Joint Range of Motion During Gait

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

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

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

See below for a diagram of the gait cycle -

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: to establish contact with surface and initiate weight acceptance

Body part	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 -

Body part	ROM requirements
Ankle	0-5° plantarflexion
Knee	15° of flexion
Hip	15° of flexion (hip is moving into extension)

Midstance:

Involves:

• Function: single limb support and stability
• ROM requirements -

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

Involves:

• Function: single limb support, stability, and propulsion
• ROM requirements -

Body part	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 -

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)

Involves:

• Function: propel the lower extremity forward and shorten the stance limb
• ROM requirements -

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

Involves:

• Function: clear lower extremity from the ground in order to advance into initial contact
• ROM requirements -

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

Involves:

• Function: decelerate lower extremity to establish contact with the ground
  • ROM requirements -

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

Maximum Values

Maximum range of motion values are the minimum prerequisites for a normal gait pattern.

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

Definitions:

• Ground reaction force (GRF) - creates an external plantarflexion or dorsiflexion torque.

• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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).
• 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.
• 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.
• Counteracted by internal flexor torque.

Hip -

• GRF is posterior to hip joint - creates an external extensor moment.
• Counteracted by internal flexor moment.

Toe off:

Ankle -

• Centre of pressure/GRF stay anterior to axis of rotation of ankle joint.
• 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.
• 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.
• Creates a posterior pelvic tilt.
• Utilise flexor musculature (iliopsoas) to counteract this moment.

Internal Torque Peaks

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)