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== The Gait Cycle  ==
== The Gait Cycle  ==
[[File:Walk.jpg|right|frameless]]
[[File:Walk.jpg|right|frameless]]
The sequences for walking that occur may be summarised as follows:<ref name="Vaughan">Vaughan CL. [https://www.ncbi.nlm.nih.gov/pubmed/12600342 Theories of bipedal walking: an odyssey]. J Biomech 2001;36(2003):513-523.Available from<nowiki/>http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.468.2414&rep=rep1&type=pdf</ref>
The action of walking may be summarised by the following sequence:<ref name="Vaughan">Vaughan CL. [https://www.ncbi.nlm.nih.gov/pubmed/12600342 Theories of bipedal walking: an odyssey]. J Biomech 2001;36(2003):513-523.Available from<nowiki/>http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.468.2414&rep=rep1&type=pdf</ref>
# Registration and activation of the gait command within the central nervous system.
# Registration and activation of the gait command within the [[Central Nervous System Pathways|central nervous system]].
# Transmission of the gait systems to the peripheral nervous system.
# Transmission of gait signals to the peripheral nervous system.
#
# Contraction of [[Muscle|muscles]].
# Contraction of [[Muscle|muscles]].
# Generation of several forces.
# Generation of forces across joints
# Regulation of joint forces and moments across [[Joint Classification|synovial joints]] and skeletal segments.
# Regulation of joint forces and moments by skeletal segments.
# Generation of ground reaction forces.
# Generation of ground reaction forces (GRF).
The normal forward step consists of two phases: stance phase; swing phase, 
* The Stance phase occupies 60% of the gait cycle, during which one leg and foot are bearing most or all of the bodyweight
* The Swing phase occupies only 40% of it <ref name="Loudon">Loudon J, et al. The clinical orthopedic assessment guide. 2nd ed. Kansas: Human Kinetics, 2008. p.395-408.</ref>, during which the foot is not touching the walking surface and the bodyweight is borne by the other leg and foot.
* In a complete two-step cycle both feet are in contact with the floor at the same time for about 25 per cent 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.<ref name="Shultz" />
The 90 second video below gives the basics of this cycle{{#ev:youtube|DP5-um6SvQI|400}}<ref>Nicole Comninellis The Gait Cycle Animation Available from https://www.youtube.com/watch?time_continue=35&v=DP5-um6SvQI</ref>[[Image:Figure2.jpg|576x576px|right|frameless]]'''Phases of the Gait Cycle (8 phase model):'''<ref name="Loudon" /><ref name="Demos">Demos, Gait analysis, (http://www.ncbi.nlm.nih.gov/books/NBK27235/), 2004.</ref>
#Initial Contact
#Loading Response
#Midstance
#Terminal Stance
#Pre swing
#Initial Swing
#Mid Swing
#Late Swing.<ref name="Berger">Berger W, et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1193250/ Corrective reactions to stumbling in man: neuronal co-ordination of bilateral leg activity during gait]. J Physiol 1984;357: 109-125.</ref><br> 
'''Heel Strike (or initial contact) -''' Short period, begins the moment the foot touches the ground and is the first phase of double support.<ref name="Shultz" />


Involves:
 
* 30° flexion of the hip: full extension in the knee: ankle moves from dorsiflexion to a neutral (supinated 5°) position then into plantar flexion.<ref name="Shultz" /><ref name="Loudon" />  
 
* After this, knee flexion (5°) begins and increases, just as the plantar flexion of the heel increased.<ref name="Loudon" />  
Normal gait consists of two phases: stance phase; swing phase. These phases are further divided into a total of 8 sub-phases.<ref name=":0">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: <nowiki>https://www.sciencedirect.com/science/article/pii/B9780323483230000044</nowiki></ref> The gait cycle involves a combination of open- and closed-chain activities.<ref name="Shultz">Shultz SJ et al. Examination of musculoskeletal injuries. 2nd ed, North Carolina: Human Kinetics, 2005. p55-60.</ref><nowiki>  </nowiki>
* Plantar flexion is allowed by eccentric contraction of the tibialis anterior
 
* Extension of the knee is caused by a contraction of the quadriceps
'''Stance Phase''' 
* Flexion is caused by a contraction of the hamstrings,
 
* Flexion of the hip is caused by the contraction of the rectus femoris.<ref name="Loudon" />
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 sub-phases: 
'''Foot Flat (or loading response phase)'''  
 
* Body absorbs the impact of the foot by rolling in pronation.<ref name="Shultz" />  
# Initial contact (heel strike)
* Hip moves slowly into extension, caused by a contraction of the adductor magnus and gluteus maximus muscles.  
#Loading response (foot flat)
* Knee flexes to 15° to 20° of flexion. <ref name="Loudon" />
#Mid-stance
* Ankle plantarflexion increases to 10-15°.<ref name="Shultz" /><ref name="Loudon" />
#Terminal stance (heel off)
'''Midstance'''
#Pre-swing (toe off)
* Hip moves from 10° of flexion to extension by contraction of the gluteus medius muscle.<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 muscles.<ref name="Shultz" />  
'''Swing Phase''' 
* During this phase, the body is supported by one single leg.
 
