Joint Range of Motion During Gait: Difference between revisions

No edit summary
No edit summary
Line 5: Line 5:


== Introduction ==
== Introduction ==
Merriam-Webster dictionary defines gait as “a manner of walking or moving on foot."<ref>Merriam-Webster. Gait. Available from: https://www.merriam-webster.com/dictionary/gait [last accessed 23.6.2022]</ref> It involves the interaction between the [[Introduction to Neuroanatomy|nervous]], musculoskeletal, and [[Cardiopulmonary Exercise Testing (CPET) In Adults|cardiorespiratory]] systems and is heavily impacted by human age, personality, mood, and sociocultural factors.<ref name=":0">Pirker W, Katzenschlager R. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318488/ 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]</ref> 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."<ref name=":0" />  
Merriam-Webster dictionary defines gait as “a manner of walking or moving on foot."<ref>Merriam-Webster. Gait. Available from: https://www.merriam-webster.com/dictionary/gait [last accessed 23.6.2022]</ref> It involves the interaction between the [[Introduction to Neuroanatomy|nervous]], musculoskeletal, and [[Cardiopulmonary Exercise Testing (CPET) In Adults|cardiorespiratory]] systems and is heavily impacted by human age, personality, mood, and sociocultural factors.<ref name=":0">Pirker W, Katzenschlager R. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318488/ 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]</ref><ref>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.</ref> 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."<ref name=":0" /><ref>Mirelman A, Shema S, Maidan I, Hausdorff JM. Gait. Handbook of clinical neurology. 2018 Jan 1;159:119-34.</ref>  


== Stance Versus Swing Phase ==
== Stance Versus Swing Phase ==
Line 11: Line 11:


* 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 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<span class="reference" id="cite_ref-Loudon_4-3"></span> 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.<ref name=":1" />
* The swing phase occupies 60-100% (total<span class="reference" id="cite_ref-Loudon_4-3"></span> 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.<ref name=":1">Loudon J, et al. The clinical orthopedic assessment guide. 2nd ed. Kansas: Human Kinetics, 2008. p.395-408.</ref>
* 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.
* 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.<ref name=":2">Shultz SJ et al. Examination of musculoskeletal injuries. 2nd ed, North Carolina: Human Kinetics, 2005. p55-60.</ref><ref>Hazari A, Maiya AG, Nagda TV. Kinematics and Kinetics of Gait. InConceptual Biomechanics and Kinesiology 2021 (pp. 181-196). Springer, Singapore.</ref>
* Gait cycle phases: the stance phase and the swing phase involves a combination of open and close chain activities.<ref name=":2">Shultz SJ et al. Examination of musculoskeletal injuries. 2nd ed, North Carolina: Human Kinetics, 2005. p55-60.</ref><ref name=":3">Hazari A, Maiya AG, Nagda TV. Kinematics and Kinetics of Gait. InConceptual Biomechanics and Kinesiology 2021 (pp. 181-196). Springer, Singapore.</ref>


<span class="reference" id="cite_ref-Shultz_3-1"></span>
<span class="reference" id="cite_ref-Shultz_3-1"></span>


== 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. [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>
The stance and swing phases of gait can be subdivided into sub-phases of gait. For the purpose of this course, traditional terminologies of gait are used.<ref name=":3" />


# Initial contact
# Initial contact
# Loading response
# Foot flat
# Midstance
# Midstance
# Terminal stance
# Heel off
# Pre-swing
# Toe off
# Initial sw<span class="reference" id="cite_ref-Shultz_3-1"></span>ing
# Initial sw<span class="reference" id="cite_ref-Shultz_3-1"></span>ing
# Mid swing
# Mid swing
# 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  
 


See below for a diagram of the gait cycle [[File:Adapted Gait Cycle.jpg|thumb|alt=|center|800x800px]]
See below for a diagram of the gait cycle [[File:Adapted Gait Cycle.jpg|thumb|alt=|center|800x800px]]
Line 33: Line 34:
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>
== Range of Motion Involved in Gait Phases ==
== Range of Motion Involved in Gait Phases ==
For the purpose of this course traditional terminologies of gait are used.
'''Initial contact (Heel strike)'''  
'''Initial contact (Heel strike)'''  


Line 256: Line 255:
* Ankle  
* Ankle  
** At initial contact - lateral calcaneus strikes the ground first.
** 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.
** 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.<ref name=":3" />
** Utilise dorsiflexors to oppose plantarflexor torque - internal torque controlled by tibialis anterior, extensor digitorum longus and extensor hallucis.
** Utilise dorsiflexors to oppose plantarflexor torque - internal torque controlled by tibialis anterior, extensor digitorum longus and extensor hallucis.


