Department of Physical Therapy and Human Movement Sciences Northwestern University Medical School Kinesiology 2002

Gait Part II

I. Describe normal muscle function during walking Terminology Review

RLA (phases)
Initial Contact Loading response Midstance Terminal stance Pre-swing Initial swing Midswing Terminal swing

Traditional (events)
Heel Strike HS foot flat FF midstance Midstance heel off Heel off toe off Toe off early accel. Acceleration midswing Midswing deceleration
Levangie and Norkin

Ellen Cook Humphrey, MA,PT, OCS, ATC I. II. III. IV. Describe joint kinematics and normal muscle function during walking Describe gait through the life span: Pediatric Describe gait through the life span: Geriatric Explain differences between walking and running
1

Rancho Los Amigos Sub-phases

Muscle Function designed for efficiency

Muscles contract when body alignment creates a torque antagonistic to weightbearing stability
(I.e. the body vector is aligned to create instability)

The intensity of muscular responses are proportional to the magnitude of the torque demand that must be restrained
as soon as alternate means are available the muscles relax

Contralateral toe off

Contralateral initial contact

Modified from RLA Observational Gait Analysis

There is a continual exchange between the external torque demand and the controlling mechanisms (muscle action, momentum, passive tension of ligaments and fascia, etc.) to resist that demand

Determining muscle function via the ground reaction force vector method. ExamplePhase G RFV torque
M uscle torque This force is resisted by the hip extensors Ankle plantar flexion Initial contact (the Attempts to GRFV is anterior produce hip flexion to hip) Terminal stance Ankle dorsiflexion

Initial Contact (Heel Strike) (see also pg. 30 of Observational Gait Analysis) HIP: 25 flexion KNEE: 0 -5 ANKLE: 0 (90 )

* CautionThis method is dynamically inaccurate and can yield wrong results

Muscle Function - Initial Contact (Heel strike)

Hip stabilized by extensor activity of hamstrings and gluts Knee stabilized by cocontraction of quads and hamstrings Ankle pre-tibial muscles dorsiflex ankle, positioning foot for initial contact
RLA DF

Muscle torque (not GRFV) is represented in boxes shown

HIP: 25 flexion KNEE: 0 15 flexion (Lowers CM) ANKLE: 0 10 plantar flexion

Loading Response Phase (Heel Strike to Foot Flat)

ext flex
(Patton)

1st rocker: 1st rocker: Calcaneus Calcaneus

slide#8

Muscle Function Loading Response (HS to Foot Flat)

Hip abductors stabilize pelvic drop in frontal plane Hip extensors counteract trunk and hip flexion Quads control knee flexion providing shock absorption Ankle dorsiflexors decelerate foot drop Tibialis anterior and posterior eccentrically decelerate pronation

Midstance Phase (Foot Flat to midstance event) HIP: 25 flexion 0 KNEE: 15 flexion 0 flexion ANKLE: 10 plantar flexion 5

dorsi flexion

ext ext
DF RLA
(Patton) slide#10

2nd rocker: 2nd rocker: ankle ankle

Muscle Function Mid-stance (FF to Midstance)

Hip abductors continue to minimize pelvic drop in the frontal plane Quads resist knee flexion until COG passes over base of support, then quads are silent Soleus and gastroc eccentrically control forward tibial progression
RLA

Terminal Stance Phase (midstance event to Heel Off)

HIP: 0 flexion 20 extension KNEE: 0 ANKLE: 5 dorsi flexion 10 dorsi flexion

ext
Continue 2nd rocker: ankle Continue 2nd rocker: ankle At end of terminal stance, At end of terminal stance, Begin 3rd rocker: MTP Begin 3rd rocker: MTP

ext PF

(Patton)

slide#12

Muscle Function - Terminal Stance

(Midstance to Heel off)
Brief burst from hip flexors resisting hyperextension of the hip Tensor fascia latae active throughout stance to resist pelvic drop Minimal to no quad or hamstring activity Ankle plantar flexors prevent forward tibial collapse and contribute to heel rise through passive tension Preswing Phase (Heel Off to Toe Off)

RLA

HIP: 20 extension 0 KNEE: 0 40 flexion ANKLE: 10 dorsi flexion 20 plantar flexion

3rd rocker: 3rd rocker: MTP MTP

flex slight flexion high PF

(Patton)

slide#14

Muscle Function - Pre-swing

(Heel to Toe off)
Femur flexes forward due to gravity and momentum, may be facilitated by adductor longus and rectus femoris Adductors stabilize weight shift across midline to other foot Rectus femoris may restrain rapid passive knee flexion, otherwise quads silent Passive tension in ankle plantar flexors facilitates knee flexion and then decreases to zero in preparation for toe off

Initial Swing (Toe Off to early acceleration)

RLA

HIP: 15 KNEE: 60 ANKLE: 10 plantar flexion

flex
zero

PF to zero

(Patton)

slide#16

Muscle Function - Initial Swing

(Toe off to Early Acceleration)
Mid-Swing Hip flexors flex hip Adductor longus brings leg toward midline Ankle pre-tibials initiate dorsiflexion to clear toes
slight flex
RLA

HIP: 25 KNEE: 25 ANKLE: 0

zero DF

(Patton)

slide#18

Muscle Function - Mid-swing

Hip flexors and momentum flex hip Hamstrings begin to decelerate knee extension
Knee extension created by tibial forward momentum
RLA

Terminal Swing (Mid-swing-deceleration)

HIP: 25 KNEE: 0 ANKLE: 0 plantar flexion

zero

Ankle pre-tibials concentrically contract to clear foot

zero

slight DF
(Patton) slide#20

Muscle Function - Terminal Swing

(Midswing-Deceleration)
Hamstrings continue to decelerate forward swing of leg Quadriceps may contract to extend knee in preparation for initial contact Ankle pre-tibials contract to prepare foot for initial contact

