Joint Range of Motion During Gait

Original Editor - Rachel Celentano based on the course by Alexandra Kopelovich

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][3] 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][4]

Stance Versus Swing Phase[edit | edit source]

The typical forward stride consists of two phases: stance phase and swing phase.[5]

  • The stance phase occupies 0-60% of the gait cycle. During stance phase, one leg and foot bear most or all of the body weight.[6]
  • The swing phase occupies 60-100% (total 40%) of the gait cycle. During swing phase, the foot does not touch the walking surface and the body weight is borne by the other leg and foot.[7]
  • 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.[6]
  • Gait cycle phases: the stance phase and the swing phase involve a combination of open and close chain activities.[8][9]

Read more here: The Gait Cycle

Phases of Gait[edit | edit source]

The stance and swing phases of gait can be subdivided into eight sub-phases.[6][9]

  1. Initial contact (heel strike)
  2. Foot flat (loading response)
  3. Midstance (single-leg support)
  4. Heel off (terminal stance)
  5. Toe off (preswing)
  6. Initial swing
  7. Mid swing
  8. Late swing (deceleration)

See below for a diagram of the gait cycle:

The video below shares a 90-second description of the basics of the gait cycle:

[10]

Range of Motion Involved in Gait Phases[edit | edit source]

Initial contact (heel strike)

  • Occurs at 0% of the gait cycle
  • Previously referred to as "heel strike", but in some pathological gaits, the heel strike may not be the initial contact [6]
  • Function:
    • To establish contact with the surface and initiate weight acceptance[11]
Range of Motion (ROM) at Initial Contact
Body part ROM requirements
Ankle 0° (neutral position)
Knee 0° (full extension)
Hip average 20° of flexion

Foot flat (loading response)

  • Occurs at 8-10% of the gait cycle
  • Function:
    • Weight acceptance and shock absorption
Range of Motion (ROM) Requirements During Foot Flat
Body part ROM requirements
Ankle 0-5° plantarflexion
Knee 15° of flexion
Hip 15° of flexion (hip is moving into extension)

Midstance (single-leg support)

  • The greater trochanter is vertically above the mid-point of the foot
  • Function:
    • Single limb support and stability
Range of Motion (ROM) Requirements During Midstance
Body part ROM requirements
Ankle 5° of dorsiflexion
Knee 5° of flexion
Hip 0° of flexion (neutral position)

Heel off (terminal stance)

  • Occurs at around 30-40% of the gait cycle
  • Function
    • Single limb support, stability, and propulsion
Range of Motion (ROM) Requirements During Heel Off
Body part ROM requirements
Ankle 0° (neutral position)
Knee 0° of flexion (complete extension)
Hip 10-20° of hyperextension

Toe off (preswing)

  • Occurs at 60% of the gait cycle (final phase of stance)
  • Function
    • Final burst of propulsion to propel the body forward
Range of Motion (ROM) Requirements During Toe Off
Body part ROM requirements
Ankle 20° of plantarflexion
Knee 30° of flexion
Hip 10-20° of hyperextension

Early swing

  • Occurs at 60-75% of the gait cycle (beginning of swing phase)
  • Toe off until the swinging limb is even with the stance limb
  • Function
    • To propel the lower extremity forward and shorten the limb for foot clearance
Range of Motion Requirements During Early Swing
Body part ROM requirements
Ankle 10° of plantarflexion
Knee 60° of flexion
Hip moves into 20° of flexion

Mid swing

  • Occurs at 75-85% of the gait cycle
  • Swinging limb is opposite the stance limb
  • Function
    • To clear the lower extremity from the ground in order to advance into initial contact
Range of Motion (ROM) Requirements During Mid Swing
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

  • Occurs at 85-100% of the gait cycle
  • Tibia vertical to initial contact
  • Function
    • To decelerate the lower extremity to establish contact with the ground
Range of Motion (ROM) Requirements During Late Swing
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 [12]

Maximum Values[edit | edit source]

It is important for clinicians to be aware of the range of motion values necessary as the minimum prerequisites for a normal gait pattern.[13] It is also important to know during which subphase of the gait cycle these ranges of motion occur as this will aid in gait analysis and enable clinicians to observe for specific gait pathology.

Maximum Range of Motion (ROM) at Lower Extremity Joints during the Gait Cycle
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[edit | edit source]

  • Ground reaction force (GRF) = forces applied by the ground to the foot, when the foot is in contact with the ground[14]
    • Creates an external plantarflexion or dorsiflexion torque
    • If GRF is anterior to the joint axis - this causes an anterior motion of the proximal segment
    • If GRF is posterior to the joint axis - this causes a posterior motion of the proximal segment
    • Read more: Ground Reaction Forces
  • Lower extremity gait musculature - creates an internal torque
  • Centre of pressure - point of application of pressure to the foot segment
  • Read more: Gait Definitions

Initial contact (heel strike)[edit | edit source]

  • Ankle
    • At initial contact - lateral calcaneus strikes the ground first.
    • Ground reaction forces are slightly posterior to the axis of rotation of the foot and ankle joint. This creates a plantarflexion moment at the ankle.[9]
    • Ankle dorsiflexors oppose this plantarflexor torque - internal torque is controlled by tibialis anterior, extensor digitorum longus and extensor hallucis.[6]
  • Knee
    • At initial contact - GRF is anterior to the knee joint creating anterior rotation of the femur.[9]
    • GRF wants to move into extension.
    • Utilise flexor musculature - hamstrings - in order to control progression.
  • Hip
    • GRF is anterior to the hip joint - this creates an external torque (anterior rotation) at the pelvis.[9]
    • Utilise extensor musculature - gluteal musculature - to oppose/control the progression or external torque.

