Lecture 8- Gait ROM and Joint Postion / Muscle Activity Flashcards
ROM AND JOINT POSITION
ROM AND JOINT POSITION
- What is the position of the ankle at initial contact (IC)?
- What also occurs here?
Neutral to slight plantar flexion
-Heel Rocker (aka 1st Rocker) is initiated
What is the position of the ankle at loading response (LR)?
5° of rapid plantarflexion to get foot flat on the floor
- What is the position of the ankle and MTP during midstance (MSt) → terminal stance (TSt)?
- What also occurs here?
Closed chain dorsiflexion to about 10°, MTP extension to 30°
-Ankle Rocker and Forefoot Rocker
What is the position of the ankle and MTP during the preswing (PSw)?
Transition from max dorsiflexion to max plantarflexion of around 15°, max MTP extension of 60°
-Heel lift off
What is the position of the ankle during initial swing (ISw)?
Dorsiflex back to around 5° of plantarflexion
What is the position of the ankle during midswing (MSw) → terminal swing (TSw)?
Dorsiflexion to neutral, prepare for heel strike
What are the critical events that happen during each phase of gait at the ankle?
- 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 3 foot and ankle rockers and their definition?
Heel Rocker (1st Rocker) -motion of the foot from a dorsiflexed to plantarflexed position during LR to achieve flat foot
Ankle Rocker (2nd Rocker) -closed chain advancement of the tibia into dorsiflexed position over a fixed foot during MSt
Forefoot Rocker (3rd Rocker) -begins when center of pressure is over the met heads and heel lift occurs in TSt/PSw
Is the GRFV posterior or anterior to the ankle joint during the heel rocker?
posterior, causing plantarflexion moment
What is the forefoot rocker also called?
Windlass mechanism
What is the position of the knee at initial contact (IC)?
Neutral to 5° flexion
- What is the position of the knee at loading response (LR)?
- What does this phase allow for?
Flexion to 15°
-shock absorption
What is the position of the knee from midstance (MSt) → terminal stance (TSt)?
Extenion back to 5° flexion/neutral
What is the position of the knee at preswing (PSw)?
Rapid flexion to 40°
- What is the position of the knee at initial swing (ISw)?
- What does this phase allow for?
More flexion to 60°
-limb clearance
- What is the position of the knee at midswing (MSw)?
- What does this phase allow for?
Rapid extension to 25° flexion
-step length
What is the position of the knee at terminal swing (TSw)?
Further extension to 5°/neutral
What are the critical events that happen during each phase of gait at the knee?
- LR- controlled knee flexion
- PSw- passive knee flexion
- ISw- knee flexion
- TSw- knee extension
What is the position of the hip at initial contact (IC) → loading response (LR)?
20° “leftover” flexion
What is the position of the hip at midstance (MSt)?
Extension into a neutral hip position as the body progresses forward
What is the position of the hip at terminal stance (TSt)?
Maximum 20° hip extension occurs
-body is past the foot
What is the position of the hip at preswing (PSw)?
Flexion to about 10° of hip extension
-reversal from extension to flexion
What is the position of the hip at initial swing (ISw)?
Continued flexion to 15°
What is the position of the hip at midswing (MSw) → terminal swing (TSw)?
Continued flexion to 25°-30°
What are the critical events that happen during each phase of gait at the hip?
- LR- hip stability
- ISw- hip flexion
- MSw- hip flexion
How much ROM do we need at all 3 joints for normal gait?
HIP (~40°)
- Flexion- 25° for step length (TSw)
- Extension- 20° for trailing limb (TSt)
KNEE (~60°)
- Flexion- 60° for foot clearance (ISw)
- Extension- 0° for step length (TSw/IC)
ANKLE (~30°)
- Plantarflexion- 20° for toe-off (PSw)
- Dorsiflexion- 10° for tibial advancement (TSt)
Where is CoM at the lowest position?
At the midpoint of both periods of double-limb support (5% and 55%)
Where is CoM at the highest position?
