Gait Deviations Associated with Pelvis and Knee Pain Syndromes: Difference between revisions
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== Introduction == | == Introduction == | ||
This article discusses gait deviations associated with pain syndromes in the pelvis and knee. While this information focuses on certain regions of the body, remember that the human body functions within a kinetic chain. No one movement is ever completely isolated and is without effect on another. | This article discusses gait deviations associated with pain syndromes in the pelvis and knee. While this information focuses on certain regions of the body, remember that the human body functions within a kinetic chain. No one movement is ever completely isolated and is without effect on another.<ref name=":1">Howell, D, Gait Deviation Associated with Pain Syndromes in the Pelvis and Knee. Gait Analysis. Physioplus. 2022</ref> | ||
For a review of the gait cycle, please review [[Gait Cycle|this article]]. For an overview of gait deviations, please review [[Gait Deviations|this article]]. To review common gait terminology and definitions, please review [[Gait Definitions|this article]]. | For a review of the gait cycle, please review [[Gait Cycle|this article]]. For an overview of gait deviations, please review [[Gait Deviations|this article]]. To review common gait terminology and definitions, please review [[Gait Definitions|this article]]. | ||
[[File:Gait cycle.jpg|center|frameless|900x900px]] | |||
== Pain Syndromes and Gait Deviation == | == Pain Syndromes and Gait Deviation == | ||
Gait deviations are likely related to the development and or associated with musculoskeletal pain syndromes. It is often the complaint of pain that will lead a patient to physiotherapy. It is the role of the physiotherapist to educate the patient on the etiology of their pain while treating and correcting the noted gait deviation. <blockquote>Gait Deviation Definition HERE</blockquote>The most commonly noted gait deviations for pain syndromes include: | Gait deviations are likely related to the development and or associated with musculoskeletal pain syndromes. It is often the complaint of pain that will lead a patient to physiotherapy. It is the role of the physiotherapist to educate the patient on the etiology of their pain while treating and correcting the noted gait deviation.<ref name=":1" /> <blockquote>Gait Deviation Definition HERE</blockquote>The most commonly noted gait deviations for pain syndromes include:<ref name=":1" /> | ||
# Decreased gait velocity (most frequent gait deviation for patients with neurological deficits) | # Decreased gait velocity (most frequent gait deviation for patients with neurological deficits) | ||
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Average walking speed for geriatric patients and those with a known fall risk is greater than one-metre to 1.4 metres/second. Deviant gait velocity is measured at a slower pace.<ref name=":0" /> | Average walking speed for geriatric patients and those with a known fall risk is greater than one-metre to 1.4 metres/second. Deviant gait velocity is measured at a slower pace.<ref name=":0" /> | ||
== Ground Reaction Forces == | |||
'''Ground reaction force''' is a summation of all the forces transmitted from the ground up into the body.<ref name=":1" /> Ground reaction force is influenced from all directions: vertical, anterior-posterior, and medial-lateral. These forces are typically measured and recorded using a three-dimensional force plate.<ref name=":2">Yu L, Mei Q, Xiang L, et al. [https://www.frontiersin.org/articles/10.3389/fbioe.2021.629809/full#refer1 Principal Component Analysis of the Running Ground Reaction Forces With Different Speeds]. Front. Bioeng. Biotechnol.. 2021; 9:629809.</ref> | |||
During walking, the '''vertical ground reaction force''' is the largest component of the total ground reaction force. This creates forces greater than a person's total body weight per step. The graphed curve of the vertical ground reaction force consists of two peaks: the impact loading<ref name=":1" /> or passive (weight acceptance as the heel strikes the ground) peak and the active (push off) peak.<ref name=":2" /> <ref name=":3">Jiang X, Napier C, Hannigan B, Eng JJ, Menon C. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436236/ Estimating vertical ground reaction force during walking using a single inertial sensor]. Sensors. 2020 Jan;20(15):4345.</ref>The passive peak is caused by the foot pushing against the ground, whereas the active peak is caused by the active force applied by the foot as it pushes away from the ground. The '''anterior-posterior ground reaction force''' includes braking peak and propulsion peak.<ref name=":2" /> The unique patterns of these peaks illustrate the load forces at the joints and muscles of the lower extremity. These forces felt throughout the limb can influence the development or exacerbation of musculoskeletal overuse or stress injuries.<ref name=":3" /> | |||
