Joint Range of Motion During Gait: Difference between revisions
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== Introduction == | == Introduction == | ||
Merriam-Webster dictionary defines gait as “a manner of walking or moving on foot<ref>Merriam-Webster. Gait. Available from: [[/www.merriam-webster.com/dictionary/gait|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. [[/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:[[/www.ncbi.nlm.nih.gov/pmc/articles/PMC5318488/|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: [[/www.merriam-webster.com/dictionary/gait|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. [[/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:[[/www.ncbi.nlm.nih.gov/pmc/articles/PMC5318488/|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" />” | ||
== Stance Versus Swing Phase == | |||
The normal forward step consists of two phases: stance phase and swing phase - | |||
* The stance phase occupies 0-60% of the gait cycle, during which one leg and foot are bearing most or all of the bodyweight | |||
* 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" />. | |||
* 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 and involves a combination of open and close chain activities<ref name=":2" />. | |||
<span class="reference" id="cite_ref-Shultz_3-1"></span> | |||
== Phases of Gait == | == Phases of Gait == | ||
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# Terminal Stance | # Terminal Stance | ||
# Pre swing | # Pre swing | ||
# Initial | # Initial Sw<span class="reference" id="cite_ref-Shultz_3-1"></span>ing | ||
# Mid Swing | # Mid Swing | ||
# Late Swing <ref>Berger W, et al. [[/www.ncbi.nlm.nih.gov/pmc/articles/PMC1193250/|Corrective reactions to stumbling in man: neuronal co-ordination of bilateral leg activity during gait]]. J Physiol 1984;357: 109-125.</ref> | # Late Swing <ref>Berger W, et al. [[/www.ncbi.nlm.nih.gov/pmc/articles/PMC1193250/|Corrective reactions to stumbling in man: neuronal co-ordination of bilateral leg activity during gait]]. J Physiol 1984;357: 109-125.</ref> | ||
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Involves: | Involves: | ||
*Function: establish contact with surface and initiate weight acceptance | *Function: establish contact with surface and initiate weight acceptance | ||
*ROM requirements - | |||
**Ankle: 0° (neutral position) | |||
**Knee: 0° (full extension) | |||
**Hip: average 20° of flexion | |||
*20-30° flexion of the hip: full extension in the knee: ankle moves from dorsiflexion to a neutral (supinated 5°) position then into plantar flexion<ref name=":2">Shultz SJ et al. Examination of musculoskeletal injuries. 2nd ed, North Carolina: Human Kinetics, 2005. p55-60.</ref><ref name=":1" />. | *20-30° flexion of the hip: full extension in the knee: ankle moves from dorsiflexion to a neutral (supinated 5°) position then into plantar flexion<ref name=":2">Shultz SJ et al. Examination of musculoskeletal injuries. 2nd ed, North Carolina: Human Kinetics, 2005. p55-60.</ref><ref name=":1" />. | ||
*After this, knee flexion (5°) begins and increases, just as the plantar flexion of the heel increased<ref name=":1" />. | *After this, knee flexion (5°) begins and increases, just as the plantar flexion of the heel increased<ref name=":1" />. | ||
Loading Response (Foot Flat): 8-10% of gait cycle | |||
Loading Response (Foot Flat): 8-10% of gait cycle | |||
Involves: | Involves: | ||
*Function: weight acceptance and shock absorption | *Function: weight acceptance and shock absorption | ||
*ROM requirements - | |||
**Ankle: moves from 0° to 5° plantarflexion | |||
**Knee: 15° of flexion | |||
**Hip: 15° of flexion (moving into extension) | |||
*Body absorbs the impact of the foot by rolling in pronation<ref name=":2" />. | *Body absorbs the impact of the foot by rolling in pronation<ref name=":2" />. | ||
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Involves: | Involves: | ||
*Function: single limb support and stability | *Function: single limb support and stability | ||
*ROM requirements - | |||
**Ankle: 5° of dorsiflexion | |||
**Knee: 5° of flexion | |||
**Hip: 0° of flexion (neutral position) | |||
*Hip moves from flexion to extension 0° by contraction of the gluteus medius muscle<ref name=":1" />. | *Hip moves from flexion to extension 0° by contraction of the gluteus medius muscle<ref name=":1" />. | ||