At the midpoint of both periods of single-limb support (30% and 80%)
What is the total vertical displacement?
~5cm
What happens to the foot during IC in the frontal plane?
slight inversion of the hindfoot
What happens to the foot during LR → MSt in the frontal plane?
eversion of the hindfoot
- causes pronation
- forefoot follows hindfoot position
What happens to the foot during TSt → PSw in the frontal plane?
inversion
-resupination!
What happens to the foot during Swing Phase in the frontal plane?
variable
What happens to the knee in the frontal plane?
Not much movement with normal gait (total around 5-10°)
-Genu valgum and genu varum
What happens at the hip and pelvis during IC in the frontal plane?
neutral ab/adduction
What happens at the hip and pelvis during LR → MSt in the frontal plane?
adduction during weight acceptance
-contralateral hip drop
What happens at the hip and pelvis during MSt → TSt in the frontal plane?
increase adduction (up to 15°) -weight shift over stance limb
Once the limb is unloaded, the ipsilateral hip ______ and moves into a relatively __________ position for swing phase.
- drops
- abducted
What are the horizontal plane motions that occur at the trunk?
- opposite rotation from pelvic motion
- total excursion- 7° to 9°
What are the horizontal plane motions that occur at the hip?
- forward rotation of the pelvis on the stance limb occurs with hip flexion during swing
- increases greater step length than that of hip flexion alone
What are the horizontal plane motions that occur at the shoulder?
- opposite sagittal plane motion from ipsilateral hip
- partially active, particularly shoulder extension
- balances rotational forces of trunk
How does the CoM displace as we go through gait?
- Maximum shift to the R occurs at the end of midstance
- Maximum shift to the L occurs during midswing of the R leg
What is the total side-to-side displacement of CoM?
5cm
What phases do we notice decreased great toe extension?
TSt and PSw
Someone with decreased great toe extension will not complete _______ rocker and ends their _______ phase noticeably early.
- forefoot
- stance
What are some causes of decreased great toe extension?
-joint hypomobility (hallux rigidus), pain, bone spur, gouty, arthritis, plantar fasciitis
What is the result of decreased great toe extension?
decreased push off, shortened stance time
What phase do we notice someone with Steppage Gait/ Increased Knee Flexion?
swing phase
Someone with a steppage gait presents with ________ hip and knee flexion and _____ of ankle DF.
- increased
- loss
What are some causes of steppage gait?
foot drop/nerve disorder, polyneuropathy, equinus deformity
What is the result of steppage gait?
prolonged swing phase, fall risk, decreased efficiency
What phases do we notice someone with Foot Flat Contact?
initial contact
Someone with foot flat contact has their ____ or ____foot make first contact with the ground instead of the heel.
mid or forefoot
What are some causes of foot flat contact?
excessive knee flexion in late swing, weak/impaired DF
What is the result of foot flat contact?
absent heel rocker (can have normal ankle rocker)
What phase do we notice someone with Circumduction?
swing phase
Someone with circumduction has a lateral whipping motion of the limb during ______ at the hip.
swing
What are some causes of circumduction?
impaired knee flexion ROM, impaired ankle DF ROM
What is the result of circumduction?
compensation for failure to functionally shorten the limb during swing, increased fall risk
What phases do we notice someone with Increased Lumbar Lordosis?
terminal stance
Someone with increased lumbar lordosis will have an increase during _________ phase.
late stance
What are some causes of increased lumbar lordosis?
hip flexor contracture, hip OA
What is the result of increased lumbar lordosis?
lack of hip extension in terminal stance is compensated for by increasing lordosis in the spine
MUSCLE ACTIVITY DURING GAIT
MUSCLE ACTIVITY DURING GAIT
What are the 2 main forces interacting during gait?
- foot forces
- ground reaction forces (GRF)
Are foot and ground reaction forces equal?
yes, but in opposite directions
What is the center of pressure?
point where the GRF acts on the foot
- At heel contact, what direction does the GRF move our ankle if the GRF is posterior to it?
