gait cycle

Gait

• Normal human gait repeats a basic sequence of limb motions that serve to progress the body along a desired path while maintaining weight-bearing stability, conserving energy, and absorbing the shock of floor impact.

Rancho Los Amigos National Rehab Center

2

• Movements that produces locomotion

• Characteristics: – Energy-economical, particularly

walking– Flexibility to cope with different

speeds, terrains etc.– Sophisticated control mechanisms

(bipedal gait inherently unstable)

Gait

• Gait - manner or style of walking• Walking is a learned complex

behavior involving the alternate balancing of the body’s weight over a single support while controlling forward motion

• At least one foot is always in contact with the ground and the forward fall of the body weight is the major propelling force

Gait

Gait Cycle

• Normal Gait – Series of rhythmical , alternating

movements of the trunk & limbs which result in the forward progression of the center of gravity

– Series of ‘controlled falls’

Gait Cycle

• The time from the point at which the heel of one foot touches the ground to the time it touches the ground again

Gait Cycle

• Objectives

– Resist/Dissipate Forces

–Maintain Balance–Move Body in Intended Direction– Conserve Energy

Resist/Dissipate Forces

• Source of Forces– Gravity–Muscle

Contraction– Inertia

Maintain Balance

• Support

• Keep upright

• Avoid collapse

• Obstacle avoidance and foot placement

• Foot clearance

• Negotiate your way through the world

Maintain Balance

• Dynamic Movement• Influenced by

external factors• Single versus

Double Support• Depends on Multiple

Systems• Adaptations in Base

of Support

Move Body in Intended Direction

• Safely move the center of mass (CM) forward

• Turn when necessary• Maintain an oscillatory pattern• Re-Positioning of Center of Gravity• Re-Positioning of Limb Segments

Energy conservation

• Smoothness

• Minimize pain

• Adapt gait to avoid

painful forces or

motions

Gait Cycle - Definitions:

• Step Length – Distance between corresponding

successive points of heel contact of the opposite feet

• Stride Length – Distance between successive points of

heel contact of the same foot– Double the step length



• Walking Base – Side-to-side distance between the line

of the two feet– Also known as ‘stride width’

• Cadence –Number of steps per unit time– Cultural/social variations

Gait Cycle

• During one gait cycle, each extremity passes through two phases

• Stance phase - a given foot is in contact with the ground, heel-strike to toe-off, 60%

• Swing phase - a given foot is in the air, toe-off to heel stride, 40%

Gait CycleGait Cycle

100%0%

Initial Contact

Initial Contact

60%

Swing(40%)

10% 50%

DoubleSupport

DoubleSupport

Stride

Stance (60%)

Single Support



• Stance phase– Contact Period • Heel strike to forefoot loading

–Midstance Period • Forefoot loading to heel raise

– Propulsive Period • Heel raise to toe off

Contact Period

• Heel strike to forefoot loading • Foot pronates at subtalar joint• Only time (stance phase) normal pronation

occurs• This absorbs shock & adapts foot to uneven

surfaces• Ground reaction forces peak• Leg is internally rotating• Ends with metatarsal heads contacting

ground

Midstance Period

• Forefoot loading to heel raise• Foot stops pronating & starts

supinating due to Tibialis posterior & Soleus contract

• And external rotation of the leg• Other leg in swing phase – all weight on

one foot• Vertical ground reaction forces

decrease – body is directly over foot• Ends as heel leaves ground

Propulsive Period

• Heel raise to toe off• Subtalar joint supination continues until

just after toe off• Leg continues to externally rotate• Vertical ground reaction forces peak –

forefoot only bearing weight on this side• Forces move from lateral to medial

passing through the hallux• First MPJ must function correctly for

maximum efficiency• Toes are loaded to stabilise MPJ’s


• Swing phase– Acceleration –Midswing– Deceleration

Swing Phase

• Foot accelerates to “catch up” with body

• Leg internally rotates (from external position)

• Foot pronates to aid ground clearance• Foot decelerates and slightly

supinates in preparation for heel strike

• Time Frame:A. Stance vs. Swing:• Stance phase = 60% of gait cycle• Swing phase = 40%

B. Single vs. Double support:• Single support= 40% of gait cycle• Double support= 20%

Gait Cycle - Components:

