Analysis of normal gait

Analysis of normal gaitNamyangju Reha. HospitalDept. of Physical TherapyLee Dong-Jin, PT1Gait Cycle Walking uses a repetitious sequence of limb motion move the body forward while simultaneously maintaining stance stability.

2 page . 2Cycle Divisions

stance phases swing phases . 3Floor Contact PeriodsStance 60% Initial Double Stance 10% Single Limb Support 40% Terminal Double Stance 10%

Swing 40% 4Stride & Step

(heel strike) (step) . (heel strike) (stride) , (stride length), (stride duration), 3.5inch 5~10cm(stride width) . (foot angle) . (cadence, walking rate) 1 90~120 .(, ) (stride) (gait cycle) .

5Stride & Step

Stride() & Step()6Divisions of the Gait Cycle

71 : Initial Contact(heel strike) 0~2% - - Heel Rocker .

: Heel Strike

: Gluteus maximus, hamstring, tibialis anterior, qudriceps(eccentric)

Hip : 30 Flex -Vector :

knee : Ext(2 Flex) - Vector :

Ankle : neutral - Vextor :

Initial contact ankle neutral , knee full ext . ankle Loading response Tibialis ant. m, Extensor digitorum longus m. eccentric contraction . Knee Quadriceps Hamstring group cycle Terminal Swing contraction knee jt . Terminal Swing Limb 25 Hip flex Gluteus maximus Hamstrings Activation pelvis gluteus medius activation.

82 : Loading Response(foot flat) 0 ~ 10% - Initial Double Limb Stance. - IS . - , ,

: Knee,Ankle Flex , Hip jt

: gluteus maximus, quadriceps, biceps femoris, tensor fascia latae

Hip : 30 Flex, Add, I/R - Vector :

Knee : 18Flex, Valgus, Tibia I/R - Vector :

Ankle : 10plantarflexion, Pronation - Vector : - , Tibia Advance

Loading Response Ankle Pretibial m.(Tibialis ant. m, Extensor digitorum longus m, Extensor hallucis longs m.) Plantarflexion . knee 15~18 Flexion Quadriceps Eccentric Contraction . Hip extensor hip jt (Gluteus maximus, Hamstring, Adductor magus), Trunk Hip Flexion .

93 : Mid Stance

10~30% - :MSw~TSw - , Stance . - Knee jt Ankle jt .

: Ankle dorsiflexion, Knee jt , Hip jt

: quadriceps M, Calf M(eccentric)

Hip : 30Flex 5Ext - Vector :

Knee : 18Flex 5Ext - Vector :

Ankle : 7 P/F 4D/F - Vector :

Mid Stance , Ankle Plantarflexion Dorsiflexion . Gastronemius m. Soleus m. Dorsiflexion , Tibia . Knee Extend Quadriceps Extend . L:oading Response Sagital stability Gluteus maximus Hip extensor Hip abductor Hip stability pelvic .

104 : Terminal stance(heel off) 30~50% - : IC - , .

: Heel Push off : soleus, gastrocnemius(eccentric) T.F.L(Hip Flex, Abd)

Hip : hyper Ext, Add, I/R - Vector :

Knee : 0~5Flex, Tibia E/R - Vector :

Ankle : 10D/F, Supination - vector :

Ankle Dorsiflexion . Ankle Tibia stability Calf m. . Soleus Gatrocnemius tibia , . Knee . Hip Tensor fascia latae Pelvic active Hip Hyperextension Hip flexor .

115 : Pre Swing(toe off) 50~60% - : IC - (Terminal Double support) - MP

: Knee Flex

: Calf M Adductor Magnus, Rectus Femoris .

Hip : hyper Ext. Gracillis, Sartorius Flex, Abd, I/R - Vector :

Knee : Flex - Vector :

Ankle : 20plantar flexion - Vector : (MP)

Pre-SwingAnkle Dorsiflexion Plantarflexion . Metatarsophalangeal jt 60 Extend Knee Passive Flexion. Hip Rectus femoris, Sartorius, Adductor longus Neural position Flexion. Femur Adductor longus, Rectus femorius Flexion.

