Lecture 20 - The Gait Cycle Flashcards
1
Q
Hip joint anteriorly responsible for
A
hip flexion
2
Q
Hip joint posteriorly responsible for
A
hip extension
3
Q
knee joint anteriorly responsible for
A
extension
4
Q
knee joint posteriorly responsible for
A
flexion
5
Q
Ankle joint anteriorly responsible for
A
dorsiflexion
6
Q
Ankle joint posteriorly responsible for
A
plantar flexion
7
Q
Anterior compartment of leg comprises of
A
- Tibialis Anterior
- Extensor hallucis longus
- Extensor digitorum longus
important for dorsiflextion
8
Q
Deep compartment (posterior) of leg comprises of
A
- Tibialis Posterior
- Flexor hallucis longus
- Flexor digitorum longus
important for plantarflextion
9
Q
Lateral compartment of leg comprises of
A
- Fibularis (peroneus) Longus
- Fibularis Brevis
- Both evert the foot
10
Q
Both tibialis muscles
A
invert
11
Q
Superficial compartment (posterior) of leg comprises of
A
Gastrocnemius and soleus
for plantarflexion and gastrocnemius for flexion of the knee joint as well as it is the only one that cross the knee joint in this compartment
12
Q
Lateral side leg muscles =
A
eversion
13
Q
Medial side leg muscles =
A
inversion
14
Q
Blood supply to the leg and foot …
A
Femoral artery passes through the adductor hiatus and once it passes through the name changes to the popliteal artery
Popliteal artery is behind the knee in the popliteal fossa and it dividdes into an anterior tibial, posterior tibial and fibular branch
Tibial arteries run parallel to the tibia and fibular/peroneal artery runs parallel to the fibula
15
Q
Sciatic nerve
A
Legs and feet are supplied by the branches of the sciatic nerve
Sciatic nerve divides into:
• Tibial nerve
- Common fibular/ peroneal nerve (splits into 2 branches)
* Superficial fibular nerve
* Deep fibular nerve
16
Q
Sciatic nerve divides into:
A
• Tibial nerve (quite central)
- Common fibular/ peroneal nerve (splits into 2 branches) (lateral)
* Superficial fibular nerve
* Deep fibular nerve
17
Q
Tibial nerve in terms of injury
A
Rarely injured because it is quite deep
18
Q
Common peroneal (common fibular) nerve in terms of injury
A
common for injury because quite superficial
injury means that they can’t dorsiflex so develop a foot drop condition
19
Q
Leg innervation - anterior compartment of leg
A
Supplied by the deep fibular nerve
20
Q
Leg innervation - posterior compartment of leg
A
Supplied by the tibial nerve
21
Q
Leg innervation - lateral compartment of leg
A
Supplied by the superficial fibular nerve
22
Q
Consequence of tibial nerve injury?
A
Note that it is not common because the nerve is deep
Paralysis of plantarflexors and intrinsic foot muscles
23
Q
Common fibular nerve divides into
A
superficial and deep branches, near the head of fibula
24
Q
Common fibular nerve innervates
A
- Short head of biceps femoris
- Lateral leg muscles (through the superficial branch)
- Anterior leg muscles (through the deep branch)
25
Deep fibular nerve path
Descends in the leg along with the anterior tibial artery and vein
26
Deep fibular nerve innervates....
Anterior leg muscles = tibialis anterior, extensor digitorum longus, extensor hallucis longus
27
Functions of the anterior leg muscles that the __________ nerve innervates
Deep fibular nerve
* Dorsiflexion (all)
* Toe extension (extensors)
* Inversion (Tibialis anterior)
28
Superficial fibular nerve innervates...
Lateral compartment muscles = fibularis longus, fibularis brevis
29
Function of the lateral compartment muscles that the _______ nerve innervates
Superficial fibular nerve
Function - foot eversion
30
Common fibular nerve damage ...
Most common nerve in the lower limb to be damaged
• Relatively unprotected at fibular neck
• Trauma: fracture of fibula head
• Compression, e.g., plaster cast
Common fibular nerve injury leads to foot drop
31
Gait cycle
Movements of the lower limbs during walking involve alternating stance and swing phases
Note: the stance phase of one limb does not end immediately when the opposite limb strikes the ground (i.e., there is a time when both limbs are on the ground)
32
Double support
One foot is leaving the ground and one foot is at the start of stance
33
Heel strike
part of stance phase, heel in contact with the ground
34
Support phase
Part of stance, going from heel strike to toe off
35
Toe-off phase
Last thing in contact with the ground, part of stance phase
36
Running and double support
no period of double support in running
37
Running
* There is no period of double support during running
* Time and frequency of the stance phase is reduced
* There are times when both feet are off the ground (float/aerial phase) - difference between walking and running
38
What muscle groups maintain standing?
