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MA,JOI(
BY
iN
i)ETEIIMINANTS
J.
B.
I)EC.
M.
SAUNDERS,
HOWARD
the
From
D.
M.Ii.,
MS.,
of A natomy
and
of Engineering,
College
ANI)
F.R.C.s.(EDIN.),
EBERHART,
Departments
The
NOItl\IAL
PATIIOL(
VERNE
SAN
T.
FRANCISCO,
Orthopaedic
INMAN,
*f
GAIT
M.D.,
AND
CALIFORNIA
Surgery,
University
)(ICAL
School
of California,
of
San
Medicine,
and
Francisco
INTRODUCTION
Human
locomotion
is a phenomenon
of the most extraordinary
complexity.
primaty
objective
of locomotion
may be simply
stated
as the translation
from
one point
to another
by means
of a bipedal
gait, its analysis
requires
the
Although
of the body
collection
of
the
an enormous
amount
of data
a complete
(lescription
kinetics
of the extremities
plete,
would
be of little
a concept
of locomotion
of the clinical
problems
ments
is a task
it is our
purpose
to
of locomotion
with
fuller
understanding
of the
the locomotor
mechanism.
greater
entire
cycle
consideration
details;
but
of events.
it is evident
of both
the
such knowledge,
kinematics
even
surgeon
unless
can be drawn
him.
However,
in
magnitude
locomotion,
and
difficulty
limit
ourselves
what
we have called
the primary
determinants
determinants
in relationship
to pathological
ciation
of these
fundamental
determinants,
disorders
the
involves
manifold
participate
of such
Therefore,
to follow
value
to the orthopaedic
from which
deductions
which
daily
confront
simultaneously
which
achievement,
expected.
in order
of locomotion
in all their
an
its early
in this
precision
and
to
which
paper
apply
exist
ideal
of
cannot
be
to
a consideration
of
and
to examine
these
that,
by an apprewill be able to analyze
corrective
between
worthy
attainment
of human
locomotion
gait.
It is our expectation
the orthopaedic
surgeon
interrelationships
an(l
if com-
it were integrated
to evolve
and applied
to the analysis
the synthesis
of all the dc-
although
that
that
the
measures
various
with
segments
of
METHODS
The
based
data
involves
present
the
aid
and
coordinate
axes
types
of
niques
of
employed
discussed
the
have
here;
but
were determined
mitted
the study
measurement
an interrupted-light
mitted
the
calculation
were
verse
t
VOL.
great
to
rotations
*
Infantile
with
found
Based
on
NO.
the
elsewhere
mentioned.
briefly
limb
papers
read
two
3. JULY
from
the
as
1953
the
and,
a function
the
sagittal
to that
employed
of velocity
and
accelerometers
of graphonumerical
segments
were
at the
Meeting
Joint
most
Group
Research
aided
Council,
Orthopaedic
by
grants
Advisory
of
Associations,
The
Committee
tech-
cannot
extremities
and
be
perBy
accelerations
also
This
in
obtained
method
perthe plane
of
to check
the
differentiation.
from
the
the
space,
were
by Marcy.
acceleration
determined
The
walkway
which
simultaneously.
plane
used
of
the
to obtain
of the
velocities
were
accurately
of the
details
of
of a glass
of space
in the
methods
Biomechanics
reasons
to
of recording,
displacements
of time,
Electrical
to
for
rates
information.
simplicity
The
and
respect
in order
desired
findings.
of these
consisted
in the three
planes
similar
components
Inc.,
One
the
as the
of
with
be employed
all
The
Displacements
accuracy.
inferior
factors
accuracy
be
calculated.
of the
A contribution
Paralysis,
35-A,
be
by such
body
is
of locomotion
directions,
in the
yield
of gait
a study
magnitudes,
must
will
described
will
technique
of the
by
but
and
determinants
Since
occurring
of methods
is dictated
displacements
were
forces
technique
by several
methods.
of the displacements
points
progression
one
fundamental
of the
and
a number
No
been
of the
of techniques.
measurement
data,
they
of the
of selected
data.
method
reduction
analysis
of a variety
rotations,
in space,
of
of a particular
ease
the
translations,
different
choice
the
with
recording
of the
three
which
obtained
the
change
the
upon
were
findings
The
by
the
London,
National
trans-
insertion
July
1, 1952.
Foundation
on Artificial
of
for
Limbs.
543
544
J.
pins
the
into
B.
D1:C.
bones.
SI.
SAUNDERS,
High-speed
V.
T.
INMAN,
motion-picture
AND
H.
D.
EBERHART
photography
proved
to be
value
only, bUt it w-as useful
for the examination
of motions
of minor
instances
Cinertt(hiOg1aj)h
had a limited
usefulness.
The gravitational
were
studied
l)V means
of elect romyography
and
by the use of force
raphy
plate,
was
most
valuable
in (letermining
will be mentioned
in greater
which
the
ground
reactions
the
and
the
walking
magnitu(les
of pressure
constants,
at
cadence
In
order
to
1)rCSeIit
to consi(ler
the
motion.
By
so (loing
weight
of the
body
The
mass
to
CENTER
moments
of inertia.
subject
investigated.
the
OF
GRAVITY
OF
THE
data
of the
body.
upon
the
This
point.
enables
us
individual
the
locomotion
in a somewhat
the fundamental
features
to avoid
segments
center
and
of gravity
idealized
concerned
since
limbs
rfhe
itself.
fashion
which
in the translation
as
are
for
BODY
we assume
be regarded,
abstract
at that
shears,
presented
conception,
an
force
from
were
devised
to
masses
of the
introduce
we
influencing
horizontal
of the
is concentrated
levei-s
or
and
of locomotion,
body
during
acting
at
torque,
of the phenomena
of gravity
of the
weightless
ating
force,
a simplified
concept
l)ehavior
of the center
the
forces
vertical
techniques
the relative
normal
TilE
venient
of
phase
of muscle
activity.
The
allowed
the direct
measuring
on the foot.
In addition
special
such
as the centers
of gravity,
calculation
the
the precise
detail
later,
of qualitative
magnitude.
In some
and muscle
forces
plates.