126 : Initial Swing(acceleration) 60~73% - Toe off . - .

: Knee, Hip Flex

: biceps femoris, sartorius, gracillis, tibialis anterior, iliacus

Hip : gracillis 20Flex

Knee : biceps femoris 60 Flex

Ankle : 20P/F tibialis anterior Neutral .

Intial SwingPretibial m.(tibialis ant. m, Extensor digitorum longus m, Extensor hallucis longus m.) Long toe extensor Ankle Plantarflexion . Mid Swing Dorsiflexion Plantarflexion . Knee hip flexion flexion, , hip liacus, biceps femoris, Sartorius, gracilis flexion.

137 : Mid Swing

70~85% - , Knee jt . - ( )

: Ankle dorsiflexion, Hip Flex

: Hip Flexor, Pretibial m

Hip : 30Flex

Knee : Ext

Ankle : Neutral , Tibialis anterior isometric C

Mid Swing Pretibial m.(tibialis ant. m, Extensor digitorum longus m, Extensor hallucis longus m.) Activate . Tibial bone knee extension Hamstring Knee Extension . Gracilis Sartorius, Iliacus mid swing Hamstring thigh .

148 : Terminal Swing(deceleration) 85~100% - Tibia . -

: Hip, Knee , Knee Ext, Ankle D/F

: Hamstring, Quadriceps, Pretialis m.

Hip : Hastring Flex

Knee : Hastring MSw Ext Knee jt , Quadriceps Knee Ext

Ankle : Tibialis anterior netutal 5P/F

Ankle Pretibial m.(tibialis ant. m, Extensor digitorum longus m, Extensor hallucis longus m.) Gait Cycle Initial contact contract . knee Quadriceps Initial Contact Knee Extend. Hamstring Gluteus maximus thigh Hip Flexion . Hamstring Thigh Knee , Hip Flexion .

15Head, Trunk, Pelvic

- 2.5 ~ 4.5 cm - : LR , PSw (DS ) - : TSt, MSw (SS )

- 4.5cm - stance .

- : 23cm/sec - : 14cm/sec - : 2cm/sec

Hip jt

Sagjital plane - pelvic drop 4

2. Coronal plane - anterior tilt 4

3. Transverse plane - rotation 10 (displacement), DS(double support, ) ,SS(Single support, )(T10)16vertical displacement of trunk during a stride indicated by head height

(stride) 17Lateral displacement of trunk during a stride

(stride) ( ) (double limb stance) . (Rt. Single limb stance) . 18Motion of the pelvis during walking

19Head, Trunk, Pelvic

Erect spine - IC - TSt

Multifidus, Rotatores, QL m. - IC

External obliques - MSw, TSt

Rectus abdominis

Gluteus maximus, Gluteus medius - TSw MSt - LR .

20Arm

Shoulder jt - IC Ext 8 - TSt Flex 24

2. Elbow jt - IC Flex 44 - IC shoulder jt Ext 20

supraspinatus, upper trapezius . - IC TSw

2. middle, posterior deltoid - Flex

3. Latissimus dorsi, Teres major - shoulder jt Ext(LR) - shoulder jt Ext(PS) , (Counter force) .21Arm swing during normal free walk

, TS(shoulder jt Flex) IC(shoulder jt Ext)

22 1. Terminal Swing(Initial Contact, heel strike)1. Hamstring - Hamstring MSt TSw - Hip Flex - Knee Hyper-Ext . - TSw Hamstring .

2. Hip Extensor ( Adductor Magnus, Gluteus Maximus) - Hamstring . - Quadriceps Knee Ext Hamstring . - Tibialis anterior Ankle Dorsiflexion .

23 2. Loading Response(foot flat)1. Hip joint - Hip Extensor( Adductor Magnus, Gluteus Maximus inferior) Femur Hip,Knee, Ext - Hip Abductor ( Gluteus Matimus superior, Gluteus medius) Femur .

