Chapter 8

Arrn
eciProcal arm swing spontaneously occurs during walking. Elftman calculated the angular momentum of the arm swing in the three functional planes and found the pattern was opposite to that of the rest of the body.? He conc1uded that this allowed the lower legs to perform their necessary motion without imparting marked rotation to the body. The significance of this caIculation is chaIlenged by the results of energy cost analysis. Testing subjects walking with their arms free to swing and with them bound showed no differences in oxygen usage.? These two findings suggest arm swing may be useful, but it is not an essentiaI component of walking.

Gait Mechanics Motion

During a stride, each arm, reciprocally, flexes extends for a total arc of arm displacement of 30 o (Figure 8.1). Timing between the two arms is a 50 o

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Gait AnalysisjPerry

'

Terminal Stance

Initial Contact

Figure 8.1 Arm swing during normal free walking. Terminal stance (maximum forward swing). Initial Contact (maximum backward swing).

the cycle, with the peak displacement in either direction occurring at initial contact. During the stance period from initial contact until contralaeral toe-off, the arm, measured as displacement of the wrist, completes an arc of approximately 20 of flexion. Then, with the onset of contralateral stance, arm motion reverses toward extension reaching a position 9 behind the vertical.I While both investigators reported good consistency in the total arc of motion, there was considerable variation among individuals in the arnount of flexion and extension used.3,4 Walking fast increases the total arc of motion by using greater shoulder extension and elbow flexion, while the other arcs are unchanged.f At either free or fast walking, as the arm swings forward and back, the shoulder and elbow move through different arcs of motion. 5houlder. From a position of maximum extension (24) at the onset of stance, the shoulder flexes to a position of 8 flexion by the end of terminal stance (contralateral initial contact time) (Figure 8.2). After holding this position of peak flexion momentarily, the shoulder then extends throughout the swing phases. Elbow. Moving in the same direction as the shoulder, the elbow also goes through an equivalent arc of flexion and extension during each stride." The

Arm

145

50 40

.
it
~

30 20
10

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~

ELBOW

o
.
~
LLJ

10

20 30

Gait Cyc/e

50

100

lQure 8.2 Arcs of elbow and shoulder motion during arm swing while walking. Horizontal scala indicates % gait cycle beginning . initial contact (O). (Adapted from Murray MP, Sepie SB, Bamard EJ. Pattems of sagittal rotation of the upper limbs in walking. Phys. Ther. 47:272-284,1967.)

elbow, however, never extends beyond 20 flexion. As a result, maximum flexion is 44 by the time of contralateral floor contact (Figure 8.2). Phasing of arm motion during walking is quite distinct. At initial contact the ipsilateral arm is maximally extended at both the shoulder and elbow. Following a brief delay (5% CC) the shoulder progressively flexes. There is a greater delay in the onset of elbow flexion that may relate to the maxima11y extended position being 20 flexion. Movement at the elbow toward greater flexion begins in mid stance. Maximum shoulder flexion of 24 is reached near the end of terminal stance (45% CC), and slightly later (55% CC) the elbow completes its flexor action of 44.Contralateral foot/floor contact at the onset of pre-swing stimulates both the shoulder and elbow to reverse their motion toward extension. This motion continues throughout the swing period. The elbow reaches its maximally extended position of 20 flexion by mid swing, while the shoulder continues extending until its final posture of 8 extension is attained as the ipsilateral heel contacts the floor once again. The phasic correlation of peak arm motion with floor contact by the ipsilateral or

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Gait AnalysisjPerry

contralateral foot is very consistent, with the majority of the subjects exhibiting less than a 0.1 second deviation.

Musc1e Control
On1y one study has assessed the electromyographic pattern of the shoulder muscles during walking." Five of the twelve muscles recorded showed activity. Judging from this single study, the supraspinatus and upper trapezius are the most active. Their onset is just after initial contact, and the action continues until the end of terminal swing, with on1yscattered short periods of rest (Figure Middle and posterior deltoid action are synchronous. Their activity begins just before the end of flexion and continues throughout extension. During the rest of the stride these two muscIes are silent. The upper latissimus dorsi and teres major complex exerts two bursts of activity. Both relate to shoulder extension. Their periods of action are at the end of extension (loading response) and at the onset of extension (pre-swing). None of the other muscles participate in the arm swing of walking (anterior deltoid, infraspinatus, sternal and cIavicular heads of the pectoralis major, rhomboids, biceps and triceps).
8.3).

Upper Trapezius

Supraspinatus Posterior De/toid Midd/e De/toid Teres Major

Gait Cyc/e

50

100

Figure 8.3 Timing 01the muscles related to arm swing during walking. Horizontal distance is one gait cycle beginning with initia. contact. (Adapted Irom Fernandez-Ballestreros ML, Buchthal F, Rosenlalck P. The pattern of muscular activily during the a swing 01 natural walking. Acta Physiol Scand 63:296-310, 1965.)

Arrn

147

Functional Interpretation
The shoulder presents three functional pattems during walking: flexion, extension and support of a dependent arm. Each has a specific pattern of muscular activity. Support of the arrn is provided at both the scapula and the humerus. The upper trapezius actively supports the scapula. It is logical to assume the levator seapulae also is contributing as it is a larger suspensory musele, and significant EMG in quiet standing has been demonstrated. Humeral support is the role of the supraspinatus.! The horizontal alignment of the supraspinatus alIows it to draw the humeral head into the socket as it also lifts the humerus/' Extension of the shoulder and deceleration of flexion are dynarnic events under distinct control by the posterior deltoid (and teres major). Simultaneous timing of the middle deltoid activity contributes to better abduction of the arm, so it will dear the body while following the pull of the extensor musdes. In contrast, the flexion component of arrn swing during walking appears to be purely passive. Currently there is no evidence of flexor musele activity (anterior deltoid, clavicular pectoralis major or bicepsj.' One can on1y specu1ate on the role of the coracobrachialis, as its actions during walking have not been studied. The role of arrn swing is indicated by the tirning of the active component. Dynamic arrn extension occurs at the same time the leg is swinging forward. Each extremity (arm and leg) also moves through a 300 arc. Hence, the arrn is providing a purposeful counterforce to minimize the rotatory displacement of the body by the locomotor mechanics of the legs, just as Elftman calculated.? Actively holding the arm back at the beginning of limb loading (the first 5% of the gait cyele) may be a second deliberate, dynarnic stabilizing maneuver.

References
1. Basmajian]v, Bantz Fl'; Factors preventing downward dislacation of the adducted shoulder joint: an electromyographic and morphological study. J Bone Joint Surg 41A:1182-1186,1959. 2. Elftman H: The functions of the arms in walking. Hum Biolll:529-536, 1939. 3. Fernandez-Ballesteros ML, Buchtal E Rosenfalck P: The pattern of muscular activity during the arm swing of natural walking. Acta Physiol Scand 63:296-310,1965. 4. Freeborn C: Analog recording of myoelectric signals. Trans Orthop Res Soc 6(1):297298,1981. 5. Murray Mp, Sepic SB, Bamard EJ: Pattems of sagittal rotation of the upper limbs in walking. Phys Ther 47(4):272-284,1967. 6. Perry J: Biomechanics of the shoulder. In Rowe CR (Ed): The Shoulder. New York, Churchill Livingstone, 1988, pp. 1-15. 7. Ralston HJ: Effect of irnrnobilization of various body segments on the energy cost of human lacomotion. Proc, 2nd I.E.A. Conf., Dortmund. Ergonomics 53,1965.