Foot flat (loading response)[edit | edit source]

  • Ankle
    • Centre of pressure remains at the posterior calcaneus - GRF remains posterior to the ankle.[9]
    • 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.[9]
    • 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.[9]
    • Utilise extensor musculature to control the knee from moving into flexion.

Midstance (single-leg support)[edit | edit source]

  • Ankle
    • GRF creates a clockwise torque of the proximal segment (on top of distal segment) - causing a dorsiflexion moment at the talocrural joint.[9]
    • Utilise plantarflexors to oppose the external torque.
  • Knee
    • GRF creates an anterior (clockwise) torque of the proximal segment (on top of distal segment) - wants to move into extension by the femur moving anteriorly on the tibia.[9]
    • Utilise flexors to oppose this torque - this activates the hamstrings.
  • Hip
    • GRF is posterior to the axis of rotation - wants pelvis to move into a posterior pelvic tilt (extension).[9]
    • Utilise flexors to oppose extension torque.

Heel off (terminal stance)[edit | edit source]

  • Ankle
    • GRF is anterior to the axis of rotation of the ankle joint - wants the tibia to flex on the talus.[9]
    • Creates an external dorsiflexion moment at the talocrural joint.
    • Utilise plantarflexors to oppose this moment.
  • Knee
    • GRF is anterior to the knee joint - this pulls the femur into extension, creating an external extensor torque.[9]
    • Counteracted by an internal flexor torque.
  • Hip
    • GRF is posterior to the hip joint - this creates an external extensor moment.[9]
    • Counteracted by an internal flexor moment.

Toe off (preswing)[edit | edit source]

  • Ankle
    • Centre of pressure/GRF stay anterior to the axis of rotation of the ankle joint.[9]
    • Creates an external dorsiflexion moment.
    • Counteracted by an internal plantarflexion moment.
  • Knee
    • GRF is posterior to the axis of rotation of the knee joint as the knee is moving into flexion.[9]
    • Creates an external flexion moment.
    • Counteracted by an internal extensor (quadriceps musculature) moment.
  • Hip
    • GRF is posterior to the axis of rotation of the hip joint as the hip is moving into extension.[9]
    • Creates a posterior pelvic tilt.
    • Utilise flexor musculature (iliopsoas) to counteract this moment.

Internal Torque Peaks[edit | edit source]

The sagittal internal torque peaks at the hip, knee and ankle are[15]:

Hip:

  • Foot flat - extensor torque
  • Heel off - flexor torque

Knee:

  • Initial contact - flexor torque (hamstrings musculature active)
  • Foot flat - extensor torque (quadriceps musculature active)
  • Heel off - flexor torque (hamstrings musculature active)

Ankle:

  • Initial contact/foot flat - dorsiflexion torque
  • Heel off - plantarflexion torque (gastrocnemius/soleus active)

References[edit | edit source]

  1. ↑ Merriam-Webster. Gait. Available from: https://www.merriam-webster.com/dictionary/gait [last accessed 23.6.2022]
  2. ↑ 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. ↑ Das R, Paul S, Mourya GK, Kumar N, Hussain M. Recent Trends and Practices Toward Assessment and Rehabilitation of Neurodegenerative Disorders: Insights From Human Gait. Frontiers in Neuroscience. 2022;16.
  4. ↑ Mirelman A, Shema S, Maidan I, Hausdorff JM. Gait. Handbook of clinical neurology. 2018 Jan 1;159:119-34.
  5. ↑ Cicirelli G, Impedovo D, Dentamaro V, Marani R, Pirlo G, D’Orazio TR. Human gait analysis in neurodegenerative diseases: a review. IEEE Journal of Biomedical and Health Informatics. 2021 Jun 28;26(1):229-42.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 Magee DJ, Manske RC. Orthopedic physical assessment-E-Book. Elsevier Health Sciences; 2020 Dec 11.
  7. ↑ Loudon J, et al. The clinical orthopedic assessment guide. 2nd ed. Kansas: Human Kinetics, 2008. p.395-408.
  8. ↑ Shultz SJ et al. Examination of musculoskeletal injuries. 2nd ed, North Carolina: Human Kinetics, 2005. p55-60.
  9. ↑ 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10 9.11 9.12 9.13 9.14 9.15 9.16 Hazari A, Maiya AG, Nagda TV. Kinematics and Kinetics of Gait. InConceptual Biomechanics and Kinesiology 2021 (pp. 181-196). Springer, Singapore.
  10. ↑ Nicole Comninellis. The Gait Cycle Animation. Available from: https://www.youtube.com/watch?time_continue=35&v=DP5-um6SvQI [last accessed 19.7.2022]
  11. ↑ Webster JB, Darter BJ. Principles of normal and pathologic gait. InAtlas of Orthoses and Assistive Devices 2019 Jan 1 (pp. 49-62). Elsevier.
  12. ↑ Alexandra Kopelovich. Gait Range of Motion. Available from: https://www.youtube.com/watch?v=5Z6shSu96CM [last accessed 19.7.2022]
  13. ↑ Kopelovich, A. Joint Range of Motion during Gait. Course. Plus. 2022
  14. ↑ Elhafez SM, Ashour AA, Elhafez NM, Elhafez GM, Abdelmohsen AM. Percentage contribution of lower limb moments to vertical ground reaction force in normal gait. Journal of Chiropractic Medicine. 2019 Jun 1;18(2):90-6.
  15. ↑ Neumann DA. Neumann Kinesiology of the musculoskeletal system: Foundations for Rehabilitation. St Louis: Mosby: 2010.
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