Electromyog-
may
for
the
to
limit
In
this
most
that
part
the
consideration
way,
the entire
therefore,
as
discussion
to
we
are
permits
the analysis
of the body
and
it is concycle
of
the
of
those
able
oper-
to treat
of
and synthesis
of
its energy
require-
ments.
which
gravity
Furthermore,
the
selection
of the center
of gravity
as a point
of reference
from
to depart
possesses
distinct
advantages
since the displacement
pattern
of the center
of
may be regarded
as constituting
the summation
or end result
of all forces
and motions
acting
upon
and
ConCcrfl((i
with
the translation
of the body
from
one
point
to another
body
has
been
the
familiar
during
locomotion.
static
Lnder
number
conditions,
of methods.
nique
of (louble
calculation
Its
the
suspension
from
center
and
volume
of gravity
contour
maps
of the
reference
anterior
The
Displacement
The
down
company
vertical
is a smooth
a small
center
more
marked
has
after
upon
been
pathway
drawn.
correction
which
the
of
and
of a balanced
from
of
the
and
several
a
by
methods
that
ground
being
gravity
by
tech-
beam
these
it is estimated
the
center
corresponding
1.25 per cent.)
occupies
by
a position
the
subject
He
is photographed
for
parallax,
the
center
to
1
just
along
curve
at
approximately
as he walks
of
The
the
position
a wall
on
cameras
are
determined
THE
in the
JOURNAL
from
OF
often
be
of gravity
are
no
is
system
aspects
various
AND
of
1).
of gravity
a coordinate
BONE
seen
level
to it (Fig.
center
the
in
of progresthe
different
in
in the
of gravity
parallel
of the
which
bobbing
plane
may
center
downward
of step
center
of this
body
displacement
synchronized
displacements
form
or fence
out
of the
of loco-
and
in the
is walking
of gravity
his
pastime.
walks
by
The
on a wall
childhood
the
the
is a feature
upward
objectively
he
displacement
against
line
and
when
the
curve.
of chalk
body
in the
is fixed,
noticeable
reflect
recording
of the
subjectively
vision
very
a wavy
of this
body
center
seen
described
scribbles
the
be
or sinusoidal
elaboration
females,
displacement
may
a piece
methods
an
the
fluctuations
holding
of gravity
It
on
undulating
boy
laboratory
than
The
and
use
results
at a distance
from
(individual
variations
downward
all.
of a person,
These
plane.
when
The
head
of others.
sion
his
to
objects
of the
the
The
determined
experimental
of Gravity
and
is familiar
males
column,
(enter
upward
rhythmic
body.
by
vertebra.
sacral
of distant
and
vertebral
of the
which
fluctuation
the
the
second
the
to
motion
up
to
of the
was found
in cadavera
in living
subjects
by
position
and,
axes
JOINT
and
SURGERY
DETERMINANTS
IN
NORMAL
AND
--
PATHOLOGICAL
r.
GAIT
1!
..,
1In
1inc
Tine
gravity
ielt
ic
dna vn on i tin
of ti
hO(lV.
I e( I
SiIHtSOi(lItl
(1
t he
posit
of
gravit
left
Fhie
eight
Ui(l
of
t he
t he
t iflie
(P1st
er of gra\it
iii
I he
when
pont
larit
At 50 per
y falls
to it s loest
hien
bot
(lescent
-hearing
ext
35-A.
from
deviations
NO
3,
innx
the
ical
are
of eight,
figure
perfect
(to
is also
to
remit
the
V.
the
so wit hiotit
curve
to
and
of
horizontal
projected
occupying
are
1953
extremes
almost
the
displacements
on
the
coronal
in
is smoot
lily
undulating
approximately
equal.
of
plane,
thiey
a two-inch
the
are
associat
same
he
center
when
than
of which
corre-
his
head,
horizontal
as
plane.
curve,
Wit
hi I lie
the
sup-
wit bout
irregumagnit
tide of the
right
one and
to left.
center
of gravity
square,
of
the
is walking
iofl
The
found
in
minima
)es a sinusoidal
left
from
and
height
the
deviation
of doul)le
displacement,
in the
y (tescrih
is at
the
cycle,
is followed
of humping
laterally
of gravit
and
fear
corre-
linib
inteival
cuive
when
the
neglected.
of the
of the
a tunnel
(lisplace(l
right
level
then
one
each
opposite
vertical
lv shorter
through
t lie center
j)it5S
the
be
maxima
in form
to thiat
of tine vertical
displacement.
in normal
Irvel
walking
is approximately
displacement
measured
horizontal
VOL.
eight
vent
ho(lv
t lie
the
foot,
and
is about
((le,
I o t he
bet veen
below
nay
the
t lie
from
same
limb
middle
As
maximum
its
of t he
they
or the
thiit
of mot
right
t inic.
( )f
Ii iegtilri.r
ion
; the
gioufl(l.
is slight
hie could
of clearance.
of progression,
it is similar
and
height,
inch
of t he
slightly
to walk
if lie were
the
At
a person
siiioot
males
linb
cent
I mat e
a(lult
of
corresponds
with
tint e evenly
lies
words,
standing
one-half
alternately
the
always
(cut
)i
(let ermilie(l
rike
that
i)er
supporting
position
rtct
irregularities.
other
of gravity
; I his
(unit
if any
so I hat,
plane
in
t o fltict
body
in
which
combined
are
foiiil
is
hi few
to his
nearly
level
Ii feet
it
of the
o I he
When
are
75
it cn ol
cycle
the
first
snall
so
trl
l)hIi5e.
center
as
aie
25
swing
inches
at
of t lie
live
horizontal
ions
occili
is
I lie
in noimtl
Iiii(l(lle
The
of t lie
les and
vatiat
ions
over
(hisplacemelit
t lie
51)011(15 eXactly
Inc would
hiave
ical
t Iu.
t lie
heel-st
pitce
of the
is standing.
summits
vent
it
(luring
subsequent
phase
lie is standing,
Rela
t lie
in a double
stance
gravity
of
foot
(lesciihes
(hiVe,
ion
(hile(t
I I0
Ui(
body
I his
iioii
of the
wit
subject
one
(yUle
( )I
y of I he
iCill
)a I ii way
flhi(l(lle
displacement,
tine
)Iiiot
vent
IL
; ifl(hivi(hlal
oscillrtt
t ia
the
ari(l
center
of
ill
sti((essivel\
of this
inches
these
loc
progression.
\\ice
rike
1)iL55C5
1
it
en of giavit
(elit
of
t
aniount
eighit-beuing
S t15c(Iit
i)lt11e
t lie
( )t
iise
t he
lied-st
body
S of
I his
iI
t lie
(lisl)hitce(l
-1 elit his
s)onding
alking,
is
total
Fhie sunnit
l)l
l)iecise
iii
ion
is, as
t he
I Ii e
level
Ci1i\(
(cut
t lint
to
flOilUal
ii
FI(.
wino i( (W n(pn(sen
glass
three-quarter
to describe
of the body
an almost
since
vertical
the
and
.546
.1.
( lig.
U.
2 ).