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Heel Off: 30-40% of gait cycle | Heel Off: 30-40% of gait cycle | ||
Involves: | Involves: | ||
* Function: single limb support, stability, and propulsion | * Function: single limb support, stability, and propulsion | ||
* ROM requirements - | |||
** Ankle: 0° (neutral position) | |||
** Knee: 0° of flexion (complete extension) | |||
** Hip: 10-20° of hyperextension | |||
* Begins when the heel leaves the floor. | * Begins when the heel leaves the floor. | ||
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Toe Off/Pre-swing: 60% of gait cycle | Toe Off/Pre-swing: 60% of gait cycle (final phase of stance) | ||
Involves: | Involves: | ||
*Function: final burst of propulsion to propel the body forward | *Function: final burst of propulsion to propel the body forward | ||
*ROM requirements - | |||
**Ankle: 20° of plantarflexion | |||
**Knee: 30° of flexion | |||
**Hip: 10-20° of hyperextension | |||
*Hip becomes less extended. | *Hip becomes less extended. | ||
*Knee is flexed 35-40° | *Knee is flexed 35-40° | ||
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Early Swing: 60-75% of gait cycle | Early Swing: 60-75% of gait cycle | ||
Involves: | Involves: | ||
*Function: propel the lower extremity forward and shorten the stance limb | *Function: propel the lower extremity forward and shorten the stance limb | ||
*ROM requirements - | |||
**Ankle: 10° of plantarflexion | |||
**Knee: 60° of flexion | |||
**Hip: moves into 20° of flexion | |||
*Hip extends to 10° and then flexes (due to contraction of the iliopsoas muscle)<ref name=":1" /> 20° with lateral rotation<ref name=":2" /><ref name=":1" />. | *Hip extends to 10° and then flexes (due to contraction of the iliopsoas muscle)<ref name=":1" /> 20° with lateral rotation<ref name=":2" /><ref name=":1" />. | ||
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*Ankle goes from 20° of plantar flexion to dorsiflexion, to end in a neutral position<ref name=":2" />. | *Ankle goes from 20° of plantar flexion to dorsiflexion, to end in a neutral position<ref name=":2" />. | ||
Mid Swing: 75-85% of gait cycle | Mid Swing: 75-85% of gait cycle | ||
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Involves: | Involves: | ||
*Function: clear lower extremity from the ground in order to advance into initial contact | *Function: clear lower extremity from the ground in order to advance into initial contact | ||
*ROM requirements - | |||
**Ankle: 0° (neutral position) | |||
**Knee: moves to 30° of flexion | |||
**Hip: 30° of flexion | |||
*Hip flexes to 30° (by contraction of the adductors) and the ankle becomes dorsiflexed due to a contraction of the tibialis anterior muscle<ref name=":1" />. | *Hip flexes to 30° (by contraction of the adductors) and the ankle becomes dorsiflexed due to a contraction of the tibialis anterior muscle<ref name=":1" />. | ||
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Late Swing: 85-100% of gait cycle | Late Swing: 85-100% of gait cycle | ||
Involves: | Involves: | ||
*Function: decelerate lower extremity to establish contact with the ground | *Function: decelerate lower extremity to establish contact with the ground | ||
**ROM requirements - | |||
***Ankle: 0° (neutral position) | |||
***Knee: 0° (complete extension) | |||
***Hip: 30° of flexion | |||
*Hip flexion of 25-30° | *Hip flexion of 25-30° | ||
Revision as of 17:36, 1 July 2022
Original Editor - User Name
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 step consists of two phases: stance phase and swing phase -
- The stance phase occupies 0-60% of the gait cycle, during which one leg and foot are bearing most or all of the bodyweight
- 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[3].
- 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 and involves a combination of open and close chain activities[4].
Phases of Gait[edit | edit source]
There are 8 phases of gait which are listed as follows[3][5]:
- Initial Contact
- Loading Response
- Midstance
- Terminal Stance
- Pre swing
- Initial Swing
- Mid Swing
- Late Swing [6]
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
Involves:
- Function: establish contact with surface and initiate weight acceptance
- ROM requirements -
- Ankle: 0° (neutral position)
- Knee: 0° (full extension)
- Hip: average 20° of flexion
- 20-30° flexion of the hip: full extension in the knee: ankle moves from dorsiflexion to a neutral (supinated 5°) position then into plantar flexion[4][3].