Appendix A Muscle Function by muscle group

1. Trunk
transversospinalis, erector spinae, quadratus lumborum counterbalance trunk flexion moment coordinate rotating the trunk opposite from pelvis

RLA

extension flexion

2. Abdominals
rotates trunk in opposite direction of pelvis

slight DF

3. Hip Flexors
(iliopsoas, TFL, sartorius, rectus femoris, and adductors) brief activity at beginning of swing to initiate hip flexion electrical silence by mid-swing eccentric control of hip extension at terminal stance

5. Hip Adductors
stabilize the limb at heel strike from TST to PSW to stabilize the limb during external rotation and assist in hip flexion

6. Hip Abductors 4. Gluteus Maximus

activity begins at TSW, rises sharply to peak during IC through LR function with hamstrings to decelerate forward trunk momentum by preventing closed-chain hip flexion assist with hip extension if resistance stabilize pelvis in the frontal plane
eccentrically control contralateral pelvic drop

active from LR through TST

7. Quadriceps
active from TSW through MST extend knee to place foot just prior to IC absorb shock and provide knee stability during early to mid-stance

9. Tensor Fascia Latae

active at terminal swing along with gluteus maximus to stabilize ITB (pulls anterior while G. Max. pulls posterior) active at end of stance and beginning of swing to assist hip flexion

8. Hamstrings
active from end of swing phase through loading response primary action is to decelerate the thigh can assists gluteus maximus in preventing hip flexion at beginning of stance assist with knee flexion during swing

10. Pre-tibial muscles (Tib. Ant., EDL, EHL)

active from initial contact through loading response to decelerate ankle plantar flexion active from pre-swing through swing to clear toes from floor

11. Gastroc/soleus
active just after midstance through terminal stance to decelerate forward progression of the tibia contribute to heel rise (passive tightening of the tendon elevates the heel) stabilizes knee at terminal stance (pulls femur posteriorly to extend knee)

13. Flexor hallucis longus

Controls the amount and rate of first MTP extension from heel off to toe off

14. Peroneus longus

Plantar flexes the first ray from heel off to toe off

12. Tibialis posterior

support the medial arch, decelerates pronation during stance

15. Intrinsic foot muscles

active throughout stance in effort to stabilize the foot

Bibliography for Kinesiology Gait Lecture - Part II

Books:
Bruckner J. The Gait Workbook: A practical Guide to Clinical Analysis. Thorofare, N.J: SLACK, 1998 Clarke JE, Whitall J. Changing Patterns of Locomotion: From Walking to Skipping. In Woolcott MH and Shumway-Cook A (eds.): Development of Posture and Gait Across the Life Span. Columbia, SC, University of South Carolina Press, 1989 Craik, RL and Oatis, CA. Gait Analysis: Theory and Application. Mosby, 1995 Eberhart HD, Inman VT, Bresler B. The Principal Elements in Human Locomotion. Chapter 15, The Lower Extremity, Locomotion Studies. Hale JL. Normal Development of Walking. Viewers Guide. IMS Creative Communications. Univ. of Toronto. Therapy Skill Builders (pub), 1993 Koerner, I. Observation of Human Gait. A study Guide to Accompany Videocassettes. University of Alberta, Canada, 1986 Norkin and Levangie. Joint Structure and Function. F.A. Davis, Philadelphia, 1992. Observational gait analysis. Downey, Calif.: Los Amigos Research and Education Institute, 1993. Perry, Jacquelin. Gait analysis: normal and pathological function. Thorofare, N.J: SLACK, 1992. Whittle, Michael. Gait analysis: an introduction. Oxford: Butterworth-Heinemann, 1991.

Journals:

Bibliography for Kinesiology Gait Lecture - Part II cont.

Adelaar RS. The Practical Biomechanics of Running. Am Journal Sports Med. Vol.. 14, No. 6, 1986 Gabell A, Nayak USL. The Effect of Age on the Variability of Gait. Journal of Gerontology. Vol.. 39, 1984 Hageman PA, Blanke DJ. Comparison of Gait in Young Women and Elderly Women. Phys Ther. Vol.. 66, 1986 Mann RA, Hagy J. Biomechanics of Walking, Running, and Sprinting. Am Journal Sports Med. Vol.. 8, No.5, 1980 Mann RA, Moran GT, Dougherty SE. Comparative Electromyography of the Lower Extremity in Jogging, Running, and Sprinting. Am Journal Sports Med. Vol.. 14, No.6, 1986 Murray MP, Drought AB, Kory RC. Walking Patterns of Normal Men. JBJS. Vol.. 46-A, No. 2, March 1964 Murray MP, Kory RC, Clarkson BH. Walking Patterns in Healthy Old Men. Journal of Gerontology. Vol.. 24, 1969 Ounpuu S. The Biomechanics of Walking and Running. Clinics in Sports Medicine. Ankle and Foot Injuries. Vol.. 13, No. 4, 1994 Saunders JBDM, Inman VT, Eberhart HD. The Major Determinants in Normal and Pathological Gait. JBJS, 35-A, 1953

Bibliography for Kinesiology Gait Lecture - Part II cont.

Videos:
Hale, JL. Normal Development of Walking. IMS Creative Communications. Pub. By Therapy Skill Builders. 1993 Koerner I. Observation of Human Gait, Parts I-III. Health Sciences Consortium. 201 Silver Cedar Court. Chapel Hill, NC 27514 (Galter call number: WE 103 014) 1983 and 1984 Normal Walking: An Overview Based on Gait Analysis. Gillette Childrens Hospital. 200 East University Avenue. St. Paul, MN 55101