Joint Range of Motion During Gait: Difference between revisions
No edit summary |
No edit summary |
||
Line 3: | Line 3: | ||
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | ||
</div> | </div> | ||
== Introduction == | == Introduction == |
Revision as of 23:20, 1 August 2022
Top Contributors - Rachel Celentano, Wanda van Niekerk and Jess Bell
Introduction[edit | edit source]
Merriam-Webster dictionary defines gait as “a manner of walking or moving on foot."[1] It involves the interaction between the nervous, musculoskeletal, and cardiorespiratory systems and is heavily impacted by human age, personality, mood, and sociocultural factors.[2] Normal gait function is determined by the optimal operation of the following: “locomotor function (for initiating and sustaining rhythmic gait), balance, postural reflexes, sensory function and sensorimotor integration, motor control, the musculoskeletal apparatus and cardiopulmonary functions."[2]
Stance Versus Swing Phase[edit | edit source]
The normal forward step consists of two phases: stance phase and swing phase -
- The stance phase occupies 0-60% of the gait cycle, during which one leg and foot are bearing most or all of the bodyweight.
- The swing phase occupies 60-100% (total 40%) of the gait cycle, during which the foot is not touching the walking surface and the bodyweight is borne by the other leg and foot.[3]
- In a complete two-step cycle both feet are in contact with the floor at the same time for about 25% of the time. This part of the cycle is called the double-support phase.
- Gait cycle phases: the stance phase and the swing phase and involves a combination of open and close chain activities.[4]
Phases of Gait[edit | edit source]
There are 8 phases of gait which are listed as follows:[3][5]
- Initial Contact
- Loading Response
- Midstance
- Terminal Stance
- Pre swing
- Initial Swing
- Mid Swing
- Late Swing [6]
See below for a diagram of the gait cycle -
The video below shares a 90-second description of the basics of the gait cycle:
Range of Motion Involved in Gait Phases[edit | edit source]
Initial contact (Heel strike): 0% of gait cycle
Involves:
- Function: to establish contact with surface and initiate weight acceptance
Body part | ROM requirements |
---|---|
Ankle | 0° (neutral position) |
Knee | 0° (full extension) |
Hip | average 20° of flexion |
Loading response (Foot flat): 8-10% of gait cycle
Involves:
- Function: weight acceptance and shock absorption
- ROM requirements -
Body part | ROM requirements |
---|---|
Ankle | 0-5° plantarflexion |
Knee | 15° of flexion |
Hip | 15° of flexion (hip is moving into extension) |
Midstance:
Involves:
- Function: single limb support and stability
- ROM requirements -
Body part | ROM requirements |
---|---|
Ankle | 5° of dorsiflexion |
Knee | 5° of flexion |
Hip | 0° of flexion (neutral position) |
Heel off: 30-40% of gait cycle
Involves:
- Function: single limb support, stability, and propulsion
- ROM requirements -
Body part | ROM requirements |
---|---|
Ankle | 0° (neutral position) |
Knee | 0° of flexion (complete extension) |
Hip | 10-20° of hyperextension |
Toe off/Pre-swing: 60% of gait cycle (final phase of stance)
Involves:
- Function: final burst of propulsion to propel the body forward
- ROM requirements -
Body part | ROM requirements |
---|---|
Ankle | 20° of plantarflexion |
Knee | 30° of flexion |
Hip | 10-20° of hyperextension |
Early swing: 60-75% of gait cycle (beginning of swing phase)
Involves:
- Function: propel the lower extremity forward and shorten the stance limb
- ROM requirements -
Body part | ROM requirements |
---|---|
Ankle | 10° of plantarflexion |
Knee | 60° of flexion |
Hip | moves into 20° of flexion |
Mid swing: 75-85% of gait cycle
Involves:
- Function: clear lower extremity from the ground in order to advance into initial contact
- ROM requirements -
Body part | ROM requirements |
---|---|
Ankle | 0° (neutral position) |
Knee | moves into 30° of flexion |
Hip | 30° of flexion (hip is moving into extension) |
Late swing: 85-100% of gait cycle
Involves:
- Function: decelerate lower extremity to establish contact with the ground
- ROM requirements -
Body part | ROM requirements |
---|---|
Ankle | 0° (neutral position) |
Knee | 0° (complete extension) |
Hip | 30° of flexion |
The following video describes the range of motion requirements involved in the different gait phases:
Range of Motion during Gait [8]
Maximum Values[edit | edit source]
Maximum range of motion values are the minimum prerequisites for a normal gait pattern.
Body part | Maximum ROM values |
---|---|
Hip | 20° of extension; 20° of flexion |
Knee | 0° (complete extension); 60° of flexion |
Ankle | 5° of dorsiflexion; 20° of plantarflexion |
Gait Kinetics[edit | edit source]
Definitions:
- Ground reaction force (GRF) - creates an external plantarflexion or dorsiflexion torque.
- Lower extremity gait musculature - creates an internal torque.
- Centre of pressure - point of application of pressure to the foot segment.
Initial contact:
Ankle -
- At initial contact - lateral calcaneus strikes the ground first.
- Point of application of GRF is slightly posterior to the axis of rotation of the foot and ankle joint - creates a plantarflexion moment at the ankle.