- After this, knee flexion (5°) begins and increases, just as the plantar flexion of the heel increased[3].
Loading Response (Foot Flat): 8-10% of gait cycle
Involves:
- Function: weight acceptance and shock absorption
- ROM requirements -
- Ankle: moves from 0° to 5° plantarflexion
- Knee: 15° of flexion
- Hip: 15° of flexion (moving into extension)
- Body absorbs the impact of the foot by rolling in pronation[4].
- Hip moves slowly into extension from 20°-15°, caused by a contraction of the adductor magnus and gluteus maximus muscles.
- Knee flexes to 15° to 20° of flexion[3].
Midstance:
Involves:
- Function: single limb support and stability
- ROM requirements -
- Ankle: 5° of dorsiflexion
- Knee: 5° of flexion
- Hip: 0° of flexion (neutral position)
- Hip moves from flexion to extension 0° by contraction of the gluteus medius muscle[3].
- 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[4].
- 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[4].
Heel Off: 30-40% of gait cycle
Involves:
- Function: single limb support, stability, and propulsion
- ROM requirements -
- Ankle: 0° (neutral position)
- Knee: 0° of flexion (complete extension)
- Hip: 10-20° of hyperextension
- Begins when the heel leaves the floor.
- Bodyweight is divided over the metatarsal heads[4].
- 10-13° of hip hyperextension, which then goes into flexion.
- Knee becomes flexed (0-5°)[3].
- Ankle supinates and plantar flexes[3]; 0° of plantarflexion or dorsiflexion.
Toe Off/Pre-swing: 60% of gait cycle (final phase of stance)
Involves:
- Function: final burst of propulsion to propel the body forward
- ROM requirements -
- Ankle: 20° of plantarflexion
- Knee: 30° of flexion
- Hip: 10-20° of hyperextension
- Hip becomes less extended.
- Knee is flexed 35-40°
- Plantar flexion of the ankle increases to 20°[4][3].
- The toes leave the ground[3].
Early Swing: 60-75% of gait cycle
Involves:
- Function: propel the lower extremity forward and shorten the stance limb
- ROM requirements -
- Ankle: 10° of plantarflexion
- Knee: 60° of flexion
- Hip: moves into 20° of flexion
- Hip extends to 10° and then flexes (due to contraction of the iliopsoas muscle)[3] 20° with lateral rotation[4][3].
- Knee flexes to 40-60°.
- Ankle goes from 20° of plantar flexion to dorsiflexion, to end in a neutral position[4].
Mid Swing: 75-85% of gait cycle
Involves:
- Function: clear lower extremity from the ground in order to advance into initial contact
- ROM requirements -
- Ankle: 0° (neutral position)
- Knee: moves to 30° of flexion
- Hip: 30° of flexion
- Hip flexes to 30° (by contraction of the adductors) and the ankle becomes dorsiflexed due to a contraction of the tibialis anterior muscle[3].
- Knee flexes 60° but then extends approximately 30° due to the contraction of the sartorius muscle[4][3] - caused by the quadriceps muscles[4][3].
Late Swing: 85-100% of gait cycle
Involves:
- Function: decelerate lower extremity to establish contact with the ground
- ROM requirements -
- Ankle: 0° (neutral position)
- Knee: 0° (complete extension)
- Hip: 30° of flexion
- ROM requirements -
- Hip flexion of 25-30°
- Locked extension of the knee
- Neutral position of the ankle[4].
The following video describes the range of motion requirements involved in the different gait phases:
Range of Motion during Gait [8]
Resources[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)
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 Loudon J, et al. The clinical orthopedic assessment guide. 2nd ed. Kansas: Human Kinetics, 2008. p.395-408.
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 Shultz SJ et al. Examination of musculoskeletal injuries. 2nd ed, North Carolina: Human Kinetics, 2005. p55-60.
- ↑ Demos, Gait analysis, (http://www.ncbi.nlm.nih.gov/books/NBK27235/), 2004.
- ↑ 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.
- ↑ Nicole Comninellis The Gait Cycle Animation Available from https://www.youtube.com/watch?time_continue=35&v=DP5-um6SvQI
- ↑ Alexandra Kopelovich. Gait Range of Motion Available from: https://www.youtube.com/watch?v=5Z6shSu96CM [last accessed 28.6.2022]