce the LoG:
- through external auditory meatus
- midway through shoulder
- slightly posterior to center of hip joint
- slightly anterior to axis of knee joint
- slightly anterior to lateral malleolus
As the LoG passes anterior to the lateral malleolus, what are the external and internal moments?
external = pulling into dorsiflexion
internal = coutner w/plantarflexion (no passive structures contribute, active contraction of solues and gastro)
as the LoG passes anterior to the knee joint, what are the external and internal moments?
external = pull into extension
internal = counter w/flexion
(prevent knee hyperextension by passive tension of posterior joint capsule and associated ligaments and active contraction of hamstrings and gastroc)
as the LoG passes posterior to the hip joint, what are the external and internal moments?
external = pull into extension
internal = counter w/flexion
(passive tension of hip ligaments and active contraction of hip flexors)
what is the ideal posture at the lumbosacral joint?
LoG passes through the body of the L5 causing a slight extension moment
creates shear force rather than a true torque
opposed by anterior longitudinal ligament, iliolumbar ligament, facet joint approximation
As the LoG passes through the external auditory meatus and anterior to the axis of the head, what are the external and internal moments?
external = flexion of cervical spine
internal = extension of cervical spine
(passive tension of ligamentum nuchae, tectorial membrane, and posterior facet joint capsules)
(active contraction of cervical extensors)
Describe the ideal standing posture from the posterior view
- Midline
- head
- spine
- feet evenly spaced
- Shoulder and scapulae
- scapulae lie flat on thorax
- approximately between T2-T7
- approximately 4 inches apart
describe the ideal standing posture from the anterior veiw
- alignment of knees
- patellae face directly forward
- slight physiological valgus
- alignment of ankles
- neutral, neither supinated nor pronated
- alignment of feet
- heels separated by ~3 inches
- out-toeing 8-10 degrees
what is the difference between a step and a stride?
stride = distance between 2 successive heel contacts of the same foot
step = distance between 2 successive heel contacts of 2 different feet
define degree of toe-out
angle between line of progression of the body and a line intersecting the center of the heel and 2nd toe
normal = 5-7 degrees
what are the 3 temporal descriptors of gait?
- stride time
- step time
- cadence
what is considered a normal cadence for men and women?
men = 108 steps/min
women = 118 steps/min
what is our spatiotemporal descriptor for gait?
gait speed/velocity
T/F: gait speed is a very functional measurement of an individual’s walking ability?
TRUE
often called the 6th vital sign
An individual’s gait speed can be predictive of what?
- future health status
- functional decline
- hospitalization rate
- mortality rate
what are the 2 phases of the gait cycle?
stance phase (60%)
swing phase (40%)
how much time in the gait cycle is spent in single-limb support?
80%
(double limb support = 20%)
what system is used to describe the individual phases/parts of the gait cycle?
Rancho Los Amigos Terminology
what are the stages of the stance phase of gait?
- initial contact
- loading response
- midstance
- terminal stance
- preswing
what are the stages of the swing phase of gait?
- initial swing
- mid swing
- terminal swing
what occurs in the Stance Phase: Initial contact (IC)?
the instant the foot hits the ground
critical event = heels first contact
what is occuring on the opposite limb during stance phase: initial contact?
TSt and PSw
(terminal stance
what are the relative joint positions during the Stance Phase: Initial contact?
- Hip = 20° flexion,
- Knee = 0-5° flexion
- Ankle = 0°
What occurs in the Stance phase: Loading Response (LR)?
shock is absorbed as forward momentum is preserved. A flat foot position is achieved
critical event = hip stability, controlled knee flexion, and ankle PF
What is occuring on the opposite limb during stance phase: loading response (LR)?
PSw
pre-swing
what are the relative joint positions for the Stance Phase: loading response?
- Hip = 20° flexion
- Knee = 15° flexion
- Ankle = 5° PF
Initial contact and loading response combine for what functional task?
weight acceptance, shock absorption, and providing a stable base for the body to progress over
absorb impact of GRF
period of dual-limb support
What occurs in the stance phase: midstance (MSt)?
the body progresses over the foot in a controlled manner. First instance of single limb support
critical events = controlled tibial advancement
What is occuring on the opposite leg during stance phase: midstance (MSt)?
