Joint Range of Motion During Gait

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

Top Contributors - Rachel Celentano and Wanda van Niekerk  

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
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 [8]

Maximum Values[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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)

References[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. Stöckel T, Jacksteit R, Behrens M, Skripitz R, Bader R, Mau-Moeller A. The mental representation of the human gait in young and older adults [Internet]. Frontiers in psychology. Frontiers Media S.A.; 2015 [cited 19-7-2022]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500916/
  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. [last accessed 19.7.2022]
  7. Nicole Comninellis. The Gait Cycle Animation. Available from: https://www.youtube.com/watch?time_continue=35&v=DP5-um6SvQI [last accessed 19.7.2022]
  8. Alexandra Kopelovich. Gait Range of Motion. Available from: https://www.youtube.com/watch?v=5Z6shSu96CM [last accessed 19.7.2022]