I in
ol
gia
; hu
t ti
smoothly
of
iiiL
lie
to
and
tue
It
center
loconot
I i inc
ion
as
the
left
at
73
procee(ls
to
fall,
to
per
motion
Newtons
itiot
sI at e.
first
iOI)
iii
iranslat
ion
law
of inotion
It
st n-night
of
a i)o(1\
line,
to
as
iight
lily
right
cycle.
When
once
more
summit
the
right
and
in its
state
body
states
that
unless
it h)e compelled
every
with
the
- ----
--
continues
h)y impressed
least
force
expenditure
--
of the
impossible
gait.
oi(ial
foice
times
accelera-
mass
(F
is
direction
a
of
as
shall
ment
of
ment
stable
the
we
gain
may
influence
t
t ciii
order
of
to
of progression
the
until
analyze
In
pat
In childreii
come
this
factors
vhiichi
50,
it
the
pathway
is necessary
introduce
center
locomotor
especially
to
see
in
Developmentally,
come
about
by
have
of the
of the
ahnoi-mahity,
to
is variable
and irregular,
year
of life. Therefore,
seventh
understanding
pathological
(10
the
determine
considerable
appeal-
of locomotion
pattern
human
energy;
and,
considering
no locomotion.
would
ap)i-0ximitte1y
the
gait,
the
body
every
attempt
to
to conserve
energy.
make
continue
displarenients
vertical
the
through
pathway
amplitude,
conserves
will
unIt
thU
gravity
gravity
1)ody
we
of
translating
undulating
pathological
of
expen(hiture
In
of low
in(I(nse(ti((ni
of (lie inonizonital
I lie pat iiwav
of I he oniten
ai)i-upt
changes
in
of motion
com-
high
center
smooth
is
ttcceleraof
time
a. function
v, t)
an(l
ma)
energy.
TIn
ampli-
deflections
Since
pd
J)nO(IU((S
the
to
tion
tion
a sinus-
gra(iual.
equal
(a
most
of low
whichi
it is
of
would
be
body,
as in
through
in
the
but
means
next
method
of the
pathway
ttide
by
The
locomotion,
are
that
maybe
wheel,
by
economical
translation
or of
mechanically
means
quite
of rest
to change
of energy
bipedal
lo;.
to
is reached
has reached
GAIT
achieved
, it
begins
is completed.
OF
line
it
the
second
to
I lie
t oe-oft,
25 per ccii I of
en i)egins
to desceIl(l
as
gradually
velocity
at
cent
the
left
of
line
eveii
t o tine
tine
As
in the
almost
a suniiit
deviation
cycle
of gravity
with
heel-strike
this
DETERMINANTS
in a straight
center
to
return
the
EBEHIIART
D.
moves
tine
of the
11.
the
sinoot
continue
cent
THE
uniforni
center
I 0 t lie
it begins
of tine forward
of
the
froni
es
AND
I)athwaY
rises
ii
(leiItt
it.
INMAN,
T.
which
O\V((l
)ll
summit
axis
the
alolig
( )t
towar(1
a secon(1
tine central
sn ie
deviates
1.ise
V.
of
a spiral
cycle
single
ily
sAtNI)ERS,
l)icture
is that
(i
cycle
n)1C.
thlcc-(IiflieflsiOflltl
.:
progression
((iit
ii.
at
regards
first
certain
of gravity,
the
achieveexperi-
and it does
not
it is of importance
mechanism
as
the
natural
energy
purely
since from
and
appreciate
cost
to
theoretical
the
be-
to
them
the
i)ody.
considcra-
i4)Ii5.
(viii
pa.s.
For
bipedal
Gait
analytical
system
purposes,
in which
the
let
lowci-
us
consider
the
behavior
extremities
are
represented
THE
of
the
center
by rigid
JOURNAL
OF
BONE
of
levers
AND
gravity
in
without
foot.
JOINT
SURGERY
DETERMINANTS
IN
NORMAL
AND
PATHOLOGICAL
547
GAIT
Fin.
In the hypothetical
pathway
of the center
compass
of
gravity
gait,
is
the
a series
of ar(s.
Fin.
The
i nfluenn-e
t he arcs
of t he
gravity.
VOL.
35-A,
NO.
3,
JUn.Y
i953
of pelvic
pat hw:u
1
rot :ution
of
line
flat (emns
centen
of
548
B.
j.
ankle,
or knee
flexion
and
M.
DEC.
mechanisms
but
extension
v.
SAUNDERS,
only
are
T.
INMAN,
articulated
(Fig.
3).
AND
at the
In
such
H.
levers
and,
the
would
by
The
energy
proportional
cost
terms
gravity
of the
inches,
extremities
with
each
step,
equal
that
in extension.
Locomotion
walking
on the heels with the knee
to
a person
of the
body
would
is double
which
using
average
have
the
the
human
to
normal
vertical
model
First
The
In
Deteriii
in a at: Pelvic
normal
level
relative
to the
the magnitude
determinants
would
the
be
the
can
walking,
significance
model
(Fig.
the
In
of
three-quarter
of intersection
of
the apof such
be followed.
pelvis
rotates
alternately
to
the
right
and
to
the
left,
At the customary
cadence
and stride
of average
persons,
is approximately
4 degrees
on either
side of the central
axis,
of pelvic
4)
of the
center
consequence,
and,
of translation
(tuced,
an(l the
angles
at the
hip
joint
phase
and
relative
producing
pelvic
tilt, the
the swing-through
The
vertical
of its
energy
at
are
Pelvic
Tilt
the
pelvis
knee
effects
joint
of that
of pelvic
the
by
rotation
rotation
occurs
alterduring
the
loss
of the
is tilted
at
the
the
relative
extremity
to the
limb
of the
swing
phase
of the
must
center
of the
of that
arcs
are
In
this
way,
to the
Trendelenburg).
extremity
the
flex
the
horizontal
displacement
of
arc.
rendered
extension
is reis conserved.
(positive
The
arc
is more
gradual,
in the succeeding
relative
5 degrees.
limb
pathway
extremities
summit.
downward
theoreti-
the
in flexion
and
of the member
adduction
in the
of our
of potential
energy
center
of gravity
the hip
oscillation
or lists
a study
somewhat
of successive
in relation
The
of the non-weight-bearing
member.
on
by
flatten
elevating
of the weight-bearing
is on the average
of the
tilt
to
intersections
elevated
an equivalent
abduction
appreciated
are
angular
rotation
for the internal
side opposite
to that
angular
displacement
at. the
experimental
time,
be
gait
is greatly
reduced.
to (-hiange
the direction
locomotion
plane
on the
The alternate
best
rotation
in compass
of inflection
same
Determinant:
In normal
can
of pelvic
is less. The
energy
required
arc
Jlie Second
rotation
effects
of gravity
the
abrupt
The
energy
cost in locomotion
and the force
required
cycle.
to allow
of gravity
occurs
in the
are
stance
To
permit
clearance
evident
for
in the
(Fig.
