L20. Gait: anatomy and physiology of walking

Question 1

what does walking involve

Answer 1

A simple yet complicated task:

Simple – we can do it without having to think about it too much

Complicated – involves so many structures in the body

• Musculoskeletal system = muscles, tendons, bones, joints,
• Nervous system = sensory, motor, autonomic, proprioception
• Cardiovascular system = heart, blood vessels

-Special senses = vision, hearing
Problem(s) with any of the systems / structures can have an effect on our ability to walk

Question 2

what is gait

Answer 2

a combination of movements :

Straight line walking / running

Jumping (…back flip?)

Terrain adjustment

Turning

Question 3

division of gate slide 9

Answer 3

how was it

Question 4

what are the position of the joints in relation to their initial contact (0-2%) & loading response (2-12%)

Answer 4

Positions of the joints
- Hip flexion

Knee neutral/extension

Ankle dorsiflexion/neutral

1st MTPJ dorsiflexion/neutral

loading response:
Hip flexion

Knee flexion

Ankle plantarflexion

1st MTPJ neutral

Question 5

what are the muscle activities in relation to the initial contact (0-2%) and loading response (2-12%)

Answer 5

-Hip extensors contract (eccentric) to control hip flexionvia momentum

Gracilis contracts (isometric) to control hip flexion and knee extension

Knee flexors contract (concentric) to start knee flexion

Knee extensors contract (eccentric) to control knee flexion

Ankle dorsiflexors contract (eccentric) to prevent foot slapping

loading response:
Hip extensors contract (concentric) to start hip extension

Knee flexors contract (concentric) to keep the knee in flexion

Knee extensors contract (eccentric) to control knee flexion

Gastroc contracts (concentric) to keep the knee in flexion

Ankle dorsiflexors contract (eccentric) to prevent foot slapping

Ankle plantarflexors contract (concentric) to bring the foot to the ground

Question 6

what are the positions of the joints in relation to the mid stance (12-31%) and the terminal stance (31-50%)

Answer 6

Hip neutral

Knee extension

Ankle neutral

1st MTPJ neutral

terminal:
Hip extension

Knee full extension

Ankle dorsiflexion

1st MTPJ neutral/dorsiflexion

Question 7

what are the muscle activities in relation to the mid stance (12-31%) and the terminal stance (31-50%)

Answer 7

Hip extensors contract (concentric) to keep the hip in extension

Knee flexors contract (eccentric) to control knee extension via momentum

Gastroc contracts (eccentric) to control knee extension via momentum

Ankle plantarflexors contract (eccentric) to stabilise the foot

terminal:
Hip flexors contract (eccentric) to control hip extension via momentum

Gastroc contracts (eccentric) to control knee extension via momentum

Ankle plantarflexors contract (eccentric) to control ankle dorsiflexion via body weight

Question 8

what are the positions of the joints in relation to the pre-swing (50-62%) and initial swing (62-75%)

Answer 8

Hip neutral

Knee flexion

Ankle plantarflexion

1st MTPJ dorsiflexion

initial swing :
Hip neutral/flexion

Knee flexion

Ankle neutral/dorsiflexion

1st MTPJ dorsiflexion/neutral

Question 9

what are the muscle activities in relation to the pre-swing (50-62%) and initial swing (62-75%)

Answer 9

Hip flexors contract (concentric) to start hip flexion

Gracilis contracts (concentric) to assist the knee in flexion

Gastroc contracts (concentric) to bring the knee into flexion

Ankle plantarflexors contract (concentric) to propels the body forward THEN Ankle dorsiflexors contract (concentric) to keep the foot off the ground

initial swing :
Hip flexors contract (concentric) to keep the hip in flexion

Gracilis contracts (concentric) to keep the knee in flexion

Ankle dorsiflexors contract (concentric) to keep the foot off the ground

Question 10

what are the positions of the joint in relation to the mid-swing (75-87%) and the terminal (87-100%)

Answer 10

Hip flexion

Knee flexion

Ankle dorsiflexion

1st MTPJ dorsiflexion

terminal swing :

Hip flexion

Knee flexion/neutral

Ankle dorsiflexion

1st MTPJ dorsiflexion

Question 11

what are the muscle activities in relation to the mid-swing (75-87%) and the terminal (87-100%)

Answer 11

Hip extensors contract (eccentric) to control hip flexion

Gracilis contracts (concentric) to keep the hip and knee in flexion

Knee flexors contract (concentric) to keep the lower leg off the ground

Ankle dorsiflexors contract (concentric) to keep the foot off the ground

terminal swing :
Hip extensors contract (eccentric) to control hip flexion via momentum

Gracilis contracts (isometric) to control hip flexion and knee extension

Knee extensors contract (concentric) to bring the knee to extension

Ankle dorsiflexors contract (concentric) to keep the foot off the ground

Question 12

what are the types of turning

Answer 12

a) Step turn
b) Ipsilateral pivot
c) Ipsilateral crossover

Question 13

describe BOS and COM & what is it used for?

Answer 13

BOS = Base of Support
Defined as the area within an outline of all ground contact points

COM = Centre of Mass
The average position of all the parts of the system, weighted according to their masses

Used to help maintain balance

Question 14

describe terrain adjustment

Answer 14

Stairs – up & down

Uneven surfaces

Various surface properties (e.g. soft/hard, slippery)

Question 15

describe how to get A complete picture of gait analysis

Answer 15

Daily walking – to & from work / school?

Activities – sports? dance?

Surfaces – smooth? uneven? soft? hard?

Only straight-line walking in clinic is not always sufficient
? Compensatory mechanisms

Question 16

what are the conditions causing disruptions in gate

Answer 16

Musculoskeletal conditions:
-E.g. Arthritis, Tendinopathy, Ligament injury

Neurological conditions
E.g. Parkinson’s, Cerebral Palsy, CVA, Peripheral neuropathy

Others:

• Pain
• Behavioural issues
• Supply of energy

Question 17

go over pics and gate scenarios

Answer 17

how was it