When interpreting a ground reaction curve, the steeper the curve the more significant the impact forces. The curve on the anterior-posterior curve (the breaking forces) will be negative. In general, the greater the forces, the greater risk for stress or overuse injuries.<ref name=":1" /> | |||
Please view the following video for a quick yet detailed overview of ground reaction forces during the human gait cycle. This video provides excellent visualization of how ground reaction forces shift in different directions as the person moves through space. | |||
== Gait Deviations == | == Gait Deviations == |
Revision as of 03:36, 31 May 2022
Top Contributors - Stacy Schiurring, Kim Jackson, Lucinda hampton and Jess Bell
Introduction[edit | edit source]
This article discusses gait deviations associated with pain syndromes in the pelvis and knee. While this information focuses on certain regions of the body, remember that the human body functions within a kinetic chain. No one movement is ever completely isolated and is without effect on another.[1]
For a review of the gait cycle, please review this article. For an overview of gait deviations, please review this article. To review common gait terminology and definitions, please review this article.
Pain Syndromes and Gait Deviation[edit | edit source]
Gait deviations are likely related to the development and or associated with musculoskeletal pain syndromes. It is often the complaint of pain that will lead a patient to physiotherapy. It is the role of the physiotherapist to educate the patient on the etiology of their pain while treating and correcting the noted gait deviation.[1]
Gait Deviation Definition HERE
The most commonly noted gait deviations for pain syndromes include:[1]
- Decreased gait velocity (most frequent gait deviation for patients with neurological deficits)
- Decreased vertical oscillation of centre of mass
- Delayed heel off
Walking Speed, the Sixth Vital Sign[edit | edit source]
According to a 2009 paper by Fritz, walking speed (ie gait velocity) is "almost the perfect measure." Patient self-selected walking speed has been found to be a reliable, valid, sensitive and specific measure which correlates with functional ability, and balance confidence.[2]
"Walking speed, like blood pressure, may be a general indicator that can predict future events and reflect various underlying physiological processes. While walking speed cannot stand alone as the only predictor of functional abilities, just at blood pressure is not the only sign of heart disease; walking speed can be used as a functional “vital sign” to help determine outcomes such as functional status, discharge location, and the need for rehabilitation." [2]
Applications of walking speed as a clinical measure:[2]
- Has the potential to predict future health status and functional decline
- Can be used to predict future hospitalisation, discharge location and patient mortality
- Reflects both patient functional and physiological changes
- Is a factor in determining potential for rehabilitation
- Aids in prediction of falls and fear of falling
- Walking speed progression has been linked to clinical meaningful changes in quality of life
Average walking speed for geriatric patients and those with a known fall risk is greater than one-metre to 1.4 metres/second. Deviant gait velocity is measured at a slower pace.[2]
Ground Reaction Forces[edit | edit source]
Ground reaction force is a summation of all the forces transmitted from the ground up into the body.[1] Ground reaction force is influenced from all directions: vertical, anterior-posterior, and medial-lateral. These forces are typically measured and recorded using a three-dimensional force plate.[3]
During walking, the vertical ground reaction force is the largest component of the total ground reaction force. This creates forces greater than a person's total body weight per step. The graphed curve of the vertical ground reaction force consists of two peaks: the impact loading[1] or passive (weight acceptance as the heel strikes the ground) peak and the active (push off) peak.[3] [4]The passive peak is caused by the foot pushing against the ground, whereas the active peak is caused by the active force applied by the foot as it pushes away from the ground. The anterior-posterior ground reaction force includes braking peak and propulsion peak.[3] The unique patterns of these peaks illustrate the load forces at the joints and muscles of the lower extremity. These forces felt throughout the limb can influence the development or exacerbation of musculoskeletal overuse or stress injuries.[4]
When interpreting a ground reaction curve, the steeper the curve the more significant the impact forces. The curve on the anterior-posterior curve (the breaking forces) will be negative. In general, the greater the forces, the greater risk for stress or overuse injuries.[1]
Please view the following video for a quick yet detailed overview of ground reaction forces during the human gait cycle. This video provides excellent visualization of how ground reaction forces shift in different directions as the person moves through space.