5). As the lateral
list occurs
while
the body
is passing
over the
supporting
member,
the center
of gravity
is lowered.
Thus
the summit
of the at-c
translation
falls and still further
flattening
of the pathway
results.
The saving
of
by the cutting
of the vertical
displacement
of the center
of gravity
in half is obvi-
The
high.
center
phase.
less
the
in
im-
Rotation
line of progression.
of this rotation
The
passage
In
hip
but
would
require
a consideration
a total
of some 8 degrees.
Since
the pelvis
is a rigid structure,
this
nately
at each hij) joint
wiiich
passes
from
relative
internal
to external
cal
the
and
point
01
stance
the
exceedingly
three
At
at
of stride,
acceleration
it is from
of locomotion
permits
produce
be imitated,
length
displacement.
a simple
the
rotation
approximately
the ai)rupt
change
in direction
of the forward
of force of considerable
magnitude.
Nonetheless
that
angular
gait
and
the arcs,
plication
This
the
compass
elevated
joint.
would
of this type
might
fixed in extension.
stature
be
of a hip
quasilocomotion
of stepping-off
distances
of gravity
of the system
radius
of these
arcs would
representing
EBERHART
equivalent
system
something
analogous
to the process
dividers.
The pathway
of the center
be a series
of intersecting
arcs. The
flexion
perfectly,
D.
model
energy
is saved
i)y greater
reduction
of the limb
in the
swing
phase
likewise
at the inflection
of the arcs. The flexion
conserves
energy
by the shortening
of
pendulum.
Third
Determinant:
A characteristic
Race
of locomotion
Flexion
in
is the
the
Stance
passage
Phase
of the
THE
body
JOURNAL
weight
OF
over
BONE
the
AND
supporting
JOINT
SURGERY
DI-:rF:HMIN.NT5
IN
NORMAI
A ND
PATIIOL0GIC.L
1-in.
The
effects
of
Inn.
Note
(onni)ined
hat
tilt achieve
of the center
VOn.
35-A,
No.
3,
JUlY
1953
.)
pelvic
tilt
side
furl her
of t he ceniten
weight-hearinng
of translation
it
tine
Ii
549
(;AIT
effects
pelvic
on
tin
flatten
of gravit
10)11-
he arc
(
of knee
rot at ion and
minimal
v(-rt
of gravity.
i(Il
flexion
(hisplacem(-n
pelvic
I
J.
550
The
net
effect
Ii.
of
DEC.
Fin.
the
M.
SAUNDERS,
V.
T.
INMAN,
AND
H.
D.
EBERHART
7
determinants,
pelvic
rotation,
pelvic
tilt, and
knee
flexion,
produces
flattening
of the
arc
of the
center
of gravity.
This
is the
equivalent
of progressive
lengthening
of
I he extremity
with
tine same
length
of stride
and
reduction
inn the range
of flexion
and
extension
of
the
as exempliho-oi
iIiJ)
inn the
series
of figures.
extremity
while
dergoing
flexion.
member
heel
enters
strike
with
extension.
to flex
until
ion
The
effects
of the arcs of foot
and
knee
rotation
abrupt
inflexions
at the intersection
of
of translation
of the
center
of gravity.
out
lock
is
since
extension
If
apparent.
further
act
the
knee
prior
The
low-ct-ed
These
in the
to its
examine
we
is first
final
the
summit
with
in extension,
full
weight-bearing,
tue
(Fig.
arc
conservation
6),
the
described
extremities
the
at
in full
knee
joint
to (to so
on
the ground.
of this flex-
Immediately
middle
of
ante-
the
period
the
of
knee
into
joint
extension
followed
tue
knee.
heel
terminal
flexion
This
begins
simultaneously
rise,
into
as the limb
is at length
carried
the swing
phase.
This
erioi
of
stance
40
per
to
as
phase,
the
with
occupying
of the
cent.
of
by
the
ai)out
cycle,
period
of
by flexion,
effects
of
by
passage
of energy
three
determinants
of gait-pelvic
same
direction
by flattening
the
of the
the
phase
joint
continues
more
passes
is immediately
unlocked
the
reduces
materially
walking
rotation,
arc
the
over
of the
by reduction
is referred
double
and
again
which
the
a flexed
center
knee
locked
tilt,
the
and
in
extremities
of flexion
THE
JOURNAL
and
OF
l)ecome
flexion-all
of gravity
of the
arc,
net effect
of which
relative
extension
BONE
is still
displacement.
knee
center
its summit.
The
of a circle,
the radius
extremity
(Fig. 7). The
range
knee
of gravity
of its vertical
pelvic
through
i)O(ly is translated.
The
first-pelvic
rotation-elevates
second
and third-pelvic
tilt and knee flexion-depress
passage
of tine center
of gravity
through
a segment
and two-tenths
longer
than
the length
of the low-er
ening
stance
knee
is tin-
flexion.
model
of
the
locked
the
15 degrees.
to
the
smooth
the
arcs
the
---
supporting
the
and
nor
once
which
---
joint
The
knee
The
Thereafter
begins
Fin,
its
AND
the
the
is the
is two
length-
at
JOINT
of
and
the
SURGERY
hip
DETERMINANTS
IN
NORMAL
AND
influence
exploded
joint
of the several
view
of locomotion
required
to
tremities
plays
slight
increases
lengthening
The
In
with
the
at
and
the
the
angular
phase
ankle
heel
of the
a radius
contact
by
of the center
is equally
of stride.
increases
Foot
fourth
of the
and
and
of gravity
relative
elongation
of its arcs.
ex-
Mechanisms
of locomotion,
center
Accurate
of the
velocities
of gait at
are achieved
by the
cadence.
determinants
of the
is seen in this
spaced.
The
in
Knee
fifth
pathway
foot
level
and
establishing
a sinusoidal
The translation
of the
Determinant:
As has
been
weighit-hearing
duced
by
the
extremities
sarily
inches
(Fig.
view
exploded
the
for
of gravity
recordings
we
in the
of the
be half
(Fig.
are
plane
phase
concerned
of progression
relationships
of the
angle
mentione(I,
extremity
the
at
the
of this
approxi-
curvature
arc
with
point
initiation
is similarly
heel
rise.