2. Knee Joint - Quadriceps Heel Rocker Knee jt Flex weight bearing .

3. Ankle Joint - Tibialis anterior LR eccentric , weight bearing Knee Flex heel rocker .24 3. Mid Stance & Terminal Stance(heel off)1. Soleus - , Forefoot Plantarflexion. - Tibia Femur Knee Ext Hip jt Ext. - TSt

2. Gastrocnimius - Soleus , Knee Flex . (2 jt )

3. Flexor Digitorum - Forefoot , , PS . 25 1. Pre Swing1. Hip adductor ( Adductor longus) - Addutor longus Hip abduction , Hip Flex.

2. Rectus femoris - PS Knee hyper Flex , Hip jt Flex .

3. Tibialis anterior - PS Plantarflexion .

26 2. Initial Swing1. Sartorius, Iliacus, Gracilis - Femur .

2. Biceps femoris(short head) - Knee Flex. foot lift .

3. Tibialis anterior - PS IS , Pantarflexion .27Loading Response(foot flat)What is Loading Response

28Why is Loading response ? 10% ,

.

Eccentric work .

1/10 . .

Motor Control Poor .

Motor Control LR .

LR motor control .

, , .

(Motor control)Eccentric work . 29Why is Loading response ?Mobility : , , , , , , , Agnosia, Apraxia Mobility .

Stability : . - , . - eccentric contraction Stability .

Conntrolled Mobility : . - Mst Knee jt Foot Hip .

(adhesion): 1 (3,1,2); , , Agnosia() apraxia()

30What is Loading response ?Gait cycleStanceSwingWeight AcceptanceSingle Limb SupportInitial ContactLoading ResponseMid StanceTerminal StancePre Swing31What is Loading response ?LR - TSw ( 1cm)

LR - .

LR - shock absorption - preservation of progression - weight-bearing stabilityPreservation 32What Happens During Loading Response ? (leg)Hip jt : 30Flex - Transverse : E/R I/R . - Coronal : slight adduction .

Knee jt : 0 ~ 10Flex - LR HyperExtension 10Flexion.

Ankle jt : Neutral ~ 10 P/F ~ Neutral

Subtalar jt : Eversion (Pronation)

Talar jt : Extension

33What Happens During Loading Response ? (arm&trunk)Contralateral leg : Pre Swing

Ipsilateral leg : Ext Felx swing

Contralateral arm : Ext .

Trunk : ElectContralateral : Ipsilateral :

34What Happens During Loading Response ? (Vector&Torque)Hip jt : Torque into Flexion, Adduction, I/R

Knee jt : Torque into Flexion

Ankle jt : Torque into P/F Torque into D/F Vector .Torque (moment)35Loading Response Neutral Vector line

Force Vector : Hip (), Knee , Ankle()

LR Vector line cranial-dorsal caudal-ventral .

Pelvic Scapular Post. Elev , Ant. depr groove .

groove LR .PosteriorElevationAnteriorDepression

Groove 36Proposal for Facilitation of Loading Response (1) - ~ Hip : 30Flex, Knee : 15Flex, Ankle : Neutral - ~ Leg : Ext , Trunk & Head : Neutral

Approximation for Knee & Ankle - Heel Kinematic chain . - . Proposal 37Proposal for Facilitation of Loading Response (2)

Weight Shift(LR)

- , ventral .

- .38Proposal for Facilitation of Loading Response (3)Weight shift(LR)

- dorsal . - Eccentric perfomance . - : , . - Knee & Ankle Shock absorption . - Wedge eccentric Knee extensor .

39Standing LR

Contact

1. Right hand - starting : Iliac crest Approximation

- end : Greater trochanter fossa Hip Ext. Rotator

2. Left hand - starting : Tibia Inner part tibia .

- end : Tibia Int. Rotator .

40Sidelying LR

Contact

1. Starting - Vector Approximation - forefoot .

2. End - forefoot . - Pelvic Ant. depr.

Quadriceps, Ext. Rotator, Abductor Thigh .41Normal Gait

42ReferenceJacquelin Perry . GAIT ANALYSIS Normal and Pathological Function, 1992Adler SS, Beckers D, Buck M. PNF in practice. 2nded , Springer, 2000David J. Magee . Orthopedic Physical Assessment. 3rded . W. B. Saunders. 1998

43Thank You!

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