ISw - MSw
(Initial swing to Midswing)
what are the relative joint positions for stance phase: midstance?
- Hip = 0°
- Knee = 5° flexion
- Ankle = 5° dorsiflexion
what occurs during stance phase: terminal stance (TSt)?
progression over the stance limb continues past the forefoot. Body is ahead of stance limb
critical events = controlled ankle DF with heel raise
what is occuring on the opposite limb during stance phase: terminal stance (TSt)?
TSw
(terminal swing)
what are the relative joint positions for stance phase: terminal stance?
- Hip = 20° extension
- Knee = 5° flexion
- Ankle = 10° dorsiflexion
What occurs during stance phase: pre swing (PSw)?
rapid unloading of the limb with weight transfer to opposite limb, starting the second period of double limb support
critical events = passive knee flexion to 40°, Ankle PF, 60° of MTP extension
what is occuring in the opposite limb during stance phase: pre swing (PSw)?
IC → LR
initial contact into loading response
what are the relative joint positions for stance phase: pre-swing (PSw)?
- Hip = 10° extension
- Knee = 40° flexion
- Ankle = 15° plantarflexed
what occurs during swing phase: initial swing (ISw)?
the thigh begins to advance as the foot leaves the floor
critical events = hip flexion, knee flexion
what is occuring at the opposite limb during swing phase: initial swing (ISw)?
LR → MSt
(loading response into midstance)
what are the relative joint positions during swing phase: initial swing (ISw)?
- Hip = 15° flexion
- Knee = 60° flexion
- Ankle = 5° plantarflexion
what occurs during swing phase: mid swing (MSw)?
thigh continues to advance, knee begins to extend as foot clearance is maintained
critical events = continued hip flexion, foot clearance
What is occuring in the opposite limb during swing phase: mid swing (MSw)?
MSt
midstance
what are the relative joint positions for swing phase: mid swing (MSw)?
- Hip = 25° flexion
- Knee = 25° flexion
- Ankle = 0° dorsiflexion
what occurs during swing phase: terminal swing (TSw)?
the leg reaches out to achieve step length
critical events = knee extension
What is occuring on the opposite limb during swing phase: terminal swing (TSw)?
TSt
terminal stance
what are the relative joint positions during swing phase: terminal swing (TSw)?
- Hip = 20° flexion
- Knee = 5° flexion
- Ankle = 0° dorsiflexion
What are the 3 functional tasks of gait?
- Weight acceptance
- Single limb support
- Swing limb advancement
When does weight acceptance occur within the gait cycle and what are it’s goals?
Occurs during: IC and LR
Goals:
- forward progression
- stability
- shock absorption
when does single limb support occur within the gait cycle and what are the goals of this task?
occurs in: MSt and TSt
Goals:
- stability
- forward progression
When does swing limb advancement occur within the gait cycle and what are the goals of this task?
occurs in: PSw, ISw, MSw, and TSw
Goals:
- foot clearance
- limb advancement
What are some general tips to take into consideration when performing a gait analysis?
- Big picture first
- Avoid tunnel vision
- Do not let classification of gait dictate your treatment
- Take your time, get it right
- Understand what you are seeing before you try to fix it
- Use anatomical and standard terminology
- Let the patient choose their walking speed
What are some general tips to take into consideration when performing a gait analysis?
- Big picture first
- Avoid tunnel vision
- Do not let classification of gait dictate your treatment
- Take your time, get it right
- Understand what you are seeing before you try to fix it
- Use anatomical and standard terminology
- Let the patient choose their walking speed
When does swing limb advancement occur within the gait cycle and what are the goals of this task?
occurs in: PSw, ISw, MSw, and TSw
Goals:
- foot clearance
- limb advancement
when does single limb support occur within the gait cycle and what are the goals of this task?
occurs in: MSt and TSt
Goals:
- stability
- forward progression
When does weight acceptance occur within the gait cycle and what are it’s goals?
Occurs during: IC and LR
Goals:
- forward progression
- stability
- shock absorption
What are the 3 functional tasks of gait?
- Weight acceptance
- Single limb support
- Swing limb advancement
what are the relative joint positions during swing phase: terminal swing (TSw)?