Primarily extensor muscles of the back and plantarflexors
Erector spinae muscles help keep us upright (they are active when standing)
39
WHat happens at lower limb joints when standing?
Hip and knee joint are extended - both are in full extension so all the ligaments are tight which helps to stabilise joints and hold upper body weight
The knees are ‘locked’ (all ligaments are taut)
40
Centre of gravitiy is _____ to the ankle joint ....
anterior - so people tend to fall forward but plantarflexors counteract this 'fall'
41
Joints behind the centre of gravity tend to ...
fall forward
42
Atlanto-occipital joint and centre of gravity
Between the head and neck (between the atlas and occipital bone)
Centre of gravity is anterior to it
For this reason, we need to keep our head upright and the erector spinae muscles help with this
43
Joints in front of the centre of gravity tend to ...
fall backwards
44
Thoracic vertebrae and centre of gravity
Centre of gravity is anterior to thoracic vertebrae
walk slightly leaning forward
45
Hip joint and centre of gravity
Hip joint in full extension
Centre of gravity is slightly posterior to the hip joint, for this reason that we start to go slightly backward at the hip joint
Iliopsoas prevents falling backwards
46
Ankle joint and centre of gravity
Centre of gravity is anterior to ankle joint
Tend to fall forward and plantarflexors prevent this (triceps surae)
47
Gait cycle involves a repetitious sequence of:
Propulsion
| Support
48
From a standing position, the gait cycle is initiated by:
* Relaxation of plantarflexors
* Dorsiflexion of the ankle joint
* Then the limb enters into the swing phase
49
Phases of the gait cycle
1 - Heel strike
2- Support
3- Toe off
4 - Carry through
2 and 3 = stance
4 = swing
50
Stance phase
• Stance begins with heel strike, ends with toe off
• Limb needs to accept weigh, decelerate mass, stabilize
pelvis, preserve foot arches
51
Swing phase
• Swing begins with toe off, ends with heel strike
52
During heel strike ,...
* Ankle joint is dorsiflexed
* Knee joint is extended
* Hip joint is flexed
53
What muscles are involved during heel strike?
* Dorsiflexors: Anterior leg muscles
* Knee extensors: Quadriceps femoris
* Hip flexors: Iliopsoas and rectus femoris
54
Hip joint during stance phase
Initial contact (heel strike)
Hip joint flexion (anterior muscles contract) to extension
Shock absorption
Flexed hip gets extended after heel strike
Hip extensors = hamstrings
Mid-stance
Hip abductors are active (gluteus medius and minmus)
Body moving from behind foot to in front of the foot
Progress body over stationary foot
Maintain limb and trunk stability
Hip extension
Hip abductors = Gluteus medius, minimus, TFL
Late stance
Hip joint extended and starts to flex at the end
Body moving even further forward
Change from hip extension to flexion
Progress body beyond supporting foot
Accelerate body
Hips start to flex in preparation for swing
55
Hip joint during stance phase - Initial contact (Heel strike)
Initial contact (heel strike)
Hip joint flexion (anterior muscles contract) to extension
Shock absorption
Flexed hip gets extended after heel strike
Hip extensors = hamstrings
56
Hip joint during stance phase - Mid-stance
Mid-stance
Hip abductors are active (gluteus medius and minmus)
Body moving from behind foot to in front of the foot
Progress body over stationary foot
Maintain limb and trunk stability
Hip extension
Hip abductors = Gluteus medius, minimus, TFL
57
Hip joint during stance phase - Late-stance
Late stance
Hip joint extended and starts to flex at the end
Body moving even further forward
Change from hip extension to flexion
Progress body beyond supporting foot
Accelerate body
Hips start to flex in preparation for swing
58
Hip joint during swing
```
Mid-swing
Limb advancement
Foot clearance off the ground
Hip flexors are active = iliopsoas, rectus femoris
Active to move thigh forward
Hip in approximate anatomical postion
```
```
Late swing
Complete limb advancement
Prepare for stance phase (deceleration)
Hip extensors contract to decelerate the forward movement. (contract to prepare for stance, to slow down the swinging motion)
Hip is flexed
```
59
Hip joint during swing - Mid-swing
```
Mid-swing
Limb advancement
Foot clearance off the ground
Hip flexors are active = iliopsoas, rectus femoris
Active to move thigh forward
Hip in approximate anatomical postion
```
60
Hip joint during swing - late swing
```
Late swing
Complete limb advancement
Prepare for stance phase (deceleration)
Hip extensors contract to decelerate the forward movement. (contract to prepare for stance, to slow down the swinging motion)
Hip is flexed
```
61
High heel shoes
Increased pressure on metatarso-phalangeal joints during stance.