- Utilise dorsiflexors to oppose plantarflexor torque - internal torque controlled by tibialis anterior, extensor digitorum longus and extensor hallucis.
Knee -
- At initial contact - GRF is anterior to the knee joint creating anterior rotation of the femur.
- GRF wants to move into extension.
- Utilise flexor musculature - hamstrings - in order to control progression.
Hip -
- GRF is anterior to hip joint - creating an external torque (anterior rotation) at the pelvis.
- Utilise extensor musculature - gluteal musculature - to oppose/control the progression or external torque.
Foot flat:
Ankle -
- Centre of pressure remains at the posterior calcaneus - GRF remains posterior to the ankle.
- Utilise dorsiflexors to prevent plantarflexion from occurring at the ankle.
Hip -
- Centre of pressure and GRF remains the same - anterior to the axis of rotation.
- Anterior pelvic tilt creates a flexion torque.
- Utilise extensor musculature to control this torque.
Knee -
- Range of motion moves from 0-15°.
- GRF posterior to the axis of rotation of the knee joint - creates a flexion torque.
- Utilise extensor musculature to control knee from moving into flexion.
Mid-stance:
Ankle -
- GRF creates a clockwise torque of the proximal segment (on top of distal segment) - causing a dorsiflexion moment at the talocrural joint.
- Utilise plantarflexors to oppose the external torque.
Knee -
- GRF creates an anterior (clockwise) torque of proximal segment (on top of distal segment) - wants to move into extension by femur moving anteriorly on tibia.
- Utilise flexors to oppose this torque - activates hamstrings.
Hip -
- GRF is posterior to the axis of rotation - wants pelvis to move into a posterior pelvic tilt (extension).
- Utilise flexors to oppose extension torque.
Heel off:
Ankle -
- GRF is anterior to the axis of rotation of ankle joint - wants tibia to flex on talus.
- Creates external dorsiflexion moment at talocrural joint.
- Utilise plantarflexors to oppose this moment.
Knee -
- GRF is anterior to knee joint - pulls femur into extension, creating an external extensor torque.
- Counteracted by internal flexor torque.
Hip -
- GRF is posterior to hip joint - creates an external extensor moment.
- Counteracted by internal flexor moment.
Toe off:
Ankle -
- Centre of pressure/GRF stay anterior to axis of rotation of ankle joint.
- Creates an external dorsiflexion moment.
- Counteracted by internal plantarflexion moment.
Knee -
- GRF is posterior to axis of rotation of knee joint as knee is moving into flexion.
- Creates an external flexion moment.
- Counteracted by an internal extensor (quadricep musculature) moment.
Hip -
- GRF is posterior to axis of rotation of hip joint as hip is moving into extension.
- Creates a posterior pelvic tilt.
- Utilise flexor musculature (iliopsoas) to counteract this moment.
Internal Torque Peaks[edit | edit source]
Hip:
- Foot flat - extensor torque
- Heel off - flexor torque
Knee:
- Initial contact - flexor torque (hamstring musculature active)
- Foot flat - extensor torque (quadriceps musculature active)
- Heel off - flexor torque (hamstring musculature active)
Ankle:
- Initial contact/Foot flat - dorsiflexion torque
- Heel off - plantarflexion torque (gastrocnemius/soleus active)
References[edit | edit source]
- ↑ Merriam-Webster. Gait. Available from: https://www.merriam-webster.com/dictionary/gait [last accessed 23.6.2022]
- ↑ 2.0 2.1 Pirker W, Katzenschlager R. Gait disorders in adults and the elderly. Wiener Klinische Wochenschrift. 2017 Feb 1;129(3-4):81-95. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318488/ [last accessed 25.6.2022]
- ↑ 3.0 3.1 Loudon J, et al. The clinical orthopedic assessment guide. 2nd ed. Kansas: Human Kinetics, 2008. p.395-408.
- ↑ Shultz SJ et al. Examination of musculoskeletal injuries. 2nd ed, North Carolina: Human Kinetics, 2005. p55-60.
- ↑ Stöckel T, Jacksteit R, Behrens M, Skripitz R, Bader R, Mau-Moeller A. The mental representation of the human gait in young and older adults [Internet]. Frontiers in psychology. Frontiers Media S.A.; 2015 [cited 19-7-2022]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500916/
- ↑ Berger W, et al. Corrective reactions to stumbling in man: neuronal co-ordination of bilateral leg activity during gait. J Physiol 1984;357: 109-125. [last accessed 19.7.2022]
- ↑ Nicole Comninellis. The Gait Cycle Animation. Available from: https://www.youtube.com/watch?time_continue=35&v=DP5-um6SvQI [last accessed 19.7.2022]
- ↑ Alexandra Kopelovich. Gait Range of Motion. Available from: https://www.youtube.com/watch?v=5Z6shSu96CM [last accessed 19.7.2022]
- Gait
- Assessment
- Falls
- Hip - Assessment and Examination
- Knee - Assessment and Examination
- Ankle - Assessment and Examination
- Foot - Assessment and Examination
- Movement Analysis
- Older People/Geriatrics
- Older People/Geriatrics - Assessment and Examination
- Older People/Geriatrics - Outcome Measures
- Older People/Geriatrics - Physical Activity
- Balance
- Stroke