The Gait Cycle: Difference between revisions

(Added tables of joint and muscle actions)
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'''Initial Contact (or Heel Strike) - 0%'''   
'''Initial Contact (or Heel Strike) - 0%'''   


The moment the foot touches the ground and begins the first phase of double support.<ref name="Shultz" />Its function is to establish contact with the ground surface and initiate weight acceptance.   
The moment the foot touches the ground and begins the first phase of double support.<ref name="Shultz" /> Its function is to establish contact with the ground surface and initiate weight acceptance.   
 
Joint and muscle actions:
* 30° flexion of the [[hip]], full extension in the [[knee]], [[Ankle & Foot|ankle]] moves from dorsiflexion to a neutral (supinated 5°) position then into plantarflexion.<ref name="Shultz" /><ref name="Loudon" />
* After this, knee flexion (5°) begins and increases, just as plantarflexion of the ankle increases.<ref name="Loudon" />
* Plantarflexion is allowed by eccentric contraction of the [[Tibialis Anterior|tibialis anterior]] and dorsiflexors.
* Knee flexion is allowed by a concentric contraction of the knee flexors and eccentric contraction of the knee extensors.
* Flexion of the hip is caused by the contraction of the [[Rectus Femoris|rectus femoris]].<ref name="Loudon" />
{| class="wikitable"
{| class="wikitable"
|+
|+
<ref name=":0" />
!
!
!Kinematics
!Kinematics/Joint Motion
!Muscle Action
!Muscle Action
|-
|-
|Ankle
|[[Ankle and Foot|Ankle]]
|Neutral, 0°
|Neutral, 0°
|Concentric to eccentric dorsiflexors
|Concentric to eccentric dorsiflexors
|-
|-
|Knee
|[[Knee]]
|5° flexion
|5° flexion
|Eccentric extensors
|Eccentric extensors
|-
|-
|Hip
|[[Hip]]
|30° flexion
|30° flexion
|Concentric extensors
|Concentric extensors and eccentric flexors
|}
|}
'''Loading Response (or Foot Flat) - 0-10%'''
'''Loading Response (or Foot Flat) - 0-10%'''


Begins with initial contact and continues until the contralateral foot leaves the ground. The foot continues to accept weight and absorb shock by rolling into pronation.<ref name="Shultz" />
Begins with initial contact and continues until the contralateral foot leaves the ground. The foot continues to accept weight and absorb shock by rolling into pronation.<ref name="Shultz" />
Joint and muscle actions:
* Hip moves slowly into extension, caused by a contraction of the [[Adductor Magnus|adductor magnus]] and [[Gluteus Maximus|gluteus maximus]] muscles.
* Knee flexes to 15° to 20° of flexion. <ref name="Loudon" />
* Ankle plantarflexion increases to 10-15°.<ref name="Shultz" /><ref name="Loudon" />
{| class="wikitable"
{| class="wikitable"
!
!
!Kinematics
!Kinematics/Joint Motion
!Muscle Action
!Muscle Action
|-
|-
Line 91: Line 80:
|Knee
|Knee
|Flexes to 10-15°
|Flexes to 10-15°
|Eccentric extensors
|Eccentric extensors and concentric flexors
|-
|-
|Hip
|Hip
Line 98: Line 87:
|}
|}


<ref name=":0" />


'''Midstance - 10-30%'''
'''Midstance - 10-30%'''