The
pattein
of the knee and the (-enter
of the abrupt
inflexions
at. the point
center
of gravity
smooths
the gait
by
obliteration
the
with
plane
a great
reduction
of energy
of progression
is illustrated
cost.
in an
of the
Pelvis
necesthiree
11)
which,
vertical
i953
displacement
reversing
associated
the
of
in
JULY
on the
8. The
progression
slightly
knee
rise.
so that
its lowest
with
forward
termination
second
reached
heel
one
the
3,
of the
has
extended,
associated
of the
with
the pelvis
or by relative
adduction
at the hip.
another,
the amount
of this displacement
would
between
the axes of the hip joints,
that
is, approximately
lateral
displacement
is corrected
by the existence
to
an(1
NO.
its
and
The
flexion
foot
rotation
over
is pro-
one
35.A.
with
flattening
of
is fully
of gravity
of the
the
is displaced
laterally
This displacement
shift
parallel
and
joint
by
in association
the center
of gravity
of the body
twice
during
the cycle
of motion.
Thus
horizontal
thus
Displacement
(hiSplacement
to about
vertical
displacement.
both
centei-
flexion
translation
Lateral
(Fig.
knee
is made
foot
9).
the interval
10). Excessive
tibiofemoral
the
pathway
for its progression
center
of gravity
in the
horizontal
were
the
of translation.
at the foot
in Figure
of
and
arc
of the
of gravity
time,
arc
second
part
and
center
by
arcs
The
fore
plantar
some
reversed
effects
of the rotations
of gravity
are illustrated
of intersection
of the
Sixth
length
Rapid
of its
slightly
heel.
the
is dorsiflexed
maintains
same
the
at
maximum
commencement
flattened
by
displacement.
tue
the
formed
the
flexion,
mately
VOL.
of motion
length
than
established
is at its
of knee
the
stage
same
Determinants:
out
a center
of downward
The
each
important
role in permitting
increased
since greater
velocities
of locomotion
rather
of intersection
Itl)OUt
extremity
at
Fifth
discussion
about
At
which
the
stride
displacements
at the ankle,
foot, and knee show that their
motions
are intimately
Two
intersecting
arcs of rotation
are established
at the foot during
the stance
(Fig.
8). The
first arc occurs
at heel contact
and is described
by rotation
of the
related.
foot
maintain
smoothing
point
in
an exceedingly
in energy
cost,
of the
Fourth
determinants
551
GAIT
FIG.
The
PATHOLOGICAL
together
three-quarter
(leviation
planes.
with
relative
adduction
at the
hip,
inches
so that
it approximates
of the center
of gravity
is almost
Togethei,
these
deviations
of the
center
If
of
reduces
the
the
the
that
of tine
symmetrical
of gravity
552
J.
fl.
oN.
Fit;.
Fig.
in
of
l():
exo-o-s.sivo
If I lie linnins
laten-al
.\I.
SAUNDERS,
\.
T.
INMAN,
AND
H.
D.
EIIEHLIA
RI
10
were
pan:nllel,
olisplao-ennennt
thene
of
tine
woulol
Fin.
centen-
11
gravity.
Fig.
I:nt enal
11: Thurougin
tine
displ:n-ennenni
is
influence
(onrecte(
of a tii)iofennoral
angle
Fin.
The sum of tine (fleets
is viewed
inn I nw phase
and
of
adduction
at
tine
hip
joint,
exo-essive
of tine several
relationship.
determinants
12
on
the
1HE
pathway
JOURNAL
of tine
OF
(enter
BONE
AND
of gravity
JOINT
SlRGlRY
DETERMINANTS
to the
contribute
IN
establishment
in the
equal
axes and add smoothness
replaced
by a sinusoidal
curve.
tiOflshii1)
in
Figure
these
gerations
range
in the
h)V
of gait,
the
described,
an(l
minor
the
Gait:
(lone
phase
for
by
in one
various
or another
of
factors,
exag-
reductions
in another,
essentially
the same
in that
it is
disturbances
of the limbs
have
of one function
is frequently
well
in the
clinical
examination
In
of
already
this way
Levels
should
be said coneeining
mathematical
formulation,
energy
level of a body
is tile
the energy
level is constant,
where
the loss of potential
When
the energy
level
sum
as
the energy
qualitative
of its potential
in the classical
and
cx-
energy
is exactly
compensated
is not. constant,
then
work
must
for
ie
to produce
the change
in energy
level.
In the computing
of the energy
levels
diffeient
segments
of the low-er extremity,
it is found
that
the levels
are not conThe difference
is a measure
of the work
done by the muscles
at the joints.
The net
in ordei
result
is the
pated
in the
put
of energy
and
hip
level
forw-ard
i-otations
stu(hies
of the
is considerably
walking
the
ergy.
though
However,
out}Jtit
is so much
the
by
later
body
at
the
(Inc
to
the
swinging
the
levels,
the
leg
knee
the
less
Part
of
time
-hen
push
the
most
of the
the
a large
portion
of the
referred
to as the
are
energy
is dissi-
output
an(1
input
process,
a rigid
phase
by
of its
potential
member
the
Outj)ut
of the
; therefore,
establishied
most
of the
energy
required
on
joints.
In
this
overall
energy
Additional
imparting
energy
also
hut
flexion;
is
of the
the
to
knee
energy
system
acceleration
locomotion
to
is not
of the
(leceleration
at
a constant
cadence
of the
energy
eited
into
in one
or more
expended
Potential
(luring
recoverable.
of the
There
storage
35-A.
NO.
energy
straight
JULY
conti-act
is evidence,
occur
1953
would
of the
dut-ing
does
3,
and
segments
1)0th
energy
energy
the
only
knee.
and
level
walking
at
divided
expend
althan
by tile
all
returned
pull
en-
and,
is less
not
Thus
to the
absorbs
by
forward
for
knee
approximately
equally
between
the production
of rhythmic
oscillations
and
the elevation
and depression
of the center
of gravity
of the body.
mechanism
were a truly
efficient
machine,
the kinetic
energy
in the system
The
in-
ankle
of the
is ahsOrbe(l
and
is lost.
case
requirement
continued
energy
body
Nonetheless,
stored
the
predominantly
of the
swing
phase.
portion
is
in support
joint
motion
the
knee.
that
these
that
vertical
(luring
the
A considerable
sw-ing
been
input
acting
the
over
is lost.
the
than
in
foot
the
muscles
(leereases
and
it has
than
in walking
he necessary
to decelerate
the
by
the knee
is dissipated
energy
absorbed
energy
greater
is provided
joint,
w-ould
displacement
of the body,
but
of the segments.
These
effects
respectively.
From
VOL.
are
rela
ltssesSe(l.
gait is considered,
something
In or(ler to aVOi(l lengthy
of a simple
pendulum
gain in kinetic
energy.
of the
stant.
in
and
in true
GAIT
Therefore
be readily
Energy
the
obliterated
be focused
serially
on the six determinants
losses
in their
range
should
I)e noted.
may
teims
by
are
exaggerations
between
the
compensated
of another.
should
and
(luring
ample
are
to
of gravity
remains
Even
gross
pathological
pattern,
since the loss
of gait
pathological
locomotion.
