Joint Range of Motion During Gait: Difference between revisions
No edit summary |
No edit summary |
||
Line 18: | Line 18: | ||
== Phases of Gait == | == Phases of Gait == | ||
There are 8 phases of gait which are listed as follows:<ref name=":1">Loudon J, et al. The clinical orthopedic assessment guide. 2nd ed. Kansas: Human Kinetics, 2008. p.395-408.</ref><ref>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 | There are 8 phases of gait which are listed as follows:<ref name=":1">Loudon J, et al. The clinical orthopedic assessment guide. 2nd ed. Kansas: Human Kinetics, 2008. p.395-408.</ref><ref>Stöckel T, Jacksteit R, Behrens M, Skripitz R, Bader R, Mau-Moeller A. [https://www.frontiersin.org/articles/10.3389/fpsyg.2015.00943/full The mental representation of the human gait in young and older adults.] Frontiers in psychology. 2015 Jul 14;6:943. </ref> | ||
# Initial Contact | # Initial Contact | ||
Line 29: | Line 29: | ||
# Late Swing <ref>Berger W, et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1193250/pdf/jphysiol00583-0125.pdf 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]</ref> | # Late Swing <ref>Berger W, et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1193250/pdf/jphysiol00583-0125.pdf 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]</ref> | ||
See below for a diagram of the gait cycle | See below for a diagram of the gait cycle [[File:Adapted Gait Cycle.jpg|thumb|alt=|center|800x800px]] | ||
The video below shares a 90-second description of the basics of the gait 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 [last accessed 19.7.2022]</ref> | The video below shares a 90-second description of the basics of the gait 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 [last accessed 19.7.2022]</ref> | ||
Line 63: | Line 63: | ||
{| class="wikitable" | {| class="wikitable" | ||
|+ | |+ | ||
Range of Motion Requirements during Foot Flat | Range of Motion (ROM) Requirements during Foot Flat | ||
!Body part | !Body part | ||
!ROM requirements | !ROM requirements | ||
Line 86: | Line 86: | ||
{| class="wikitable" | {| class="wikitable" | ||
|+ | |+ | ||
Range of Motion (ROM) Requirements during Midstance | |||
!Body part | !Body part | ||
!ROM requirements | !ROM requirements | ||
Line 121: | Line 122: | ||
|10-20° of hyperextension | |10-20° of hyperextension | ||
|} | |} | ||
'''Toe off''' | '''Toe off''' | ||
Line 149: | Line 149: | ||
* 60-75% of gait cycle (beginning of swing phase) | * 60-75% of gait cycle (beginning of swing phase) | ||
* Toe off until the swinging limb is even with the stance limb | |||
*Function | *Function | ||
Line 171: | Line 172: | ||
* 75-85% of gait cycle | * 75-85% of gait cycle | ||
* Swinging limb is opposite the stance limb | |||
*Function | *Function | ||
**To clear lower extremity from the ground in order to advance into initial | **To clear lower extremity from the ground in order to advance into initial contact | ||
* | * | ||
{| class="wikitable" | {| class="wikitable" | ||
Line 194: | Line 196: | ||
* 85-100% of gait cycle | * 85-100% of gait cycle | ||
* Tibia vertical to initial contact | |||
* Function | * Function | ||
** To decelerate lower extremity to establish contact with the ground | ** To decelerate lower extremity to establish contact with the ground | ||
Line 219: | Line 222: | ||
== Maximum Values == | == Maximum Values == | ||
Maximum range of motion values | Maximum range of motion values is the minimum prerequisites for a normal gait pattern.<ref>Kopelovich, A. Joint Range of Motion during Gait. Course. Plus. 2022</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
|+ | |+ | ||
Maximum Range of Motion at Lower Extremity Joints during Gait Cycle | |||
!Body part | !Body part | ||
!Maximum ROM values | !Maximum ROM values | ||
Line 236: | Line 240: | ||
== Gait Kinetics == | == Gait Kinetics == | ||
'''Definitions | '''Definitions''' | ||
* Ground reaction force (GRF) | * Ground reaction force (GRF) | ||
** creates an external plantarflexion or dorsiflexion torque | |||
** If GRF anterior to joint axis - causes anterior motion of the proximal segment | |||
** If GRF is posterior to joint axis - causes posterior motion of the proximal segment | |||
* Lower extremity gait musculature - creates an internal torque. | * Lower extremity gait musculature - creates an internal torque. | ||
* Centre of pressure - point of application of pressure to the foot segment | * Centre of pressure - point of application of pressure to the foot segment | ||
'''Initial contact | '''Initial contact''' | ||
Ankle - | * 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. | |||
* At initial contact - | * Knee | ||