- What internal torque must be produced to counteract and stabilize?
- plantar flexion torque
- dorsiflexion torque
- ________ torque is produced by the GRF and causes movement at each joint of the LE.
- _________ torque is generated to match or overcome the external torque primarily by __________ but also ______ internal structures.
-external
- internal
- muscle activation, but also passive internal structures
- _________ muscle activation is when the internal torque is moving the joint in the direction of the muscle’s action.
- During gait, concentric contractions are used to provide ______ and produce ________ of a segment.
- concentric
- stability, movement
- _________ muscle activation is when the internal torque is moving the joint in the direction opposite of the muscle’s action.
- During gait, eccentric contractions are used to provide __________ and ________ a limb segment.
- eccentric
- shock absorption, decelerating
What are some presentations of muscle dysfunction?
- weakness
- loss of power
- decreased endurance
- spasticity
- contracture
Is muscular dysfunction usually more noticeable during OGA or ROM loss?
Observational Gait Analysis (OGA)
With muscular dysfunction, does the torque from GRFV change?
No, just the patient’s ability to counter it
Muscle Activation - IC
HIP
-ALL Hip extensors contract ___________ to prepare for LR
KNEE
- __________ hamstring contraction to counteract extension torque
- Knee extensors transition from concentric to eccentric contraction in preparation for loading response
ANKLE
-Pretibials (tib ant, long toe extensors) contract _________
- concentrically
- eccentric
- concentrically
Muscle Activation - LR
HIP
-__________ contraction of hip extensors
-Gmax, Adductor Magnus, TFL, GMed peak
KNEE
- ________ contraction of knee extensors
- __________ activity peaks
ANKLE
- ___________ contraction of ankle dorsiflexors
- ____________ activity peaks
- Transition to eccentric contraction of ankle ____________ in late LR
-concentric
- eccentric
- quadriceps
- eccentric
- tibialis anterior
- plantarflexors
MUSCLE ACTIVATION - MSt
HIP
-No hip muscular activity required in sagittal plane
KNEE
-______ eccentric to no activity
ANKLE
-________ contraction of gastroc/soleus
- quads
- eccentric
Muscle Activation - TSt
HIP
-Minimal activity in sagittal plane
KNEE
- No quad or HS activity
- Tibial position maintained by ________
ANKLE
- _________ contraction of ankle plantarflexors to prevent tibial collapse with heel rise
- ____________ activity peaks
-gastroc
- concentric
- gastroc/soleus
Muscle Activation - PSw
HIP
-____________ contraction of hip flexors
-_______________ peaks
KNEE
- Knee flexion is mainly ________
- Slight concentric contraction of ___________ and eccentric ________
ANKLE
- Ankle _________ activity ceases in early preswing and passive tension contributes to ankle moving into plantar flexion
- Ankle __________ concentric contraction initiated at the end of PSw
- concentric
- adductor longus
- passive
- knee flexors
- rectus
- plantarflexion
- dorsiflexor
Muscle Activation - ISw
HIP
-Continued concentric contraction of __________
-_________ peaks
KNEE
- Concentric contraction of knee flexors
- ____________ (SH), __________, _______ peak
- Flexion continues to be aided by flexion at the _____
ANKLE
-Concentric contraction of ____________
Toe _________ activity peaks
- hip flexors
- iliacus
- biceps femoris (SH), sartorious, gracilis
- hip
- tib anterior
- extensor
Muscle Activation - MSw
HIP
-Continued concentric contraction of _________
-Initiation of _________ hip extensors (HS) to control hip flexion
KNEE
- Knee extension created by ________
- Knee flexors contract ___________ at the end of MSw to control extension
ANKLE
-Continued contraction of ___________
- hip flexors
- eccentric
- momentum
- eccentrically
-dorsiflexors
Muscle Activation - TSw
HIP
-Concentric contraction of ____________
KNEE