OF
are due
the interaction
center
levels
kinetic
of approximately
is illustrated
EXAMINATION
exaggeration
of Patholoqical
Before
spiral
inflexions
factors
.)33
GAIT
of the
all sharp
these
determinant
attention
exaggerations
disturi)ances
Evaluation
since
of
CLINICAL
of one
the
for
(hisOr(ters
even
sum
in locomotion
Owing
to
so that
the final pathway
of the
the most
economical
to maintain.
little
influence
on the fundamental
compensated
of progression
gait,
The
PATHOLOGICAL
12.
variations
determinants.
seven-al
AND
plane
to the
THE
Individual
NORMAL
in the
be stored
body.
ion and
however,
muscular
until
However,
since
elongation,
that
system
it is required
energy
under
certain
and
perhaps
tile
muscles,
specific
If the
human
\o1il(l
he
to initiate
when
storage
is never
and
as much
40
con-
movement
stimulated,
complete
rigid
as
is
legs
or
situations,
per
cent.
of
554
J.
200
I).
M.
DEC.
SAUNDERS,
T.
VERTICAL
/00
V.
INMAN,
AND
H.
D.
EBERHART
LOAD
FUSED
ANKLE
NORMAL
ao
ANKLE
TIME,
SECONDS
FORE
Q_40
AND
AFT
SHEAR
2\j/)/:t,v//\
FIG.
13
of
Fig.
13:
a person
shown.
The
There
Fig.
14:
motion
acceleration
of the
figure).
and aft
The
joint
center
inflexion
in the
arcs
of
ankle
is transmitted
to the
by excessive
flexion
maintains
the path of translation
of the
of
of gravity.
volve
the
contraction
moving
As
the
center
of the
is expended
recovered
on its descent.
tinde
of this- expenditure
walking
up a slight
grade
body
during
The
net
result
is qualitatively
is much
more
is displaced
its
is a continual
With
the
loss
of
one
of the
major
determinants
the
grade
pull
as
this
expenditure
the
minimal
of pathological
of energy.
to
very
action
the
muscle
sinusoidal
of the
of the
brief
periods
of two joint
pathway
a portion
of this
of energy.
of low
energy
The
That
of approximately
of gravity.
a result
compensate
w-ithin
their
ai)ility
of the body through
a sinusoidal
requires
recovery
they
in-
that
walk-
4 per
of injury
or
is
magni-
i-emaining
mechanisms
will
ment
of the center
of gravity
analysis
of
mechwhich
displacements
the
limiting
the
expenditure
appreciated
fatiguing
than
ing down
a gentle
slope
is still easier.
A descending
requires
little
or no elevation
of the body
against
its
only
and
but
timing
to the
segments,
and
locomotor
The factors
storage
here,
precise
through
elevation,
the
energy
discussed
muscle
contraction
of activity,
and
muscles.
of gravity
energy
is
be-
and
the normal
figure
illustrates
not altered.
abrupt
which
permit
this
will not be
amplitude,
foot
difference
fused
ankle
The
lower
shears
are
the energy
put into
anism
is recoverable.
14
body
of one
at the fused
the smoothness
Fin,
of the
panarthrodesis
is no appreciable
tween
records
ankle
(upper
that
the fore
knee
vertical
with
cent.
disease,
the
to produce
an over-all
displacepath
of low amplitude,
since
this
is true
is confirmed
1)y
gait.
THE
JOURNAL
OF
BONE
AND
JOINT
SURGERY
Hfl
DETERMINANTS
The
Force
IN
NORMAL
AND
PATHOLOQICAL
VERTICAL
Plate
rea(Iy
means
determining
GAIT
of
is
tue
availai)le
vertical
for
FLOOR
REACTIONS
tine
displacement
of
O.D.
B.w.
tine center
of gravity
of the body
thi-ough
the
use of a force
plate.
A force
plate
is a device
for measuring
the ground
i-eactions,
including
torque,
(luring
locomotion.
Essentially
the
al)Paratus
of a
supported
consists
is
which
rigidly
columns
opposing
all).
The
to which
are
pairs
of strain
deformations
coordinates,
by balanced
as well
1)ridge
OIl
by
In
operation,
plates
in
the
are employed;
the
course
of walking,
then
on
the
other
with
the
acts
as an
inertialess
The
force
plate
scale
center
two
Bare
of great
of gravity
of the
body
Furthermore,
accelerations,
plate,
therefore,
becomes
useful
instrument
for the
the degree
of compensation
major
are
constituents
amplified
study
which
of the
when
they
a pci-son
When
the
in
angular
changes
ankle.
The
degree
tions
of the
force
the
only
the
the
sound
body
of the
is over
with
lower
are
abnormality
to the
is normal
In the
Minor
changes
is the
arthrodesed
joints.
Because
two
intersecting
arcs,
the
foot.
However,
an exaggeration
the curve
of knee
displacement
VOL.
35-A.
shock
NO.
3,
JULY
wave
arthrodesed
foot
and is accomplished
1953
(Fig.
of the
centers
have
little
indicating
effect
on
a smooth
verti-.
transla-
of gravity.
for the evaluation
of
of one or more
of the
in the
displacement
pattern
acceleration.
GAIT
of the
may
Reactions
15
1G.
heights
and
loss
the
in vertical
ankle
of the knee
compensate
force-plate
heel
locomotion
following
as changes
a panarthrodesis
of compensation
Varying
hes9ht5
heal
very
extremity.
pattern
and hip
of pathological
has occurred
recorded
displacement
in the knee
plate.
heels
Effect of varyin9
on VertcaI
Floor
PATHOLOGICAL
changes
#{149} ,,
eg s
force
hQels
by geomet-
since
the force
it is exceedingly
The
Flat
vertical
methods
for
the
determination
of sudden
deviations
of the
center
of gravity
of the
body
caused
by
aitei-ations
in acceleration.
.
shoes
measured
accelerathe displacement
any
changes
in the normal
dispattern
of the
body
as a whole
more
accurate
than
photographic
placement
and
is
Flat
sensitivity.
the
to
sensitive
foot
such)
directly
accelerations.
From
these
tions,
it is easy
to calculate
of the
of
in
z
subject
Stepfirst
on one,
plate.
ihese
In essence,
records
nc integration.
plate
measures
plate
metal
bonded
a series
gages
(some
fifty
in the
x, y, and
force
ping,
walkway.
metal
four
as torque,
are measured
circuits
and are iecoided
oscillograph.
an
heavy
be
measured
record
noted
and
subtalar
recording
presented,
during
the
the
walks,
minor
noted.