- Hip = 20° flexion
- Knee = 5° flexion
- Ankle = 0° dorsiflexion
What is occuring on the opposite limb during swing phase: terminal swing (TSw)?
TSt
terminal stance
what occurs during swing phase: terminal swing (TSw)?
the leg reaches out to achieve step length
critical events = knee extension
what are the relative joint positions for swing phase: mid swing (MSw)?
- Hip = 25° flexion
- Knee = 25° flexion
- Ankle = 0° dorsiflexion
What is occuring in the opposite limb during swing phase: mid swing (MSw)?
MSt
midstance
what occurs during swing phase: mid swing (MSw)?
thigh continues to advance, knee begins to extend as foot clearance is maintained
critical events = continued hip flexion, foot clearance
what are the relative joint positions during swing phase: initial swing (ISw)?
- Hip = 15° flexion
- Knee = 60° flexion
- Ankle = 5° plantarflexion
what is occuring at the opposite limb during swing phase: initial swing (ISw)?
LR → MSt
(loading response into midstance)
what occurs during swing phase: initial swing (ISw)?
the thigh begins to advance as the foot leaves the floor
critical events = hip flexion, knee flexion
what are the relative joint positions for stance phase: pre-swing (PSw)?
- Hip = 10° extension
- Knee = 40° flexion
- Ankle = 15° plantarflexed
what is occuring in the opposite limb during stance phase: pre swing (PSw)?
IC → LR
initial contact into loading response
What occurs during stance phase: pre swing (PSw)?
rapid unloading of the limb with weight transfer to opposite limb, starting the second period of double limb support
critical events = passive knee flexion to 40°, Ankle PF, 60° of MTP extension
what are the relative joint positions for stance phase: terminal stance?
- Hip = 20° extension
- Knee = 5° flexion
- Ankle = 10° dorsiflexion
what is occuring on the opposite limb during stance phase: terminal stance (TSt)?
TSw
(terminal swing)
what occurs during stance phase: terminal stance (TSt)?
progression over the stance limb continues past the forefoot. Body is ahead of stance limb
critical events = controlled ankle DF with heel raise
what are the relative joint positions for stance phase: midstance?
- Hip = 0°
- Knee = 5° flexion
- Ankle = 5° dorsiflexion
What is occuring on the opposite leg during stance phase: midstance (MSt)?
ISw - MSw
(Initial swing to Midswing)
What occurs in the stance phase: midstance (MSt)?
the body progresses over the foot in a controlled manner. First instance of single limb support
critical events = controlled tibial advancement
Initial contact and loading response combine for what functional task?
weight acceptance, shock absorption, and providing a stable base for the body to progress over
absorb impact of GRF
period of dual-limb support
what are the relative joint positions for the Stance Phase: loading response?
- Hip = 20° flexion
- Knee = 15° flexion
- Ankle = 5° PF
What is occuring on the opposite limb during stance phase: loading response (LR)?
PSw
pre-swing
What occurs in the Stance phase: Loading Response (LR)?
shock is absorbed as forward momentum is preserved. A flat foot position is achieved
critical event = hip stability, controlled knee flexion, and ankle PF
what are the relative joint positions during the Stance Phase: Initial contact?
- Hip = 20° flexion,
- Knee = 0-5° flexion
- Ankle = 0°
what is occuring on the opposite limb during stance phase: initial contact?
TSt and PSw
(terminal stance
what occurs in the Stance Phase: Initial contact (IC)?
the instant the foot hits the ground
critical event = heels first contact
what are the stages of the swing phase of gait?
- initial swing
- mid swing
- terminal swing
what are the stages of the stance phase of gait?
- initial contact
- loading response
- midstance
- terminal stance
- preswing
what system is used to describe the individual phases/parts of the gait cycle?
Rancho Los Amigos Terminology
how much time in the gait cycle is spent in single-limb support?
80%
(double limb support = 20%)
what are the 2 phases of the gait cycle?
stance phase (60%)
swing phase (40%)
An individual’s gait speed can be predictive of what?
- future health status
- functional decline
- hospitalization rate
- mortality rate
T/F: gait speed is a very functional measurement of an individual’s walking ability?