-Concentric contraction of knee _________ to insure full extension
Peak __________ eccentric contraction to decelerate thigh
ANKLE
-Continued contraction of ____________
-hip extensors
- extensors
- hamstring
-dorsiflexors
Frontal Plane Activation - LR
HIP
-Hip ___________ contraction eccentrically
-_____ and ____________ peak
ANKLE
-________ contracting eccentrically
- abductors
- GMed and Adductor Magnus
-inverters
Frontal Plane Activation - MSt
HIP
-Hip ________ contracting eccentrically then concentrically
ANKLE
-___________ contracting concentrically
- abductors
- inverters
Frontal Plane Activation - TSt and PSw
HIP
-Hip _________ contracting concentrically
ANKLE
-___________ contraction concentrically
- abductors
- inverters
Frontal Plane Activation - ISw, MSw, and TSw
HIP
-Hip __________ contract concentrically
ANKLE
-________ contracting concentrically
- adductor
- evertors
Key Roles - ANKLE Musculature
Ankle Dorsiflexors
-Eccentric activation to control ____________ of the ankle at IC until foot flat
Ankle Plantarflexors
- Eccentric contraction moving into MSt to control _____________
- Concentric contraction at ____ assists with forward propulsion
Ankle Inverters
- Eccentrically contracts to control ________ until MSt
- Concentrically contracts to _________ the foot for push-off in TSt/PSw
Ankle Everters
-Also activate as co-contraction to counter strong inversion effect occuring during ___/___
-plantar flexion
- tibial advancement
- TSt
- pronation
- supinate
-LR/MSt
Key Roles - KNEE Musculature
Knee Extensors
-Eccentrically control knee flexion in ___
-Concentrically to extend the knee and support body in ___
Knee Flexors
-Decelerate knee _________ in preparation for placement of the foot on the ground
- LR
- MSt
-extension
Key Roles - HIP Musculature
Hip Extensors
-Activated in TSw prior to IC to initiate hip __________ and prepare LE for ________________ at the beginning of stance
Hip Flexors
-Advance lower extremity forward during ___
Concentrically lift lower extremity to allow for ____________ during swing
Hip Abductors
-Control the slight lowering of the ___________ pelvis on the side of the swing limb then provide pelvic stability in stance
Hip Adductors
-Assist with initiation of hip ______ after toe-off
- extension
- weight acceptance
- ISw
- toe clearance
- contralateral
- hip flexion
What phase is Trendelenburg Gait seen?
LR-PSw
What is observed movement occurring with Trendelenburg Gait?
excessive downward drop of contralateral pelvis during stance
What is the cause of Trendelenburg Gait?
GMed weakness (mild)
What are some results of Trendelenburg Gait?
- longer swing limb
- decreased effeciency
- possible decreased stance time
How can we clinically observe for Trendelenburg Sign?
have patient stand on one limb and observe for level pelvis
What phase is Compensated Trendelenburg seen?
LR-PSw
What is observed movement occurring with Compensated Trendelenburg?
- trunk leans toward/over the stance limb
- level pelvis
What is the cause of Compensated Trendelenburg?
GMed weakness (moderate-severe)
What is the result of Compensated Trendelenburg?
compensates by not allowing the contralateral pelvis to drop during stance reducing demand on GMed
What phase is Foot Slap seen?
IC-LR
What is observed occurring during Foot Slap?
PF torque goes unchecked by anterior tib
What is the cause of Foot Slap?
Tib Ant weakness
What is the result of Foot Slap?
- rapid PF after heel contact, can be audible
- usually can clear foot during swing
Foot Slap is similar to ________ gait and ________ gait.
- steppage
- foot flat
What phase is Knee Extension Thrust Seen?
IC
What is observed occurring during Knee Extension Thrust?
knee snapping back into extension early in stance phase
What is the cause of Knee Extension Thrust?
quad spasticity from UMN lesion
What is the result of Knee Extension Thrust?
- rapid and often excessive knee extension during LR
- can occur with/cause knee hyperextension over time
