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.”

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 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.
• 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.

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

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

Range of Motion Involved in Gait Phases

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.

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

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.

• 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.

• Ankle plantarflexion increases to 10-15°.

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.

• 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: 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.

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

• Knee becomes flexed (0-5°).

• Ankle supinates and plantar flexes; 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°.
• The toes leave the ground.

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) 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: 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.

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

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
• 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