These
small
lost in the foot and
the
vertical
compensation
transition
13). The
pathway
by exaggerating
the
fixed ankle,
of which
are
joints
be
accelerais excellent;
of body
weight
of the center
of gravity
initial
knee
bend
on the
the displacement
located
at the
of the initial
knee
flexion
prevents
from
being
transmitted
to the trunk
heel
of the
and
from
of
side
knee
joint
ball of the
the discontinuity
and maintains
of
the
.1.
H.
n)n.;(.
\I.
SAUNDERS,
V.
T.
INMAN,
AND
II.
D.
EIIERHART
ZI-.
Oz
OW
o
0
-Jil.
11.0
Id
>Q.
Id
120
PERCENT
VERTICAL
OF
FLOOR
SUBJECT
REACTION
WITH
l)(n1sate
at
less
1)0, slight
Illodificat
tern
A
iiile
angular
they
this
pelvis,
loss
hips,
is
and
(xaggeitite(i,
ever,
not
similar
vei-t
(Fig.
15).
flexion
up
Tine
ieal
an
The
the
ions
exaggel-at((l
weal-ing
(emit
ci-
of
high
of
gI-avity
\Vhen
of the
tine
knee
ai-i-angement
chai-aeten-izes
tine
patient
compensatoi-y
To
gain
since
clearance
the
are
achieved,
is
the
important
of tile
a
which
is
the
pelvis
retention
of
the
the
Thus
for
of the
normal
in gait seen
in
low heels,
the
In
familiar
to
show
person
is
the
the
in
and
This
is,
that
in
this
high
or
hip
mechanism
pathway
of
the
rotation
all.
mci-eased
foot
in both
whole
namely,
tilt
pelvic
records
and
loss
a normal
tilat
14)
compeflsate(l
howgait
low
heels
an(l
knee
cause(1
displacement
by
of the
maintained.
stiff
movements
foi-
result
the
cOni)-
constituents,
and
force-plate
the
These
to
(Fig.
in the change
of heels.
remaining
whether
offset
its
segments
gait
of
t.he
with
with
the
the
showni.
lower
extremity
are similar
of the foot to the integrated
is increased
(-haractei-istic
body
ith
heights
the
attempt
body.
various
of
is
tine
completely
(lepicted
in
gait,
the
hip
of tile
flexion
to
of
and
hip
side.
b)een
contributions
knee
is immobilized,
of
knee
of
affected
has
tue
a fused
indicative
gravity
with
movements
body
of
segments
motions
heels,
tine
modifications
aflecte(l
aceelerat
on
shloes
initial
pi-oducing
motioin
is vell
the
of
are
of gravity
vaiious
by
an-c eompensatoi-v
the
out.
made
met-ely
ceiltel
mechanism
in
presence
anud
mechanism
(lecrease
knees.
the
side
of
HIP
(enter
ankle
walking
he
of
beliavion
the
()I
loss
tile
of
the
in
normal
tine
an(1
of t
heels
high
for
t(IIl
iii
tie
neactionis
the
oIl
foot
iOilS
However,
and
of
the
displacement
sexes.
Otis
I)1t
of
floor
inij)
of (lisplacenlent
siniilaiCOflll)eilsat()Iv
\VoIiTlen
RIP
nornnml
(lisplacenlent
I1OIlilal
(OnlIJIete
l)itt
the
inn I lie
refl((-te(l
FOR
FUSED
Fnn.
Tine (Iiffenennc(
al)nnorlnalities
are
CYCLE
knee
in
foot,
lower
the
contm-ibution
extremity
requires
remaining
excessive
to the
obviously
no
detailed
normal
elevation
JOURNAL
and
The
description,
segments
of the
THE
orderly
is lost.
pelvis
OF
but
should
on the
BONE
harmonilimp
AND
be
affected
JOINT
which
certain
pointed
side
SURGERY
DETERMINANTS
is necessary,
Sl)it(
or
of
increase
(leviations
body
these
gravity
of
an
IN
in
the
from
retains
of the
NORMAL
heel
AND
is required
rise
what
are considered
a remarkably
constant
(hisplacelnent
as noted
from
the force-plate
t Inc kiiee
of from
is to 20 degrees
is pieserved
The
nlechianisms
of tile low-er extremity
vell
for
gravity
of
extent,
in
(ally
tile flexion
the swing
1)y
Early
flexion
lie leg
lie swing
pilase.
swing
phlase
initiate
tion
swing
by
to start
the
knee
of
prostheses
for
All
of these
to
with
had
managed
the
expense
side
reduction
of the
moment
a (louble
this
Tile
ion
[he
remaining
VOL.
35-A.
exerted
center
of
an
the
path
to
be
intended
appearance
of
the
the
the
knee
amputees
the
heel
rise.
mechanism
they
With
played
study
by
the
to
develop
knee
beginning
the
devices
Adjoints.
of the
However,
the
a wrench
functionless
insist
placed
over
that
and
so that
a pylon
distally
that
In tile
pendulum
prosthetic
gait..
which
energy
swing
increased
provide,
requires
more
energy.
(The devices
were,
therefore,
disliked
by the ampitwould
leave
the limb shop with a well functioning
device
and an
in his gait,
only to return
at a later
time
with
a free-swinging
knee
-eight
phase.
Council
the
the
role
in the
expended
at the
the
to
Immobiliza-
of the
Research
rise
in locomo-
gained
been
into
joints,
is several
tripling
example
has
heel
that
commencement
of gravity.
experience
effort
the
hip.
to initiate
the propulsion
of
the energy
necessary
almost
A vivid
incorporated
whole
of the
requirements
to
National
to limit
the
alone
flexors
center
leads
by
of the
flexors
at the
energy
of the
limb.
the
hip
little
toward
to reduce
Much
of
the
hip,
two thirds.
it converts
knee.
the
braces
the
since
flexors
hesitancy
arthrodesed
is provided
in
of
of the
hip
phase
and
imparted
in the
of the
stump
conventional
by
the
driver
the
cost
was
lowered
at
realize
to initiate
the
the
importance
swing
phase
of
on
should
he as light
as possible
does
appreciably
itself
and
the
of a free
amputee
energy
extremity
prosthesis,
incorporation
a screw
the
thus
not
requires
of the
knee
obviates,
joint
increase
minimal
conversion
in weight.
lower
effort
to
extremity
to a certain
difficulty.
inconspicuous
be detected
normal
segments
can
easily
for
NO.
at
reasonably
of inertia
the
by
by the
involved
Limbs
extension
w-hen
relatively
posit
partially
out
amputees.
abnormal
of inertia
tine swing
degree,
be
or long
locomotion
the
to render
amputated
if flexion
of the
muscles
moment
requires
contributes
does function
of the
devices
flexor
requirement
and
with
casts,
phase
the
the
in minimizing
to smooth
Artificial
and
The
into
and
improve
flexion
the
pathway
in
double
weight-bearing
by the upward
thrust
of the aesthetic
appearance
of his gait.
exponents
of pylons
for above-the-knee
amputees
joint
in decreasing
tile amount
of energy
required
The
stai-t
noimal
by
he observed
knee
joint
knee
were
its resultant
tine knee
the
the
in the
partly
force
a force
The
hydraulic
the amputee
to expend
tee.)