Gait Deviations[edit | edit source]
Gait Deviation | Expected Movement Pattern | Deviant Movement Pattern | Secondary Signs Associated with Deviant Movement |
---|---|---|---|
Increased vertical oscillation of centre of mass
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Choose a fixed location such as the top of the head, sacrum, or belt line. Compare the highest point during swing phase to the lowest point during stance phase.
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Decreased vertical oscillation of centre of mass | (Same as above) |
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Contralateral pelvic drop | During stance phase, a line drawn between the posterior superior iliac spines (PSIS's) should deviate no more than four degrees inferiorly. | During stance phase, the line between the PSIS's will deviate inferiorly greater than four degrees.
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|
Contralateral pelvic elevation
(Hip or pelvic hiking) |
During stance phase, a line drawn between the posterior superior iliac spines (PSIS's) should deviate no more than four degrees superiorly. | During stance phase, the line between the PSIS's will deviate superiorly greater than four degrees.
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Lack of knee separation
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Unless morbidly obese, when walking and viewed from front or behind, there should be a space or "daylight" between the knees and thighs. | When walking and viewed from front or behind, there is an absence of space or "daylight" between the knees or thighs.
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|
Foot crossing the midline | When walking and viewed from front or behind, the opposite foot strike should be visible and not cross a vertical line which travels from the belly button to the ground.
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When walking and viewed from behind, the opposite foot strike is not visible because the foot crosses the vertical line.
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Popliteal skin crease
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When viewed from behind during stance phase, the skin crease on the back of the knee should be horizontal. | When viewed from behind, the skin crease will be oblique from superiolateral to inferiomedial (inferring there is excessive movement of the femur into medial rotation).
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Varus thrust | During stance phase, when viewed from front or behind, there should be little to no lateral/medial deviation or translation of the knee | During stance phase, when viewed from front or behind, there is a high-velocity small-amplitude lateral deviation of the knee with a rapid return to neutral alignment. |
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Pain Syndromes Associated with Gait Deviations[edit | edit source]
Gait Deviation | Associated Pain
and Pain Syndromes |
---|---|
Increased vertical oscillation of centre of mass
|
|
Decreased vertical oscillation of centre of mass |
|
Contralateral pelvic drop |
|
Contralateral pelvic elevation
(Hip or pelvic hiking) |
|
Lack of knee separation
|
|
Foot crossing the midline |
|
Popliteal skin crease
|
|
Varus thrust |
|
Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Howell, D, Gait Deviation Associated with Pain Syndromes in the Pelvis and Knee. Gait Analysis. Physioplus. 2022
- ↑ 2.0 2.1 2.2 2.3 Fritz S, Lusardi M. White paper:“walking speed: the sixth vital sign”. Journal of geriatric physical therapy. 2009 Jan 1;32(2):2-5.
- ↑ 3.0 3.1 3.2 Yu L, Mei Q, Xiang L, et al. Principal Component Analysis of the Running Ground Reaction Forces With Different Speeds. Front. Bioeng. Biotechnol.. 2021; 9:629809.
- ↑ 4.0 4.1 Jiang X, Napier C, Hannigan B, Eng JJ, Menon C. Estimating vertical ground reaction force during walking using a single inertial sensor. Sensors. 2020 Jan;20(15):4345.