Ankle is pretty much in plantarflexion
Prone to hallux valgus (bunion), calluses, metatarsalgia, etc.
Research has found that in extreme cases it can lead to pain all the way up to the spine
62
Ankle joint during stance
```
Heel strike
Initial impact deceleration
Shock absorption
Dorsiflexors contract to lower foot to ground
Ankle is dorsiflexed
```
```
Mid stance
Foot has been lowered to the ground
Movement forward
Dorsiflexors contract to pull tibia forwards over the foot, then gravity and momentum take over - dorsiflexors are active again but helping move the leg forward, contraction beings the leg forward
Ankle in anatomical position
Fixed on the ground
```
```
Late stance
Prepare for swing phase
Accelerate body forward
Plantarflexors = triceps surae (active so it is hitting the ground)
Toe-off propulsion
Foot stabilisers active
```
63
Ankle joint during stance - heel strike
```
Heel strike
Initial impact deceleration
Shock absorption
Dorsiflexors contract to lower foot to ground
Ankle is dorsiflexed
```
64
Ankle joint during stance - mid stance
```
Mid stance
Foot has been lowered to the ground
Movement forward
Dorsiflexors contract to pull tibia forwards over the foot, then gravity and momentum take over - dorsiflexors are active again but helping move the leg forward, contraction beings the leg forward
Ankle in anatomical position
Fixed on the ground
```
65
Ankle joint during stance - late stance
```
Late stance
Prepare for swing phase
Accelerate body forward
Plantarflexors = triceps surae (active so it is hitting the ground)
Toe-off propulsion
Foot stabilisers active
```
66
Ankle joint during swing
Mid swing
Limb advancement
Foot clearance off the ground - so that the foot does not hit the ground
Dorsiflexors = anterior leg muscles
Toe extensors = extensor hallucis longus, extensor digitorum longus
Ankle is dorsiflexed, toes extended
Late swing (deceleration)
Complete limb advancement
Prepare for stance phase (deceleration)
Dorsiflexors and toes extensors ensure foot is in optimal position for heel strike
Dorsiflexors are active to prepare for heel strike
67
Ankle joint during swing - mid swing
Mid swing
Limb advancement
Foot clearance off the ground - so that the foot does not hit the ground
Dorsiflexors = anterior leg muscles
Toe extensors = extensor hallucis longus, extensor digitorum longus
Ankle is dorsiflexed, toes extended
68
Ankle joint during swing - late swing
Late swing (deceleration)
Complete limb advancement
Prepare for stance phase (deceleration)
Dorsiflexors and toes extensors ensure foot is in optimal position for heel strike
Dorsiflexors are active to prepare for heel strike
69
Gait changes with age
* Muscles get weaker/atrophy
* Flexed posture in lower limb during standing, flexed neck (knee and neck become slightly flexed so centre of gravity relaitonship is now different)
* Balance compromised
* Gait is slower, decreased stride length, increased stance time, more time in double stance, less propulsive forces developed
70
Other causes of gait changes - medical treatment
Medical treatment – e.g., androgen deprivation (stops production of testosterone) therapy (ADT) causes muscle atrophy and increase fat in men
Shows shrinkage in muscles on xray when before and after compared
* Reduced muscle force (e.g., quadriceps, iliopsoas, soleus) (muscles smaller therefore smaller amount of force generation)
* Step width increases
* Forward acceleration decreases
* At risk of falling & bone fracture - there is a higher risk of loss of balance and bones more easy to fracture due to lack of testosterone
71
Gait changes - Hip abductors damae due to superior gluteal nerve injury
* Unable to maintain pelvis level during single leg stance (contralateral drop)
* Compensation: contralateral lateral trunk flexion (pelvis tilts to opposite side during stance phase)
72
Gait changes - anterior leg muscles damage due to common fibular nerve injury
* Weak dorsiflexion ( dorsiflexors not active)
* Toes don’t clear during swing
* Foot slap/ foot drop after heel strike
* Compensation: Knee raised high during swing