Many
an amputee
improved
appearance
joint
However,
S particularly
true
time
of its fixation.
are able to compensate
partly
the
joint
arthrodesis,
on
to
iPsistance
side.
rfili
decreases
of a person
knee
the
mechanisms
an(1
1)llase
gait
above-the-knee
and
fllecilanical
that
swing
and
mechanism
as may
in human
Committee
visoi-y
this
demands
phase
joint
normal
third
and the former,
approximately
of the swing
phase
is important,
thus
normal
but
knee
the
decreases
emphasized.
tile
by
in turn
in the
of the
tequired
and
tile
space,
foot
one
initiation
at the
of the
be
thi-ough
tile
as normal
bodily
motions,
and nearly
normal
path
of
occurs
late
is produced
of the
suppresses
impon-tance
should
body
on
records.
at the
apparently
maintenance
pendulum
This
than
The
ti()Il
knee
greater
of the
knee
This
of tile
times
the
hip, which
of walking,
flexion
a double
extremity.
Fixation
as
approximately
of the
into
lower
of the
phase
plantar
contrib)uting
far
557
CAIT
1)ody
latter
as
the energy
to almost
leg
tile
knee
the
Iloweven-,
is increased
to
stiff
tile
PATHOLOGICAL
the
3.
JULY
loss
1953
of the
hip
limp
caused
by
an
arthrodesed
by
abnormalities
of the inferior
in the vertical
extremity
are
joint.
It will
that
be recalled
pelvic
hip
in good
functional
floor reactions
(Fig.
able
to compensate
rotation
and
pelvic
16).
only
tilt
558
B.
..
are important
of tile i)O(ly.
hip
joints
At
SAUNDERS,
M.
factors
in
the point
weight-bearing,
importance.
respect
the
which
T.
INMAN,
the vertical
elevation
with
in
externally
about
the weight-bearing
of the femur
with respect
to the
of considerable
V.
(lecreasing
of maximal
in mid-position
are
double
m)LC.
are
hip
pelvis.
joint.
This
the
hip
U.
D.
EBERtIAIt
displacement
of the center
to rotation.
feet
When
AND
of the
of gravity
From
videst
apart
remains
and to allow the
loss of one of the major
The
by exaggerated
reveal.
In such
body
is still
motions
cases the
translate(l
ever,
the amputee
and the vertical
minor
high
by
disease
So
system
is the
subject
which
through
in direction
from
are required
great
elderly
smoothly
cost
will
must
that,
as
our
pathway
experience
shorten
his
rotation
phase
life
requirements
at
fully
normal
manner.
compensated
amputees
of gravity
at low
shown,
the
the
is
limitation
energy
for
clearly
of the
cost.
How-
satisfactorily
Because
of the
pathway
of the center
of gravity,
and make
such
deviations
very
has
from
of
rotates
during
the swing
what little
internal
is unable
to compensate
from the normal
pattern.
the smooth
sinusoidal
which
dissipate
energy
inevitably
supply
knee
position
pelvis
resultant
below-the-knee
that
the center
a sinusoidal
foot and
markedly
the
with
to rotate
in an approximately
of the extremity
is almost
levels
as studies
in
floor reactions
indicate
changes
accelerations
costly.
the
at other
vertical
pelvis
joints
to the
stride,
be expressed
as internal
rotation
although
of small
magnitude,
of motion,
it will be found
that
the hip vill be held in external
phase
so as to be in a position
to make
available
during
the stance
rotation
point
in the
This may
movement,
is affected
this
center
of gravity
of the body,
the
the
demands
loss
upon
usurious
rate
of two
his
of 300
joints
in
cardiovascular
per
cent.
SUMMARY
Human
so
locomotion
is a phenomenon
the multitude
of space
that
analysis
great
planes
of the
of individual
is difficult
are
of the concept
that
fundamentally
through
space
along
a pathway
necessary
unifying
principle
which
most
motions
without
extraordinary
complexity
occurring
simultaneously
some
unifying
principle.
locomotion
is the
requiring
the least
permits
of qualitative
translation
expenditure
analysis
in which
in the three
The
adoption
of the center
of gravity
of energy
supplies
the
in terms
of the essential
determinants
of gait.
The
six major
determinants
are pelvic
rotation,
pelvic
tilt,
knee
and hip flexion,
knee
and ankle
interaction,
and lateral
pelvic
displacement.
The
serial
observations
of irregularities
in these
determinants
provides
insight
into individual
variation and a dynamic
assessment
of pathological
gait.
Pathological
gait may be viewed
as
an attempt
to preserve
as low a level of energy
consumption
as possible
by exaggerations
of the
motions
at
of one
makes
determinant
effective
unaffected
of which
compensation
threefold
is increased
levels.
that
with
an
Compensation
at the
impossible
is reasonably
effective
inevitable
drain
upon
the
body
with
the
loss
of two determinants
in terms
of energy
economy.
REFERENCES
M. I.;
1. CROSKEY,
of the
2.
P.
DAWSON,
of Gravity
in
H.
D.;
INMAN,
T.
D.;
Fundamental
Berkeley,
MARRY,
Artificial
University
La
E. J.:
Limbs.
A Report
of California,
m#{233}thode graphique
A.
LUESSEN,
Am.
V. T.;
EBERHART,
of
M.;
Man.
MCCOWAN,
Design
3.
Center
J.
J.
on
the
1947.
dans
Human
National
les
sciences
I. E.;
HAHRON,
61:
SAUNDERS,
Studies
to
C.;
Physiol.,
171-185,
B.
and
H.
WRIGHT,
E.:
The
Height
1922.
M.;
DEC.
Research
and
Council,
exp#{233}rimentales,
THE
JOURNAL
S.;
A.
LEvENS,
Locomotion
Other
Committee
Paris,
OF
on
G.
BONE
B.;
BRESLER,
Information
Masson,
AND
and
Relating
Artificial
Limbs.
1885.
JOINT
SURGERY
to