Begins when the contralateral foot leaves the ground and continues until ipsilateral heel lifts off the ground. The body is supported by a single leg and begins to move from force absorption at impact to force propulsion forward.<ref name="Shultz" />
Begins when the contralateral foot leaves the ground and continues until ipsilateral heel lifts off the ground. The body is supported by a single leg and begins to move from force absorption at impact to force propulsion forward.<ref name="Shultz" />
Joint and muscle actions:
* Hip moves from 10° of flexion to extension by contraction of the hip extensors.<ref name="Loudon" />
* Knee reaches maximal flexion and then begins to extend.
* Ankle becomes supinated<ref name="Shultz" /> and dorsiflexed (5°), which is caused by some contraction of the [[Triceps Surae|triceps surae]] muscles.<ref name="Shultz" />
{| class="wikitable"
{| class="wikitable"
!
!
!Kinematics
!Kinematics/Joint Motion
!Muscle Action
!Muscle Action
!
|-
|-
|Ankle
|Ankle
|Gradual dorsiflexion
|Gradual dorsiflexion
|Eccentric plantarflexors
|Eccentric plantarflexors and concentric dorsiflexors
|
|-
|-
|Knee
|Knee
|Begins to extend
|Begins to extend
|Concentric extensors
|Concentric extensors
|
|-
|-
|Hip
|Hip
|Gradual extension
|Gradual extension
|Concentric extensors
|Concentric extensors
|
|}
|}


 
<ref name=":0" />


'''Terminal Stance (or Heel Off) - 30-50%'''
'''Terminal Stance (or Heel Off) - 30-50%'''


Begins when the heel leaves the floor and continues until the contralateral foot contacts the ground. In addition to single limb support and stability, this event serves to propel the body forward.  
Begins when the heel leaves the floor and continues until the contralateral foot contacts the ground. In addition to single limb support and stability, this event serves to propel the body forward. Bodyweight is divided over the metatarsal heads.<ref name="Shultz" />  
 
Joint and muscle actions:
* Bodyweight is divided over the metatarsal heads.<ref name="Shultz" />
* 10-13° of hip hyperextension, which then goes into flexion.
* Knee becomes flexed (0-5°)<ref name="Loudon" />
* Ankle supinates and plantar flexes.<ref name="Loudon" />
{| class="wikitable"
{| class="wikitable"
!
!
!Kinematics
!Kinematics/Joint Motion
!Muscle Action
!Muscle Action
!
|-
|-
|Ankle
|Ankle
Line 151: Line 125:
|Eccentric plantarflexors then
|Eccentric plantarflexors then
concentric plantarflexors
concentric plantarflexors
|
|-
|-
|Knee
|Knee
Line 157: Line 130:
beginning to flex
beginning to flex
|Concentric extensors then  
|Concentric extensors then  
Eccentric extensors
Eccentric extensors and concentric flexors
|
|-
|-
|Hip
|Hip
|Extends until a maximum of 10° extension
|Extends until a maximum of 10° extension
|Eccentric flexors
|Eccentric flexors
|
|}
|}


 
<ref name=":0" />


'''Pre-Swing (or Toe Off) - 50-60%'''
'''Pre-Swing (or Toe Off) - 50-60%'''


Begins when the contralateral foot contacts the ground and continues until the ipsilateral foot leaves the ground. Provides the final burst of propulsion as the toes leave the ground.<ref name="Loudon" />
Begins when the contralateral foot contacts the ground and continues until the ipsilateral foot leaves the ground. Provides the final burst of propulsion as the toes leave the ground.<ref name="Loudon" />
Joint and muscle actions:
* Hip becomes less extended.
* Knee is flexes to 35-40°
* Plantarflexion of the ankle increases to 20°.<ref name="Shultz" /><ref name="Loudon" />
{| class="wikitable"
{| class="wikitable"
!
!
!Kinematics
!Kinematics/Joint Motion
!Muscle Action
!Muscle Action
!
|-
|-
|Ankle
|Ankle
|Begins to plantarflex rapidly before foot leaves the ground
|Begins to plantarflex rapidly before foot leaves the ground
|Concentric plantarflexors
|Concentric plantarflexors
|
|-
|-
|Knee
|Knee
|Begins to flex rapidly
|Begins to flex rapidly
|Eccentric extensors
|Eccentric extensors
|
|-
|-
|Hip
|Hip
|Begins to flex before foot leaves the ground
|Begins to flex before foot leaves the ground
|Eccentric flexors then
|Concentric flexors
concentric flexors
|
|}
|}