** At initial contact - GRF is anterior to the knee joint creating anterior rotation of the femur. | |||
* Utilise | ** 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. | |||
* GRF | * Hip | ||
* Utilise extensor musculature | ** 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 | ||
* Utilise | ** 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 | ** Utilise flexors to oppose extension torque. | ||
'''Heel off''' | |||
* | * Ankle | ||
* GRF | ** GRF is anterior to the axis of rotation of ankle joint - wants tibia to flex on talus. | ||
* Utilise | ** 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''' | |||
'''Toe off | |||
* GRF | * Ankle | ||
* Creates an external | ** Centre of pressure/GRF stay anterior to axis of rotation of ankle joint. | ||
* Counteracted by | ** 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. | |||
* GRF is posterior to axis of rotation of hip joint as hip is moving into extension. | * Hip | ||
* Creates a posterior pelvic tilt. | ** GRF is posterior to axis of rotation of hip joint as hip is moving into extension. | ||
* Utilise flexor musculature (iliopsoas) to counteract this moment. | ** Creates a posterior pelvic tilt. | ||
** Utilise flexor musculature (iliopsoas) to counteract this moment. | |||
== Internal Torque Peaks == | == Internal Torque Peaks == |
Revision as of 14:09, 3 September 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 stride consists of two phases: the stance phase and the swing phase.[3]
- The stance phase occupies 0-60% of the gait cycle, during which one leg and foot are bearing most or all of the body weight.
- 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.[4]
- 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 involves a combination of open and close chain activities.[5]
Phases of Gait[edit | edit source]
There are 8 phases of gait which are listed as follows:[4][6]
- Initial Contact
- Foot Flat
- Midstance
- Heel Off
- Toe Off
- Initial Swing
- Mid Swing
- Late Swing [7]
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
- Function:
- To establish contact with surface and initiate weight acceptance[9]
Body part | ROM requirements |
---|---|
Ankle | 0° (neutral position) |
Knee | 0° (full extension) |
Hip | average 20° of flexion |
Foot flat
- 8-10% of gait cycle
- Function:
- weight acceptance and shock absorption
Body part | ROM requirements |
---|---|
Ankle | 0-5° plantarflexion |
Knee | 15° of flexion |
Hip | 15° of flexion (hip is moving into extension) |
Midstance
- The greater trochanter is vertically above the mid-point of the foot
- Function:
- Single limb support and stability
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
- Function
- Single limb support, stability, and propulsion
Body part | ROM requirements |
---|---|
Ankle | 0° (neutral position) |
Knee | 0° of flexion (complete extension) |
Hip | 10-20° of hyperextension |
Toe off
- 60% of gait cycle (final phase of stance)
- Function
- Final burst of propulsion to propel the body forward
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)
- Toe off until the swinging limb is even with the stance limb
- Function
- To propel the lower extremity forward and shorten the stance limb
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
- Swinging limb is opposite the stance limb
- Function
- To clear lower extremity from the ground in order to advance into initial contact
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
- Tibia vertical to initial contact
- Function
- To decelerate lower extremity to establish contact with the ground
- To decelerate lower extremity to establish contact with the ground
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 [10]
Maximum Values[edit | edit source]
Maximum range of motion values is the minimum prerequisites for a normal gait pattern.[11]
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
- If GRF anterior to joint axis - causes anterior motion of the proximal segment
- If GRF is posterior to joint axis - causes posterior motion of the proximal segment
- 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]
- ↑ 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.
- ↑ 4.0 4.1 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. Frontiers in psychology. 2015 Jul 14;6:943.
- ↑ 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]
- ↑ Webster JB, Darter BJ. Principles of normal and pathologic gait. InAtlas of Orthoses and Assistive Devices 2019 Jan 1 (pp. 49-62). Elsevier.
- ↑ Alexandra Kopelovich. Gait Range of Motion. Available from: https://www.youtube.com/watch?v=5Z6shSu96CM [last accessed 19.7.2022]
- ↑ Kopelovich, A. Joint Range of Motion during Gait. Course. Plus. 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
- Rehabilitation
- Course Pages