* At this moment the body begins to move from force absorption at impact to force propulsion forward.<ref name="Shultz" />
The swing phase occupies 40% of the total gait cycle <ref name="Loudon">Loudon J, et al. The clinical orthopedic assessment guide. 2nd ed. Kansas: Human Kinetics, 2008. p.395-408.</ref>, 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 three sub-phases: 
'''Heel Off'''
 
* Begins when the heel leaves the floor.  
#Initial swing
* Bodyweight is divided over the metatarsal heads.<ref name="Shultz" />  
#Mid-swing
* 10-13° of hip hyperextension, which then goes into flexion.
#Late swing<ref name="Berger">Berger W, et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1193250/ Corrective reactions to stumbling in man: neuronal co-ordination of bilateral leg activity during gait]. J Physiol 1984;357: 109-125.</ref>
* Knee becomes flexed (0-5°)<ref name="Loudon" />
 
* Ankle supinates and plantar flexes.<ref name="Loudon" />
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.<ref name=":0" /> 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.
'''Toe Off/pre-swing'''
[[File:Gait cycle.jpg|alt=|center|frameless|800x800px|Gait Cycle]]
* Hip becomes less extended.
 
* Knee is flexed 35-40°
 
* Plantar flexion of the ankle increases to 20°.<ref name="Shultz" /><ref name="Loudon" />
The 90-second video below gives the basics of this cycle:
* The toes leave the ground.<ref name="Loudon" />
{{#ev:youtube|DP5-um6SvQI|400}}<ref>Nicole Comninellis The Gait Cycle Animation Available from https://www.youtube.com/watch?time_continue=35&v=DP5-um6SvQI</ref>
'''Early Swing'''
 
* 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" />
==== Breakdown of Gait Cycle Sub-Phases ====
* Knee flexes to 40-60°
'''Initial Contact (or Heel Strike) - 0%'''
* Ankle goes from 20° of plantar flexion to dorsiflexion, to end in a neutral position.<ref name="Shultz" />
 
'''Mid Swing'''
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.
* 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" />
{| class="wikitable"
* 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" />
|+
'''Late Swing/declaration'''
<ref name=":0" />
* Hip flexion of 25-30°
!
* Locked extension of the knee
!Kinematics/Joint Motion
* Neutral position of the ankle.<ref name="Shultz" />
!Muscle Action
|-
|[[Ankle and Foot|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.<ref name="Shultz" />
{| class="wikitable"
!
!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
|}
 
<ref name=":0" />
 
'''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" />
{| class="wikitable"
!
!Kinematics/Joint Motion
!Muscle Action
|-
|Ankle
|Gradual dorsiflexion
|Eccentric plantarflexors and concentric dorsiflexors
|-
|Knee
|Begins to extend
|Concentric extensors
|-
|Hip
|Gradual extension
|Concentric extensors
|}
 
<ref name=":0" />
 
'''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.<ref name="Shultz" />  
{| class="wikitable"
!
!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
|}
 
<ref name=":0" />
 
'''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" />
{| class="wikitable"
!
!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
|}
 
<ref name=":0" />
 
'''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.
{| class="wikitable"
!
!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
|}
 
<ref name=":0" />
 
'''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.
{| class="wikitable"
!
!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
|}
 
<ref name=":0" />
 
'''Late Swing/Deceleration - 85-100%'''
 
Begins when the swing leg tibia is vertical and ends with initial contact. Limb advancement slows in preparation.
{| class="wikitable"
!
!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
|}
<ref name=":0" />
 
== Clinical Application ==
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.<ref name=":0" /> Injury or disease can alter any of the sub-phases of the gait cycle, resulting in distinct [[Gait Deviations|characteristics of the gait pattern]].<ref>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: <nowiki>https://www.sciencedirect.com/science/article/abs/pii/S1877132720300397</nowiki></ref>


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

Latest revision as of 20:21, 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 (GRF).


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 sub-phases:

  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 three sub-phases:

  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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