TRUE
often called the 6th vital sign
what is our spatiotemporal descriptor for gait?
gait speed/velocity
what is considered a normal cadence for men and women?
men = 108 steps/min
women = 118 steps/min
what are the 3 temporal descriptors of gait?
- stride time
- step time
- cadence
define degree of toe-out
angle between line of progression of the body and a line intersecting the center of the heel and 2nd toe
normal = 5-7 degrees
what is the difference between a step and a stride?
stride = distance between 2 successive heel contacts of the same foot
step = distance between 2 successive heel contacts of 2 different feet
describe the ideal standing posture from the anterior veiw
- alignment of knees
- patellae face directly forward
- slight physiological valgus
- alignment of ankles
- neutral, neither supinated nor pronated
- alignment of feet
- heels separated by ~3 inches
- out-toeing 8-10 degrees
Describe the ideal standing posture from the posterior view
- Midline
- head
- spine
- feet evenly spaced
- Shoulder and scapulae
- scapulae lie flat on thorax
- approximately between T2-T7
- approximately 4 inches apart
As the LoG passes through the external auditory meatus and anterior to the axis of the head, what are the external and internal moments?
external = flexion of cervical spine
internal = extension of cervical spine
(passive tension of ligamentum nuchae, tectorial membrane, and posterior facet joint capsules)
(active contraction of cervical extensors)
what is the ideal posture at the lumbosacral joint?
LoG passes through the body of the L5 causing a slight extension moment
creates shear force rather than a true torque
opposed by anterior longitudinal ligament, iliolumbar ligament, facet joint approximation
as the LoG passes posterior to the hip joint, what are the external and internal moments?
external = pull into extension
internal = counter w/flexion
(passive tension of hip ligaments and active contraction of hip flexors)
as the LoG passes anterior to the knee joint, what are the external and internal moments?
external = pull into extension
internal = counter w/flexion
(prevent knee hyperextension by passive tension of posterior joint capsule and associated ligaments and active contraction of hamstrings and gastroc)
As the LoG passes anterior to the lateral malleolus, what are the external and internal moments?
external = pulling into dorsiflexion
internal = coutner w/plantarflexion (no passive structures contribute, active contraction of solues and gastro)
Describe the Ideal Standing Posture
ideal alignment palce the LoG:
- through external auditory meatus
- midway through shoulder
- slightly posterior to center of hip joint
- slightly anterior to axis of knee joint
- slightly anterior to lateral malleolus
Long-term deviation of the LoG passing through/around joint axis will result in __________
structural changes
what are 3 keys to a successful postural assessment?
- assess from multiple angles
- remove obstructive clothing
- observe more than the area of complaint
if the LoG is anterior to the joint axis, the external moment will cause what?
anterior motion of the proximal segment supported by that joint
Direction depends on the ________ of the ________ in relation to the ___________
location
LoG
joint axis
what occurs if the LoG passes at a distance from the joint axis?
external gravitation moment
this results in rotation around the joint axis unless it is opposed by a counterbalancing internal moment/muscle contraction
what occurs if the line of gravity (LoG) passes through a joint axis?
no torque is created around the joint
how can you define equilibrium with respect to internal/external forces?
sum of internal and external forces equal to zero
what is the goal of changes in support strategies?
move/enlarge the body’s BOS so that it remains under the COM
it is the only strategy that is successful with large perturbations
what are 2 changes in support stategies?
- stepping strategies
- grasping strategies
what is the pattern for an ankle strategy? Hip strategy?
ankle = distal-to-proximal pattern
hip = proximal-to-distal pattern
what are muscle synergies/strategies (pertaining to postural control)?
centerally organized patterns of muscle activity that occur in response to perturbations of standing postures
what is the difference between sensory and mechanical perturbations?
sensory = may be caused by altering visual input
mechanical = displacement causing changes in the relationship of the body’s COM to BOS
what is the clinical relevance of postural sway?
increased sway = increase fall risk due to COM nearing/getting outside of BOS
how much postural sway is normal?
