Chapter 9Chapter 9Evaluation of GaitEvaluation of Gait

IntroductionIntroduction

Gait Analysis – functional evaluation of a Gait Analysis – functional evaluation of a person’s walking or running styleperson’s walking or running style Systematic method of identifying specific Systematic method of identifying specific

deviations in the gait pattern and determining deviations in the gait pattern and determining their cause and implicationstheir cause and implications

Goals of analysis varyGoals of analysis vary

IntroductionIntroduction

Dysfunctional or antalgic gait can arise Dysfunctional or antalgic gait can arise from acute or chronic injury or improper from acute or chronic injury or improper biomechanicsbiomechanics Prohibits normal weight-bearingProhibits normal weight-bearing Influences stresses placed on joint surfacesInfluences stresses placed on joint surfaces Predisposes patient to additional injuryPredisposes patient to additional injury

Rehabilitation and/or correction of Rehabilitation and/or correction of biomechanicsbiomechanics

Observation TechniquesObservation Techniques

Process of gathering, organizing, and Process of gathering, organizing, and interpreting sensory information interpreting sensory information

Observation best obtained by using stop-Observation best obtained by using stop-action videoaction video Video can be slowed down and replayedVideo can be slowed down and replayed Permanent record on filePermanent record on file Limb position, ROM, speed of motion, force Limb position, ROM, speed of motion, force

production, timing of events in gait cycle production, timing of events in gait cycle

Observation TechniquesObservation Techniques

TreadmillsTreadmills Pros and consPros and cons Stride lengthStride length

Guidelines for observational gait analysisGuidelines for observational gait analysis Page 304Page 304

Auditory information (cadence)Auditory information (cadence)Correlate findings with orthopedic and Correlate findings with orthopedic and postural evaluationspostural evaluations Figure 9-2, pages 305-306Figure 9-2, pages 305-306

Gait CycleGait Cycle

Represents the combined function of the Represents the combined function of the lower extremity, pelvis, and spinal columnlower extremity, pelvis, and spinal columnWalking – cyclical motion, bipedalWalking – cyclical motion, bipedalCenter of gravityCenter of gravity Easily displaced in the desired directionEasily displaced in the desired direction Positioned high, second sacral segmentPositioned high, second sacral segment Greater portion of body weight is located in Greater portion of body weight is located in

trunk, head, and shoulderstrunk, head, and shoulders Figure 9-3, page 307Figure 9-3, page 307

Gait CycleGait Cycle

Components of normal walking gait do not Components of normal walking gait do not transfer to most athletic activitiestransfer to most athletic activities

Specific to the motion:Specific to the motion: Force distribution across the foot, muscle Force distribution across the foot, muscle

actions, joint motions, and center of gravity actions, joint motions, and center of gravity

Normal GaitNormal Gait

Normal cadence = 107 (Normal cadence = 107 (+ + 2.7) steps per 2.7) steps per minuteminute

Normal stride length = 75 (Normal stride length = 75 (+ + 1.6) cm1.6) cm

Symmetrical and uninterrupted rhythmSymmetrical and uninterrupted rhythm

Terminology – Table 9-1, page 307Terminology – Table 9-1, page 307 Rancho Los AmigosRancho Los Amigos

Normal GaitNormal Gait

Affected by intrinsic factorsAffected by intrinsic factors Joint ROMJoint ROM Muscle strengthMuscle strength Body typeBody type GenderGender

Affected by extrinsic factorsAffected by extrinsic factors Incline of surfaceIncline of surface Surface typeSurface type footwearfootwear

Gait PhasesGait Phases

Stance PhaseStance Phase Initial contact of heel until toe breaks contact Initial contact of heel until toe breaks contact

with surface (toe-off)with surface (toe-off)

Swing PhaseSwing Phase Between toe-off and next initial contactBetween toe-off and next initial contact Open kinetic chain, non-weight bearingOpen kinetic chain, non-weight bearing Limb repositions itselfLimb repositions itself

Figure 9-4, page 308Figure 9-4, page 308

Gait PhasesGait Phases

During walking – one leg is in stance During walking – one leg is in stance phase while the other leg is in the swing phase while the other leg is in the swing phasephase