 
<ref name=":0" />


'''Early Swing - 60-75%'''
'''Early Swing - 60-75%'''


Begins when the foot leaves the ground until it is aligned with the contralateral ankle. This event functions to advance the limb and shorten the limb for foot clearance.
Begins when the foot leaves the ground until it is aligned with the contralateral ankle. This event functions to advance the limb and shorten the limb for foot clearance.
Joint and muscle actions:
* Hip extends to 10° and then flexes due to contraction of the iliopsoas muscle<ref name="Loudon" /> 20° with lateral rotation.<ref name="Shultz" /><ref name="Loudon" />
* Knee flexes to 40-60°
* Ankle goes from 20° of plantar flexion to dorsiflexion, to end in a neutral position.<ref name="Shultz" />
{| class="wikitable"
{| class="wikitable"
!
!
!Kinematics
!Kinematics/Joint Motion
!Muscle Action
!Muscle Action
!
|-
|-
|Ankle
|Ankle
Line 220: Line 175:
|Eccentric dorsiflexors then
|Eccentric dorsiflexors then
concentric dorsiflexors and eccentric plantarflexors
concentric dorsiflexors and eccentric plantarflexors
|
|-
|-
|Knee
|Knee
|Rapid knee flexion
|Rapid knee flexion until a maximum of about 60°
|Eccentric extensors and concentric flexors
|Eccentric extensors and concentric flexors
|
|-
|-
|Hip
|Hip
|Gradually flexes
|Gradually flexes
|Concentric flexors
|Concentric flexors
|
|}
|}


 
<ref name=":0" />


'''Mid-Swing - 75-85%'''
'''Mid-Swing - 75-85%'''


Begins from the ankle and foot alignment and continues until the swing leg tibia is vertical. As in early swing, it functions to advance the limb and shorten the limb for foot clearance.
Begins from the ankle and foot alignment and continues until the swing leg tibia is vertical. As in early swing, it functions to advance the limb and shorten the limb for foot clearance.
Joint and muscle actions:
* Hip flexes to 30° (by contraction of the adductors) and the ankle becomes dorsiflexed due to a contraction of the tibialis anterior muscle.<ref name="Loudon" />
* Knee flexes 60° but then extends approximately 30° due to the contraction of the sartorius muscle<ref name="Shultz" /><ref name="Loudon" />(caused by the quadriceps muscles).<ref name="Shultz" /><ref name="Loudon" />
* Ankle remains neutral.
{| class="wikitable"
{| class="wikitable"
!
!
!Kinematics
!Kinematics/Joint Motion
!Muscle Action
!Muscle Action
!
|-
|-
|Ankle
|Ankle
|Maintains a neutral position
|Maintains a neutral position
|Concentric dorsiflexors
|Concentric dorsiflexors
|
|-
|-
|Knee
|Knee
|Reaches a maximum of around 60° flexion
|Begins to extend
|Eccentric extensors and concentric flexors
|Eccentric flexors  
|
|-
|-
|Hip
|Hip
|Continues to flex until a maximum of just over 30°
|Continues to flex until a maximum of just over 30°
|Concentric flexors
|Concentric flexors
|
|}
|}


 
<ref name=":0" />


'''Late Swing/Deceleration - 85-100%'''
'''Late Swing/Deceleration - 85-100%'''


Begins when the swing leg tibia is vertical and ends with initial contact. Limb advancement slows in preparation.
Begins when the swing leg tibia is vertical and ends with initial contact. Limb advancement slows in preparation.
Joint and muscle actions:
* Hip remains flexed to 25-30°.
* Locked extension of the knee.
* Ankle remains neutral.<ref name="Shultz" />
{| class="wikitable"
{| class="wikitable"
!
!
!Kinematics
!Kinematics/Joint Motion
!Muscle Action
!Muscle Action
!
|-
|-
|Ankle
|Ankle
|Maintains a neutral position
|Maintains a neutral position
|Concentric dorsiflexors
|Concentric dorsiflexors
|
|-
|-
|Knee
|Knee
|Extends until full extension, and flexes just
|Extends until full extension, and flexes just
slightly before initial contact
slightly before initial contact
|Eccentric flexors, then  
|Eccentric flexors, then concentric flexors
concentric flexors
|
|-
|-
|Hip
|Hip
|Hip remains flexed to around 30 °
|Hip remains flexed to around 30 °
|Concentric flexors
|Concentric flexors and eccentric extensors,
|
then concentric extensors
|}
|}
<ref name=":0" />


