Joint Range of Motion During Gait: Difference between revisions

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* 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" />.
* 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 and involves a combination of open and close chain activities<ref name=":2" />.
* Gait cycle phases: the stance phase and the swing phase and 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>.


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


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</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</ref>
== Range of Motion Involved in Gait Phases ==
== Range of Motion Involved in Gait Phases ==
Initial contact (Heel Strike): 0% of gait cycle
'''Initial contact (Heel strike)''': 0% of gait cycle


Involves:
Involves:  
*Function: establish contact with surface and initiate weight acceptance  
*Function: to establish contact with surface and initiate weight acceptance
*ROM requirements -  
*ROM requirements -  
**Ankle: 0° (neutral position)
**Ankle: 0° (neutral position)
**Knee: 0° (full extension)
**Knee: 0° (full extension)
**Hip: average 20° of flexion  
**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" />.


*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:
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**Ankle: moves from 0° to 5° plantarflexion
**Ankle: moves from 0° to 5° plantarflexion
**Knee: 15° of flexion  
**Knee: 15° of flexion  
**Hip: 15° of flexion (moving into extension)
**Hip: 15° of flexion (hip is moving into extension)
*Body absorbs the impact of the foot by rolling in pronation<ref name=":2" />.
 
*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<ref name=":1" />.


*Ankle plantarflexion increases to 10-15°<ref name=":2" /><ref name=":1" />.




Midstance:
'''Midstance''':


Involves:
Involves:
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**Knee: 5° of flexion
**Knee: 5° of flexion
**Hip: 0° of flexion (neutral position)
**Hip: 0° of flexion (neutral position)
*Hip moves from flexion to extension 0° by contraction of the gluteus medius muscle<ref name=":1" />.


*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<ref name=":2" />.


*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<ref name=":2" />.
'''Heel off''': 30-40% of gait cycle
 
 
 
Heel Off: 30-40% of gait cycle


Involves:
Involves:
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** Knee: 0° of flexion (complete extension)
** Knee: 0° of flexion (complete extension)
** Hip: 10-20° of hyperextension  
** Hip: 10-20° of hyperextension  
* Begins when the heel leaves the floor.
*Bodyweight is divided over the metatarsal heads<ref name=":2" />.
*10-13° of hip hyperextension, which then goes into flexion.
*Knee becomes flexed (0-5°)<ref name=":1" />.


*Ankle supinates and plantar flexes<ref name=":1" />; 0° of plantarflexion or dorsiflexion.






Toe Off/Pre-swing: 60% of gait cycle (final phase of stance)
'''Toe off/Pre-swing''': 60% of gait cycle (final phase of stance)


Involves:
Involves:
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**Knee: 30° of flexion  
**Knee: 30° of flexion  
**Hip: 10-20° of hyperextension  
**Hip: 10-20° of hyperextension  
*Hip becomes less extended.
*Knee is flexed 35-40°
*Plantar flexion of the ankle increases to 20°<ref name=":2" /><ref name=":1" />.
*The toes leave the ground<ref name=":1" />.






Early Swing: 60-75% of gait cycle
 
'''Early swing''': 60-75% of gait cycle (beginning of swing phase)


Involves:
Involves:
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**Ankle: 10° of plantarflexion
**Ankle: 10° of plantarflexion
**Knee: 60° of flexion  
**Knee: 60° of flexion  
**Hip: moves into 20° 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" />.


*Knee flexes to 40-60°.
'''Mid swing''': 75-85% of gait cycle  
 
*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  


Involves:
Involves:
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**Knee: moves to 30° of flexion  
**Knee: moves to 30° of flexion  
**Hip: 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" />.


*Knee flexes 60° but then extends approximately 30° due to the contraction of the sartorius muscle<ref name=":2" /><ref name=":1" /> - caused by the quadriceps muscles<ref name=":2" /><ref name=":1" />.






Late Swing: 85-100% of gait cycle
'''Late swing''': 85-100% of gait cycle


Involves:
Involves:
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***Knee: 0° (complete extension)
***Knee: 0° (complete extension)
***Hip: 30° of flexion  
***Hip: 30° of flexion  
*Hip flexion of 25-30°
*Locked extension of the knee
*Neutral position of the ankle<ref name=":2" />.




Revision as of 21:22, 5 July 2022

Original Editor - Rachel Celentano based on the course by Alexandra Kopelovich

Top Contributors - Rachel Celentano, Wanda van Niekerk and Jess Bell  

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (5/07/2022)

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]:

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

See below for a diagram of the gait cycle -

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

[7]

Range of Motion Involved in Gait Phases[edit | edit source]

Initial contact (Heel strike): 0% of gait cycle

Involves:

  • Function: to establish contact with surface and initiate weight acceptance
  • ROM requirements -
    • Ankle: 0° (neutral position)
    • Knee: 0° (full extension)
    • Hip: average 20° of flexion


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 (hip is moving into extension)



Midstance:

Involves:

  • Function: single limb support and stability
  • ROM requirements -
    • Ankle: 5° of dorsiflexion
    • Knee: 5° of flexion
    • Hip: 0° of flexion (neutral position)



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



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



Early swing: 60-75% of gait cycle (beginning of swing phase)

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

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



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


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]

  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. ↑ 3.0 3.1 Loudon J, et al. The clinical orthopedic assessment guide. 2nd ed. Kansas: Human Kinetics, 2008. p.395-408.
  4. ↑ Shultz SJ et al. Examination of musculoskeletal injuries. 2nd ed, North Carolina: Human Kinetics, 2005. p55-60.
  5. ↑ Demos, Gait analysis, (http://www.ncbi.nlm.nih.gov/books/NBK27235/), 2004.
  6. ↑ 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.
  7. ↑ Nicole Comninellis The Gait Cycle Animation Available from https://www.youtube.com/watch?time_continue=35&v=DP5-um6SvQI
  8. ↑ Alexandra Kopelovich. Gait Range of Motion Available from: https://www.youtube.com/watch?v=5Z6shSu96CM [last accessed 28.6.2022]
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