Efficient walkingEfficient walking Minimal upward and side-to-side motionMinimal upward and side-to-side motion Maximal forward motionMaximal forward motion Rotation of pelvis in transverse plane adds to Rotation of pelvis in transverse plane adds to

step lengthstep length

Stance PhaseStance Phase

60% of gait cycle60% of gait cycle

Closed kinetic chain during weight-Closed kinetic chain during weight-bearing, allows forces from lower extremity bearing, allows forces from lower extremity to be transmitted to ground, producing to be transmitted to ground, producing movementmovement Leg decelerates just before initial contact, Leg decelerates just before initial contact,

preventing injury to heelpreventing injury to heel Enables balance and push offEnables balance and push off

Stance PhaseStance Phase

5 distinct periods:5 distinct periods: Initial contactInitial contact Loading responseLoading response midstancemidstance terminal stanceterminal stance PreswingPreswing

Box 9-1, pages 310-311Box 9-1, pages 310-311

Initial ContactInitial Contact

Begins with foot touching surfaceBegins with foot touching surface

Contact should be through lateral aspect Contact should be through lateral aspect of plantar surfaceof plantar surface

Opposite limb is ending with toe-offOpposite limb is ending with toe-off

Subtalar joint – supinated @ 5 degreesSubtalar joint – supinated @ 5 degrees

Talocrural joint – dorsiflexedTalocrural joint – dorsiflexed

Both limbs in contact with surfaceBoth limbs in contact with surface

Loading ResponseLoading Response

Response to absorption of body weight by Response to absorption of body weight by initiating flattening of the footinitiating flattening of the foot

Subtalar joint – pronatesSubtalar joint – pronates Unlocks midtarsal joints, allowing foot to Unlocks midtarsal joints, allowing foot to

become flexiblebecome flexible Tibial internal rotation – increased medial Tibial internal rotation – increased medial

forces at foot, leg, kneeforces at foot, leg, knee

Talocrural joint – plantarflexesTalocrural joint – plantarflexes

Loading ResponseLoading Response

Muscle support – decelerates pronation Muscle support – decelerates pronation and plantarflexionand plantarflexion

Hip remains flexedHip remains flexed

Period lasts until double limb support has Period lasts until double limb support has endedended

MidstanceMidstance

Begins as body weight moves over Begins as body weight moves over stationary support limb and ends when stationary support limb and ends when center of gravity is directly over the footcenter of gravity is directly over the foot

Subtalar joint – supinatesSubtalar joint – supinates Locks midtarsal joints, makes foot a rigid leverLocks midtarsal joints, makes foot a rigid lever Preparing for efficiency during propulsionPreparing for efficiency during propulsion

Talocrural joint – dorsiflexesTalocrural joint – dorsiflexes

Hip moves into extensionHip moves into extension

Terminal StanceTerminal Stance

Starts as center of gravity passes over the Starts as center of gravity passes over the foot and ends just before the contralateral foot and ends just before the contralateral limb makes contact with the groundlimb makes contact with the ground

Body moves forward with weight shifting Body moves forward with weight shifting over metatarsal heads until contralateral over metatarsal heads until contralateral limb provides new base of supportlimb provides new base of support

Toes extended, tibia externally rotatedToes extended, tibia externally rotated

Subtalar joint – supinatedSubtalar joint – supinated

Hip and knee continue to flexHip and knee continue to flex

PreswingPreswing

Transitional period of double supportTransitional period of double support

Limb is uploaded and prepared to swingLimb is uploaded and prepared to swing

Begins with initial contact of contralateral Begins with initial contact of contralateral limb and ends with toe-off of stance limblimb and ends with toe-off of stance limb

Swing PhaseSwing Phase

Begins as soon as the toes leave the Begins as soon as the toes leave the surface and terminates when the limb next surface and terminates when the limb next makes contact with the surfacemakes contact with the surface

Gravity assists in pulling leg mass downGravity assists in pulling leg mass down

Momentum gained at toe-ff helps carry leg Momentum gained at toe-ff helps carry leg through the swing phasethrough the swing phase

Three periodsThree periods Initial swing, midswing, terminal swingInitial swing, midswing, terminal swing Box 9-2, pages 312-313Box 9-2, pages 312-313

Initial SwingInitial Swing

Begins at the point where toes leave the Begins at the point where toes leave the ground and continues until knee reaches ground and continues until knee reaches its maximum range of flexion (@ 60its maximum range of flexion (@ 60OO))