* Knee   
* Knee   
** At initial contact - GRF is anterior to the knee joint creating anterior rotation of the femur.  
** At initial contact - GRF is anterior to the knee joint creating anterior rotation of the femur.<ref name=":3" />
** GRF wants to move into extension.  
** GRF wants to move into extension.  
** Utilise flexor musculature - hamstrings - in order to control progression.  
** Utilise flexor musculature - hamstrings - in order to control progression.  


* Hip   
* Hip   
** GRF is anterior to hip joint - creating an external torque (anterior rotation) at the pelvis.  
** GRF is anterior to hip joint - creating an external torque (anterior rotation) at the pelvis.<ref name=":3" />
** Utilise extensor musculature - gluteal musculature - to oppose/control the progression or external torque.  
** Utilise extensor musculature - gluteal musculature - to oppose/control the progression or external torque.  


Line 271: Line 270:


* Ankle   
* Ankle   
** Centre of pressure remains at the posterior calcaneus - GRF remains posterior to the ankle.  
** Centre of pressure remains at the posterior calcaneus - GRF remains posterior to the ankle.<ref name=":3" />
** Utilise dorsiflexors to prevent plantarflexion from occurring at the ankle.  
** Utilise dorsiflexors to prevent plantarflexion from occurring at the ankle.  


* Hip   
* Hip   
** Centre of pressure and GRF remains the same - anterior to the axis of rotation.  
** Centre of pressure and GRF remains the same - anterior to the axis of rotation.<ref name=":3" />
** Anterior pelvic tilt creates a flexion torque.  
** Anterior pelvic tilt creates a flexion torque.  
** Utilise extensor musculature to control this torque.  
** Utilise extensor musculature to control this torque.  
Line 281: Line 280:
* Knee  
* Knee  
** Range of motion moves from 0-15°
** Range of motion moves from 0-15°
** GRF posterior to the axis of rotation of the knee joint - creates a flexion torque.
** GRF posterior to the axis of rotation of the knee joint - creates a flexion torque.<ref name=":3" />
** Utilise extensor musculature to control knee from moving into flexion.
** Utilise extensor musculature to control knee from moving into flexion.


Line 287: Line 286:


* Ankle   
* Ankle   
** GRF creates a clockwise torque of the proximal segment (on top of distal segment) - causing a dorsiflexion moment at the talocrural joint.  
** GRF creates a clockwise torque of the proximal segment (on top of distal segment) - causing a dorsiflexion moment at the talocrural joint.<ref name=":3" />
** Utilise plantarflexors to oppose the external torque.  
** Utilise plantarflexors to oppose the external torque.  


* Knee   
* 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.  
** 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.<ref name=":3" />
** Utilise flexors to oppose this torque - activates hamstrings.  
** Utilise flexors to oppose this torque - activates hamstrings.  


* Hip   
* Hip   
** GRF is posterior to the axis of rotation - wants pelvis to move into a posterior pelvic tilt (extension).  
** GRF is posterior to the axis of rotation - wants pelvis to move into a posterior pelvic tilt (extension).<ref name=":3" />
** Utilise flexors to oppose extension torque.  
** Utilise flexors to oppose extension torque.  


Line 301: Line 300:


* Ankle  
* Ankle  
** GRF is anterior to the axis of rotation of ankle joint - wants tibia to flex on talus.  
** GRF is anterior to the axis of rotation of ankle joint - wants tibia to flex on talus.<ref name=":3" />
** Creates external dorsiflexion moment at talocrural joint.  
** Creates external dorsiflexion moment at talocrural joint.  
** Utilise plantarflexors to oppose this moment.  
** Utilise plantarflexors to oppose this moment.  


* Knee   
* Knee   
** GRF is anterior to knee joint - pulls femur into extension, creating an external extensor torque.  
** GRF is anterior to knee joint - pulls femur into extension, creating an external extensor torque.<ref name=":3" />
** Counteracted by internal flexor torque.  
** Counteracted by internal flexor torque.  


* Hip   
* Hip   
** GRF is posterior to hip joint - creates an external extensor moment.  
** GRF is posterior to hip joint - creates an external extensor moment.<ref name=":3" />
** Counteracted by internal flexor moment.  
** Counteracted by internal flexor moment.  