== Clinical Application ==
== Clinical Application ==
Line 303: Line 238:


== References  ==
== References  ==
<references /><br>    
<references /><br>
 
[[Category:Assessment]]
[[Category:Assessment]]
[[Category:Gait]]
[[Category:Gait]]

Revision as of 19:54, 12 May 2022

Original Editor - Karsten De Koster Top Contributors - Daphne Xuan and Tarina van der Stockt

The Gait Cycle[edit | edit source]

Walk.jpg

The action of walking may be summarised by the following sequence:[1]

  1. Registration and activation of the gait command within the central nervous system.
  2. Transmission of gait signals to the peripheral nervous system.
  4. Contraction of muscles.
  5. Generation of forces across joints
  6. Regulation of joint forces and moments by skeletal segments.
  7. Generation of ground reaction forces.


Normal gait consists of two phases: stance phase; swing phase. These phases are further divided into a total of 8 sub-phases.[2] The gait cycle involves a combination of open- and closed-chain activities.[3]

Stance Phase

The stance phase occupies 60% of the total gait cycle, during which some part of the foot is in contact with the ground. It is further divided into five events:

  1. Initial contact (heel strike)
  2. Loading response (foot flat)
  3. Mid-stance
  4. Terminal stance (heel off)
  5. Pre-swing (toe off)


Swing Phase

The swing phase occupies 40% of the total gait cycle [4], during which the foot is not in contact with the ground and the bodyweight is borne by the other leg and foot. It is further divided into 3 events:

  1. Initial swing
  2. Mid-swing
  3. Late swing[5]


In a complete two-step cycle both feet are in contact with the ground at the same time for 20% of the total gait cycle, 10%at the beginning of the stance phase and 10% at the end of the stance phase.[2] These are termed 'double-support periods'. The rest of the time is spent in single support, when only one foot is in contact with the ground.


The 90-second video below gives the basics of this cycle:

[6]

Breakdown of Gait Cycle Sub-Phases[edit | edit source]

Initial Contact (or Heel Strike) - 0%

The moment the foot touches the ground and begins the first phase of double support.[3] Its function is to establish contact with the ground surface and initiate weight acceptance.

[2]
Kinematics/Joint Motion Muscle Action
Ankle Neutral, 0° Concentric to eccentric dorsiflexors
Knee 5° flexion Eccentric extensors
Hip 30° flexion Concentric extensors and eccentric flexors

Loading Response (or Foot Flat) - 0-10%

Begins with initial contact and continues until the contralateral foot leaves the ground. The foot continues to accept weight and absorb shock by rolling into pronation.[3]

Kinematics/Joint Motion Muscle Action
Ankle Rapid plantarflexion to 10° Eccentric dorsiflexors
Knee Flexes to 10-15° Eccentric extensors and concentric flexors
Hip Gradual extension Concentric extensors

[2]

Midstance - 10-30%

Begins when the contralateral foot leaves the ground and continues until ipsilateral heel lifts off the ground. The body is supported by a single leg and begins to move from force absorption at impact to force propulsion forward.[3]

Kinematics/Joint Motion Muscle Action
Ankle Gradual dorsiflexion Eccentric plantarflexors and concentric dorsiflexors
Knee Begins to extend Concentric extensors
Hip Gradual extension Concentric extensors

[2]

Terminal Stance (or Heel Off) - 30-50%

Begins when the heel leaves the floor and continues until the contralateral foot contacts the ground. In addition to single limb support and stability, this event serves to propel the body forward. Bodyweight is divided over the metatarsal heads.[3]