7 mm during quiet stance
COP can be mapped to determine sway
what are proactive (anticipatory) responses?
responses that occur in anticipation of internally generated destabilizing forces
what are reactive (compensatory) responses?
responses that occur as reactions to external forces that displace the body’s COM
what 2 responses enable postural control?
reactive (compensatory) response
proactice (anticipatory) response
Define postural control
maintenance of COM over BOS to control body’s orientation in space and stabilize head w/respect to vertical to orient gaze
Define Center of Gravity
also called COM
point where mass of body is centered
Define Base of Support
area bounded posteriorly by the tips of the heels and anteriorly by a line joining the tips of the toes
what are the 5 principles of diagnosis for soft tissue injuries?
- look for “inherent likelihoods”
- look for objective physical signs
- Palpation
- selective tensionoing: non-contractile vs contractile tissue
- The “pain” is the pain for which the pt. is seeking treatment
T/F: palpation is helpful but can be unreliable
TRUE
some things are just naturally tender to palpate which can often be misinterpreted
list different types of contractile tissues
- tendons
- muscles
- musculotendinous junction
- bone adjacent to attachment of tendon
a contractile tissue will have stress with what 3 tests/things?
- isometric contraction
- stretching
- palpation
List different non-contractile tissues
- joint capsules
- ligaments
- bursae
- aponeuroses
- nerves
a non-contractile tissue will have stress with what?
- stretch
- palpation
*no increase in discomfort/stress with isometric contraction
when testing active and passive movements, what things should you observe/look for?
- pain
- ROM
- quality of movement
- willingness to move
- compare AROM, PROM, resistance testing and palation between involved and uninvolved side
T/F: you do not need to manually test a muscle through it’s full ROM
It depends
only to rule out/rule in a suspicous area
when palpating a stationary joint what things are you looking for?
- temperature
- swelling
- gaps
- tenderness
- pulsation
when palpating a moving joint what things are you looking for?
- crepitus
- clicks
- end-feel
- hypermobility
- hypomobility
- willingness to move
- pain
what can you use to help you make a decision/diagnosis when the pt is in severe or slight pain?
- pt. history
- functional testing - try to recreate their pain in a motion
- ask them to return when symptom returns
what AROM results should you expect for a muscle/tendon strain, tendonitis or possible small tear?
likely limited due to pain and/or weakness
may be able to move through full ROM but with pain
what PROM results should you expect from a muscle/tendon strain, tendonitis or possible small tear?
if truly passive: should have full pain free motion in all directions
EXCEPT
direction which stretches involved area may be limited due to pain (empty end feel)
what isometric/MMT results should you expect from a muscle/tendon strain, tendonitis or possible small tear?
likely weak and painful when testing involved area
what palpation results should you expect when testing a muscle/tendon strain, tendonitis or possible small tear?
involved area painful to palpation
what AROM results should you expect from a muscle or tendon complete tear?
very limited due to weakness
likely not as much pain as seen w/partial tear, but much more weakness
what PROM results should you expect from a muscle or tendon complete tear?
if truly passive: full pain free motion in all directions
EXCEPT
direction that stretches involved area, may be limited due to pain (empty end feel) if a muscle is guarding in the area
what isometric/MMT results should you expect from a muscle or tendon complete tear?
extremely weak
what palpation results should you expect from a muscle or tendon complete tear?
involved area painful to palpation
what AROM results should you expect to see from a joint capsule injury?
limited
possibly painful at end ranges
what PROM results should you expect to see from a joint capsule injury?
limited in same direction as AROM with firm end feel
possibly painful at end ranges
what Isometrics/MMT results should you expect to see in a joint capsule injury?
if done at mid range - shouldn’t produce sig pain and should be strong
may have pain due to compensation or guarding of surrounding muscles
what Palpation results should you expect to see in joint capsule injury
depends on depth of joint capsule
most of the time, cannot palpate deep enough to feel joint capsule
surrounding structures may be inflammed and cause discomfort with palpation
T/F: if the AROM or PROM loss doesn’t match the capsular pattern for that joint it is prob not an issue with the joint capsule
FALSE
can still be the joint capsule even if it doesn’f follow the capsular pattern.
what AROM results should you expect to see in a ligament injury?
full but pain at end ranges that stretch the ligament
what PROM results should you expect to see in a ligament injury?
full but pain at end range that stretches the ligament
what Isometric/MMT results should you expect from a ligament injury?
strong and no pain when tested in mid range
UNLESS there is guarding in area
What Palpation results should you expect to see in a ligament injury?
involved ligaments are painful to palpation
