Joint Range of Motion During Gait

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Introduction

Merriam-Webster dictionary defines gait as “a manner of walking or moving on foot.” It involves the interaction between the nervous, musculoskeletal, and cardiorespiratory systems and is heavily impacted by human age, personality, mood, and sociocultural factors. 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.”

Phases of Gait

There are 8 phases of gait which are listed as follows:

1. Initial Contact
2. Loading Response
3. Midstance
4. Terminal Stance
5. Pre swing
6. Initial Swing
7. Mid Swing
8. Late Swing

Range of Motion Involved in Gait Phases

Initial contact (Heel Strike):

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.

• After this, knee flexion (5°) begins and increases, just as the plantar flexion of the heel increased.

• Plantar flexion is allowed by eccentric contraction of the tibialis anterior

• Extension of the knee is caused by a contraction of the quadriceps

• Flexion is caused by a contraction of the hamstrings,

• Flexion of the hip is caused by the contraction of the rectus femoris.

Loading Response (Foot Flat):

Involves:

• Body absorbs the impact of the foot by rolling in pronation.

• Hip moves slowly into extension, caused by a contraction of the adductor magnus and gluteus maximus muscles.

• Knee flexes to 15° to 20° of flexion.

• Ankle plantarflexion increases to 10-15°.

Midstance:

Involves:

• Hip moves from 10° of flexion to extension by contraction of the gluteus medius muscle.

• Knee reaches maximal flexion and then begins to extend.

• Ankle becomes supinated and dorsiflexed (5°), which is caused by some contraction of the triceps surae muscles.

• 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.

Heel Off:

Involves:

• Begins when the heel leaves the floor.

• Bodyweight is divided over the metatarsal heads.

• 10-13° of hip hyperextension, which then goes into flexion.

• Knee becomes flexed (0-5°).

• Ankle supinates and plantar flexes.

Early Swing:

Involves:

• Hip extends to 10° and then flexes due to contraction of the iliopsoas muscle 20° with lateral rotation.

• Knee flexes to 40-60°.

• Ankle goes from 20° of plantar flexion to dorsiflexion, to end in a neutral position.

Mid Swing:

Involves:

• Hip flexes to 30° (by contraction of the adductors) and the ankle becomes dorsiflexed due to a contraction of the tibialis anterior muscle.

• Knee flexes 60° but then extends approximately 30° due to the contraction of the sartorius muscle. (caused by the quadriceps muscles).

Late Swing:

Involves:

• Hip flexion of 25-30°

• Locked extension of the knee

• Neutral position of the ankle.

The following video describes the range of motion requirements involved in the different gait phases:

Range of Motion during Gait

<ref>Alexandra Kopelovich. Gait Range of Motion Available from: https://www.youtube.com/watch?v=5Z6shSu96CM [last accessed 22/6/22]

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