Kinematics/Joint Motion Muscle Action
Ankle Gradual dorsiflexion until a maximum of 10° before beginning

to plantarflex

Eccentric plantarflexors then

concentric plantarflexors

Knee Continues extending until a maximum of 5° of flexion before

beginning to flex

Concentric extensors then

Eccentric extensors and concentric flexors

Hip Extends until a maximum of 10° extension Eccentric flexors

[2]

Pre-Swing (or Toe Off) - 50-60%

Begins when the contralateral foot contacts the ground and continues until the ipsilateral foot leaves the ground. Provides the final burst of propulsion as the toes leave the ground.[4]

Kinematics/Joint Motion Muscle Action
Ankle Begins to plantarflex rapidly before foot leaves the ground Concentric plantarflexors
Knee Begins to flex rapidly Eccentric extensors
Hip Begins to flex before foot leaves the ground Concentric flexors

[2]

Early Swing - 60-75%

Begins when the foot leaves the ground until it is aligned with the contralateral ankle. This event functions to advance the limb and shorten the limb for foot clearance.

Kinematics/Joint Motion Muscle Action
Ankle Continues to plantarflex until a maximum of 20° before

moving back towards a neutral position

Eccentric dorsiflexors then

concentric dorsiflexors and eccentric plantarflexors

Knee Rapid knee flexion until a maximum of about 60° Eccentric extensors and concentric flexors
Hip Gradually flexes Concentric flexors

[2]

Mid-Swing - 75-85%

Begins from the ankle and foot alignment and continues until the swing leg tibia is vertical. As in early swing, it functions to advance the limb and shorten the limb for foot clearance.

Kinematics/Joint Motion Muscle Action
Ankle Maintains a neutral position Concentric dorsiflexors
Knee Begins to extend Eccentric flexors
Hip Continues to flex until a maximum of just over 30° Concentric flexors

[2]

Late Swing/Deceleration - 85-100%

Begins when the swing leg tibia is vertical and ends with initial contact. Limb advancement slows in preparation.

Kinematics/Joint Motion Muscle Action
Ankle Maintains a neutral position Concentric dorsiflexors
Knee Extends until full extension, and flexes just

slightly before initial contact

Eccentric flexors, then concentric flexors
Hip Hip remains flexed to around 30 ° Concentric flexors and eccentric extensors,

then concentric extensors

[2]

Clinical Application[edit | edit source]

Understanding the gait cycle allows for effective gait analysis. When analysing gait, it should be done systematically, looking at each joint separately throughout the entire gait cycle and detecting deviations from normal.[2] Injury or disease can alter any of the sub-phases of the gait cycle, resulting in distinct characteristics of the gait pattern.[7]

References[edit | edit source]

  1. ↑ Vaughan CL. Theories of bipedal walking: an odyssey. J Biomech 2001;36(2003):513-523.Available fromhttp://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.468.2414&rep=rep1&type=pdf
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Webster JB, Darter BJ. Principles of Normal and Pathologic Gait. Atlas of Orthoses and Assistive Devices [Internet]. 2019 [cited 2022 May 11];49-62.e1. Available from: https://www.sciencedirect.com/science/article/pii/B9780323483230000044
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Shultz SJ et al. Examination of musculoskeletal injuries. 2nd ed, North Carolina: Human Kinetics, 2005. p55-60.
  4. ↑ 4.0 4.1 Loudon J, et al. The clinical orthopedic assessment guide. 2nd ed. Kansas: Human Kinetics, 2008. p.395-408.
  5. ↑ 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.
  6. ↑ Nicole Comninellis The Gait Cycle Animation Available from https://www.youtube.com/watch?time_continue=35&v=DP5-um6SvQI
  7. ↑ Shah K, Solan M, Dawe E. The gait cycle and its variations with disease and injury. Orthopaedics and Trauma [Internet]. 2020 Jun [cited 2022 May 12];34(3):153–60. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1877132720300397


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