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AMBULATION & GAIT

Human Gross Anatomy


David G. Greathouse, PhD, PT, ECS
November 2, 2004

Objectives
Define and describe the components of the gait cycle.
Describe the kinematics of the pelvis, hip, knee and
ankle during the gait cycle.
Describe the muscular activity and actions produced
by the muscles of the LE during gait.
Discuss the pathokinesiology of the following gait
impairments: Gluteus medius muscle weakness,
anterior leg compartment syndrome (foot drop),
posterior leg compartment syndrome, and antalgic
patterns - lower extremity and trunk-spine.

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

Gait - Definitions
Gait - manner or style of walking
Gait cycle beginning of a walking event by one
limb and continuing until the event is repeated
again with the same limb
time from heel strike to the next ipsilateral heel strike

Stride - one complete gait cycle


Step - beginning of an event by one limb until the
beginning of the same event with the contralateral
limb

Phases of Gait Cycle

Gait Cycle
Swing phase - during the walking cycle, a
given foot is in the air, toe-off to heel stride,
38% (ordinary walking)
Stance phase - during a walking cycle, a
given foot is in contact with the ground,
heel-strike to toe-off, 62% (ordinary
walking)

Definitions (cont)
Duration of the gait cycle - for any one limb
extends from the time the heel contacts the
ground until the same heel contacts the
ground again
Heel-strike (HS) or heel-on - heel contacts
the ground
Toe-off (TO) - toes leaving the ground

Definitions (cont)
Speed of locomotion - steps per minute or
meters per second
Cadence - number of steps completed per unit
of time (steps/min)
Typical gait cycle - 1 to 2 seconds (82 m/min,
113 steps/min, 3 miles/hr)
Double support - both limbs are in stance
phase at the same time

Eccentric Contraction
Muscles operate eccentrically to either
dissipate energy for decelerating the body
or to store elastic recoil energy for a
shortening (concentric) contraction.

Running
Double support no
longer present
Both feet off ground
for brief time

Subphases Stance Phase


Initial Contact (IC)
The moment when the foot contacts the ground, heel strike
(heel strike)

Loading response (LR)


The weight is rapidly transferred onto the outstretched limb,
the first period of double-limb support (foot flat)

Midstance (MSt)
The body progresses over a single, stable limb

Terminal Stance (TSt)


Progression over the stance limb continues. The body
moves ahead of the limb and weight is transferred onto the
forefoot

Pre-Swing (PSw)
A rapid unloading of the limb occurs as weight is
transferred onto the forefoot (toe-off)

Subphases of Swing Phase


Initial swing (ISw)
The thigh begins to advance as the foot comes up from
the floor.

Midswing (MSw)
The thigh continues to advance as the knee begins to
extend; the foot clears the ground.

Terminal Swing (TSw)


The knee extends; the limb prepares to contact the
ground for Initial Contact.

Gait Cycle

Gait Cycle Functional Tasks


Weight Acceptance (WA)
This is the period when weight is rapidly loaded on the
outstretched limb. The impact of the floor-reaction force
is absorbed and the body continues in a forward path
while stability is maintained. (Initial Contact and
Loading Response)

Single Limb Support (SLS)


Is the period when the body progresses over a single,
stable limb. Weight is transferred onto the metatarsal
heads and the heel comes off the ground. (Mid Stance
and Terminal Stance)

Swing Limb Advancement (SLA)


Is the time when the limb is unloaded and the foot comes
off the ground. The limb is moved from behind to in
front of the body, reaching to take the next step. (PreSwing, Initial Swing, Mid Swing and Terminal Swing)

Phases
Function

Kinematics of
the Gait Cycle
A = Sagittal plane
B = Frontal plane
C = Horizontal plane

Muscle Activity in the Gait Cycle


HS FF HO TO

Eccentric
Concentric

Muscle Activity in the Gait Cycle


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

Muscle Activity in the Gait Cycle


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

Muscle Activity in the Gait Cycle


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

Muscle Activity in the Gait Cycle


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

Muscle Activity in the Gait Cycle


Fibularis longus and brevis
Stance phase
Concentric contraction maintain medial and lateral
stability of the foot

Foot Intrinsics
Stance phase
Concentric contraction support plantar fascia

Gluteus Medius Muscle


Weakness
Etiology - L4/L5/S1, Sup gluteal n, polio,
post-surgery, amputee (prosthetics)
Support effect of muscle on pelvis is lost
Right gluteus medius muscle out
Stance phase on RLE - Left pelvis drops
(Trendelenberg - uncompensated)
Compensated - trunk laterally leans to R
Circumduction leg swings in arc fashion

Anterior Leg Compartment


Weakness
Foot drop
Etiology - L4/L5/S1, Common or Deep
Fibular (Peroneal) nerve - Dislocation of
fibular head, Ant compartment syndrome,
SLWC tight
Loss of DF of foot
High stepping gait, foot slap

Posterior Compartment of the


Leg Weakness
Etiology - Tibial n injury, L5/S1/S2
Paralysis of PF of the foot or intrinsics
Unable to PF foot or flex toes, no toe-off

Antalgic Patterns of the LE


Ortho or musculoskeletal dysfunctions
Pain in any or all joints in the LE
Changes in gait kinematics, stride parameters,
and temporal sequencing
Rate of loading will be decreased - Partial
Weight Bearing
OA of the hip, knee joint injury, ankle injury

Antalgic Patterns of the Trunk


HNP
Forward bend (Flex) - Backward bend (Ext)
Sidebending - lateral bending

QUESTIONS ?