Femur advancesFemur advances

Ankle dorsiflexes, allowing toe clearanceAnkle dorsiflexes, allowing toe clearance

Subtalar joint - pronationSubtalar joint - pronation

MidswingMidswing

Knee extends until tibia is vertical to Knee extends until tibia is vertical to surfacesurface

Thigh continues to advance, toe clearance Thigh continues to advance, toe clearance is ensured, propulsion continuesis ensured, propulsion continues

Talocrural joint – dorsiflexed to neutral or Talocrural joint – dorsiflexed to neutral or slight dorsiflexionslight dorsiflexion

Terminal SwingTerminal Swing

Occurs from end of midswing to initial Occurs from end of midswing to initial contact period of the stance phasecontact period of the stance phaseTrunk is erectTrunk is erectThigh decelerates for heel contactThigh decelerates for heel contactKnee extends to create step length for Knee extends to create step length for heel contactheel contact Step length – distance traveled between initial Step length – distance traveled between initial

contacts of right and left footcontacts of right and left foot

Subtalar joint - supinationSubtalar joint - supination

Qualitative Observation of GaitQualitative Observation of Gait

Rise and fall of the body in vertical Rise and fall of the body in vertical direction = 5cmdirection = 5cm

Path of center of gravity is sinusoidal or a Path of center of gravity is sinusoidal or a smooth curvesmooth curve No sharp brakingNo sharp braking

As speed increase, arm action is involvedAs speed increase, arm action is involved

Questions to address during gait analysisQuestions to address during gait analysis Page 309Page 309

Running GaitRunning Gait

Series of smoothly coordinated jumps Series of smoothly coordinated jumps executed from one foot to the other footexecuted from one foot to the other foot

Purpose – to move body from one position Purpose – to move body from one position to another at a moderate to fast speedto another at a moderate to fast speed

As speed increase – techniques changesAs speed increase – techniques changes Arm swing ROM, stride length, cadence, and Arm swing ROM, stride length, cadence, and

knee flexion ROMknee flexion ROM

Running GaitRunning Gait

Muscular force and speed of contraction Muscular force and speed of contraction also changealso change Control pronation during loading response Control pronation during loading response

and initiate supination prior to preswingand initiate supination prior to preswing

Walking versus Running GaitWalking versus Running Gait2 distinct differences:2 distinct differences: Flight phase – neither foot is in contact with Flight phase – neither foot is in contact with

the groundthe ground At no time are both feet in contact with the At no time are both feet in contact with the

surface at the same timesurface at the same time

Stance phaseStance phase Walking – 62% of the cycle; Running – 33% of Walking – 62% of the cycle; Running – 33% of

the cyclethe cycle

Same joints usedSame joints used Differences in degrees of motion and timing of Differences in degrees of motion and timing of

actionsactions

Figure 9-5, page 314Figure 9-5, page 314

Ground Reaction ForcesGround Reaction Forces

Every contact of the foot with the surface Every contact of the foot with the surface generates an upward reaction forcegenerates an upward reaction force

GRFs are measured and comparedGRFs are measured and compared Figure 9-6, page 315Figure 9-6, page 315 Vertical component of GRF during running is Vertical component of GRF during running is

2 to 3 times the runner’s body weight2 to 3 times the runner’s body weight

Classified as rearfoot, midfoot, or forefoot Classified as rearfoot, midfoot, or forefoot strikersstrikers

Ground Reaction ForcesGround Reaction Forces

Factors influencing GRF patterns:Factors influencing GRF patterns: Running speedRunning speed Running styleRunning style Ground surfaceGround surface Grade of inclineGrade of incline Shoes/orthoticsShoes/orthotics

Questions to address during observation Questions to address during observation of running gaitof running gait Page 315Page 315

Pathologies Affecting the Gait Pathologies Affecting the Gait CycleCycle

Box 9-3, page 316Box 9-3, page 316

Table 9-2, page 317Table 9-2, page 317

Acute Lower Extremity Strains and Acute Lower Extremity Strains and SprainsSprains

Overuse InjuriesOveruse Injuries

Leg Length DiscrepanciesLeg Length Discrepancies

Functional BracingFunctional Bracing