• Support:(1) Single Support: only one foot in contact with

the floor(2) Double Support: both feet in contact with

floor

• Stance PhaseStance Phase

• Begins with heel strike and ends

when the toe leaves the ground

• Weight is transferred from the heel

to the head of the metatarsals as the

center of gravity passes forward over

the foot

• divided into 5 phases

Cycle DivisionsCycle Divisions


• Initial contact

– Beginning of Loading

– Foot Position may vary, but is generally supinated

– Represents end of single support on the opposite side


• Initial contact– Contact should be through lateral aspect

of plantar surface– Opposite limb is ending with toe-off– Subtalar joint – supinated @ 5 degrees– Talocrural joint – dorsiflexed– Both limbs in contact with surface

Cycle DivisionsCycle Divisions• Loading response– The limb reacts to the weight

of the body by rolling forward on the heel to sustain body momentum

– The foot is brought into full contact with the ground

– Maximum Impact Loading occurs


• Loading response– Response to absorption of body weight by

initiating flattening of the foot– Subtalar joint – pronates

• Unlocks midtarsal joints, allowing foot to become flexible• Tibial internal rotation – increased medial

forces at foot, leg, knee

– Talocrural joint – plantarflexes– Foot rapidly moves into pronation


• Midstance– Begins the interval of single

stance– An ankle rocking action

occurs to bring the body weight over the planted foot this helps sustain the body’s forward momentum

– All weight supported by single leg


• Midstance– Subtalar joint – supinates• Locks midtarsal joints, makes foot a rigid

lever• Preparing for efficiency during propulsion

– Talocrural joint – dorsiflexes


• Terminal stance– Begins with raising

the heel (heel-off)– The lower limb rolls

forward on to its forefoot and the body advances ahead of the sole-supporting foot

Terminal Stance

• Terminal stance– Provides new base of support– Toes extended, tibia externally rotated– Subtalar joint – supinated– Foot remains pronated initially then re-

supinates


• Preswing– The lower limb is

positioned to quickly swing forward beneath the advancing body

– The body weight is unloaded from one limb and transferred to the opposite limb

– Toe-off

Preswing

• Transitional period of double support• Limb is uploaded and prepared to swing• Begins with initial contact of contralateral

limb and ends with toe-off of stance limb


• Swing phaseSwing phase– Begins as soon as the toes leave the

surface and terminates when the limb next makes contact with the surface

–Momentum gained at toe-off helps carry leg through the swing phase

– Consists of three phases


• Initial swing – The foot is pushed off the ground– The limb is accelerated forward

helping to provide the force to sustain forward body movement

– Femur advances– Ankle dorsiflexes, allowing toe

clearance– Subtalar joint - pronation


• Midswing– The limb passes beneath the

body to where the tibia is vertical

– CG directly over opposite supporting foot

– Propulsion continues– Talocrural joint – dorsiflexed

to neutral or slight dorsiflexion


• Terminal swing– The limb decelerates

forward motion in preparation for the initial contact (IC) of the stance to initiate a new step

– Subtalar joint – supination– Foot supinated and

positioned for foot strike

CG ExcursionCG Excursion

• Pelvic Rotation

• Pelvic lateral tilt + drop

• Knee, Ankle and foot interaction

- Pelvic moves fwd with swing limb

- Trials behind with the following limb

- Flattens the arc of CM motion by

increasing the effective leg-length at

these times

Pelvic RotationPelvic Rotation

Pelvic Lateral Tilt and Pelvic Lateral Tilt and DropDrop

- Shortens the leg during stance- Flexion at the beginning and end of

stance smoothes the abrupt changes in CG

- Flattens the arc

Stance Knee FlexionStance Knee Flexion

Pre-Requisites of Good Pre-Requisites of Good GaitGait

• Stability in stance

• Foot clearance in swing

• Pre-positioning of the foot

• Adequate step length

• Energy conservation

• High neuro-muscular control required

in single support phase of gait

• Use of walking aids if neuro-muscular

status is compromised – creates

triangular base

Stability in StanceStability in Stance

• Ensures correct flow of momentum

• Correct distribution of weight

which helps with balance

Adequate Step LengthAdequate Step Length

• 90% shock absorbed by quadriceps

contraction during the weight

acceptance phase of gait

• 10% from:

–Fat pad/ligaments providing elastic

property and rheology (useful when

60% BW falls on heel at initial contact)