Line 316: Line 315:


* Ankle   
* Ankle   
** Centre of pressure/GRF stay anterior to axis of rotation of ankle joint.  
** Centre of pressure/GRF stay anterior to axis of rotation of ankle joint.<ref name=":3" />
** Creates an external dorsiflexion moment.  
** Creates an external dorsiflexion moment.  
** Counteracted by internal plantarflexion moment.  
** Counteracted by internal plantarflexion moment.  


* Knee   
* Knee   
** GRF is posterior to axis of rotation of knee joint as knee is moving into flexion.  
** GRF is posterior to axis of rotation of knee joint as knee is moving into flexion.<ref name=":3" />
** Creates an external flexion moment.  
** Creates an external flexion moment.  
** Counteracted by an internal extensor (quadricep musculature) moment.  
** Counteracted by an internal extensor (quadricep musculature) moment.  


* Hip   
* Hip   
** GRF is posterior to axis of rotation of hip joint as hip is moving into extension.  
** GRF is posterior to axis of rotation of hip joint as hip is moving into extension.<ref name=":3" />
** Creates a posterior pelvic tilt.  
** Creates a posterior pelvic tilt.  
** Utilise flexor musculature (iliopsoas) to counteract this moment.  
** Utilise flexor musculature (iliopsoas) to counteract this moment.  

Revision as of 10:47, 5 September 2022

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 normal forward stride consists of two phases: the stance phase and the swing phase.[5]

  • 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.[6]
  • 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.[7][8]

Phases of Gait[edit | edit source]

The stance and swing phases of gait can be subdivided into sub-phases of gait. For the purpose of this course, traditional terminologies of gait are used.[8]

  1. Initial contact
  2. Foot flat
  3. Midstance
  4. Heel off
  5. Toe off
  6. Initial swing
  7. Mid swing
  8. Late swing


See below for a diagram of the gait cycle

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

[9]

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[10]
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

  • 8-10% of 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

  • 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

  • 30-40% of 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

  • 60% of gait cycle (final phase of stance)
  • Function
    • Final burst of propulsion to propel the body forward
Range of Motion Requirements During Toe Off
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
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

  • 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
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

  • 85-100% of gait cycle
  • Tibia vertical to initial contact
  • Function
    • To decelerate 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 [11]

Maximum Values[edit | edit source]

Maximum range of motion values is the minimum prerequisites for a normal gait pattern.[12]

Maximum Range of Motion at Lower Extremity Joints during 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

  • 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.[8]
    • 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.[8]
    • 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.[8]
    • 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.[8]
    • 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.[8]
    • 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.[8]
    • 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.[8]
    • 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.[8]
    • 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).[8]
    • 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.[8]
    • 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.[8]
    • Counteracted by internal flexor torque.
  • Hip
    • GRF is posterior to hip joint - creates an external extensor moment.[8]
    • Counteracted by internal flexor moment.

Toe off

  • Ankle
    • Centre of pressure/GRF stay anterior to axis of rotation of ankle joint.[8]
    • 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.[8]
    • 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.[8]
    • 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]

  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. ↑ Loudon J, et al. The clinical orthopedic assessment guide. 2nd ed. Kansas: Human Kinetics, 2008. p.395-408.
  7. ↑ Shultz SJ et al. Examination of musculoskeletal injuries. 2nd ed, North Carolina: Human Kinetics, 2005. p55-60.
  8. ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 8.12 8.13 8.14 8.15 8.16 Hazari A, Maiya AG, Nagda TV. Kinematics and Kinetics of Gait. InConceptual Biomechanics and Kinesiology 2021 (pp. 181-196). Springer, Singapore.
  9. ↑ Nicole Comninellis. The Gait Cycle Animation. Available from: https://www.youtube.com/watch?time_continue=35&v=DP5-um6SvQI [last accessed 19.7.2022]
  10. ↑ Webster JB, Darter BJ. Principles of normal and pathologic gait. InAtlas of Orthoses and Assistive Devices 2019 Jan 1 (pp. 49-62). Elsevier.
  11. ↑ Alexandra Kopelovich. Gait Range of Motion. Available from: https://www.youtube.com/watch?v=5Z6shSu96CM [last accessed 19.7.2022]
  12. ↑ Kopelovich, A. Joint Range of Motion during Gait. Course. Plus. 2022
Retrieved from "https://www.physio-pedia.com/index.php?title=Joint_Range_of_Motion_During_Gait&oldid=316186"