Shock Absorption Shock Absorption

–Synovial fluid with its viscoelatic

properties which allow it to

dissipate forces

–Cartilage and Capsules absorbing

synovial fluid

–Bone trabecular formations and

ability to bend

Shock AbsorptionShock Absorption

Forces

• The principal forces are:– Body weight (BW)– Ground reaction force (GRF)– Muscle force (MF)

Body Weight

• Always acts vertically downwards from the CG

• If its line of action does not pass through a joint, it will produce a torque about that joint

• The torque will cause rotation at the joint unless it is opposed by another force (e.g. muscle, or ligament)

• BW contributes to GRF

Ground Reaction Forces Ground Reaction Forces (GRF)(GRF)

• “Reaction” force

• Forces exerted between the body and the ground during ambulation

• GRFs are composed of vector forces acting in vertical, fore-aft, and medial-lateral directions

Ground Reaction Force

• Push exerted by ground on foot, as a consequence of Newton’s 3rd Law.

• Equal magnitude, opposite direction, same point of application as action force.

• If line of the reaction force does not pass through a joint, it will produce a torque about that joint

Muscle force

• Contribute to ground reaction force • Ensure balance• Increase energy economy• Allow flexible gait patterns• Slow down and/or prevent limb

movements

.

Muscle Activity in the Gait Cycle


Stance Phase:• The gluteus maximus and hamstrings

extend the hip early in the stance phase • The hip flexors check this movement

before toe-off• The gluteus medius and minimus abduct

the hip • The hip medial rotators act in the first

half of the stance phase• Late in the stance phase the adductors

and lateral rotators check the momentum generated by the former muscles


Stance Phase:• The quadriceps femoris acts at the

beginning of the stance phase extending the knee

• The hamstrings flex the knee just before toe-off

• The dorsiflexors of the foot act immediately after heel strike to check plantar flexion under the force of gravity and bring the foot into full contact with the ground


Stance Phase:• The plantar flexors act throughout the

second half of the stance phase powering the forward thrust of the body using the thigh and leg as a single unit

• The body is powered forward by the plantar flexors and hip extensors

• As the body weight comes onto the foot the intrinsic foot muscles contract to support the plantar ligaments


Swing Phase:• The hip flexors already function at

the end of the stance phase continue into early swing phase along with the adductors and lateral rotators

• They are essentially silent in midswing relying on momentum of the thigh mass to bring the thigh forward


Swing Phase:• Thigh momentum is checked at the end

of the swing phase by the hip extensors• The hamstrings function late in the

stance phase and continue into early swing phase to flex the knee

• The forward momentum of the limb in the swing results in the transition from flexion to extension at the knee with some assistance from the quadriceps muscles


• This momentum is checked by the hamstrings prior to heel strike

• Dorsiflexors and the ankle act throughout the swing phase


EccentricConcentric

• Pretibial Muscles– Anterior tibial, EDL, EHL– Prior to and during heel strike

• Eccentric contraction - lowers foot to the ground

– Prior to and during preswing• Concentric contraction – DF foot, clear toes off

ground

• Calf Muscles– Gastrocs, Soleus (FDL, FHL, Posterior tibial)– Foot flat

• Eccentric contraction - control of tibia over the foot

– Heel off• Concentric contraction – ankle plantarflexion


• Quadriceps– Vastus medialis/lateralis/intermedius, RF– Before Heel Strike

• Concentric contraction – initiate knee extension

– Swing phase• Eccentric contraction – slow down leg (tibia)

• Hamstrings– Biceps, Semitendinosus, Semimembranosus– Heel strike

• Eccentric contraction - HS peaks – protects knee from hyperextension

– Swing phase• Concentric contraction – knee flexion, hip

extension


• Hip Abductors – Gluteus medius, Gluteus minimus, TFL– Stance phase

• Concentric contraction - stabilize pelvis

• Hip Adductors– Adductor longus/brevis, Gracilis,

Adductor magnus (horizontal and vertical heads)

– Early and late stance • Concentric contraction –stabilize pelvis


• Gluteus Maximus– Stance phase

• Eccentric contraction – decelerate forward momentum

– Pre-Swing phase• Concentric contraction – hip extension

• Erector Spinae– Heel strike through Toe-off– Maintain trunk posture

• Foot Intrinsics– Stance phase

• Concentric contraction – support plantar fascia


gait cycle

Documents

gait gait manner

gait normal human gait

given foot

foot placement foot

propulsive period heel

balance support

base of support

body weight