sports medicine ii secta. normal gait = series of rhythmical, alternating movements of the trunk...
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UNDERSTANDING
GAITSports Medicine II
SECTA
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Gait Cycle - Definitions:
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’
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Gait Cycle - Definitions:
Gait Cycle = Single sequence of functions by one limb Begins when reference foot contacts the
ground Ends with subsequent floor contact of the
same foot
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Gait Cycle - Definitions:
Step Length = Distance between corresponding successive
points of heel contact of the opposite feet
Rt step length = Lt step length (in normal gait)
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Gait Cycle - Definitions:
Stride Length = Distance between successive points of heel
contact of the same foot Double the step length (in normal gait)
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Gait Cycle - Definitions:
Walking Base = Side-to-side distance between the line of the
two feet Also known as ‘stride width’
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Gait Cycle - Definitions:
Cadence = Number of steps per unit time Normal: 100 – 115 steps/min Cultural/social variations
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Gait Cycle - Definitions:
Velocity = Distance covered by the body in unit time Usually measured in m/s Instantaneous velocity varies during the gait
cycle Average velocity (m/min) = step length (m) x
cadence (steps/min)
Comfortable Walking Speed (CWS) = Least energy consumption per unit distance Average= 80 m/min (~ 5 km/h , ~ 3 mph)
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Gait Cycle - Components:
Phases:(1) Stance Phase: (2) Swing Phase:
reference limb reference limb in contact not in contact with the floor with the floor
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Gait Cycle - Components:
Support:(1) Single Support: only one foot in contact with
the floor(2) Double Support: both feet in contact with floor
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Gait Cycle - Subdivisions:
A. Stance phase:1. Heel contact: ‘Initial contact’
2. Foot-flat: ‘Loading response’, initial contact of forefoot w. ground
3. Midstance: greater trochanter in alignment w. vertical bisector of foot
4. Heel-off: ‘Terminal stance’
5. Toe-off: ‘Pre-swing’
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Gait Cycle - Subdivisions:
B. Swing phase:1. Acceleration: ‘Initial swing’
2. Midswing: swinging limb overtakes the limb in stance
3. Deceleration: ‘Terminal swing’
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Gait Cycle
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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%
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With increasing walking speeds: Stance phase: decreases Swing phase: increases Double support: decreases
Running: By definition: walking without double support Ratio stance/swing reverses Double support disappears. ‘Double swing’
develops
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Path of Center of Gravity
Center of Gravity (CG): midway between the hips Few cm in front of S2
Least energy consumption if CG travels in straight line
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CG
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Path of Center of Gravity
A. Vertical displacement: Rhythmic up & down
movement Highest point: midstance Lowest point: double support Average displacement: 5cm Path: extremely smooth
sinusoidal curve
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Path of Center of Gravity
B. Lateral displacement: Rhythmic side-to-side
movement Lateral limit: midstance Average displacement: 5cm Path: extremely smooth
sinusoidal curve
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Path of Center of Gravity
C. Overall displacement: Sum of vertical &
horizontal displacement Figure ‘8’ movement of
CG as seen from AP view
Horizontalplane
Verticalplane
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Determinants of Gait :
Six optimizations used to minimize excursion of CG in vertical & horizontal planes
Reduce significantly energy consumption of ambulation
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Determinants of Gait :
(1) Pelvic rotation: Forward rotation of the pelvis in the horizontal plane
approx. 8o on the swing-phase side Reduces the angle of hip flexion & extension Enables a slightly longer step-length w/o further lowering
of CG
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Determinants of Gait :
(2) Pelvic tilt: 5o dip of the swinging side (i.e. hip adduction) Reduces the height of the apex of the curve of CG
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Determinants of Gait :
(3) Knee flexion in stance phase: Approx. 20o dip Shortens the leg in the middle of stance phase Reduces the height of the apex of the curve of CG
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Determinants of Gait :
(4) Ankle mechanism: Lengthens the leg at heel contact Smoothens the curve of CG Reduces the lowering of CG
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Determinants of Gait :
(5) Foot mechanism: Lengthens the leg at toe-off as ankle moves from
dorsiflexion to plantarflexion Smoothens the curve of CG Reduces the lowering of CG
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Determinants of Gait :
(6) Lateral displacement of body: The normally narrow width of the walking base
minimizes the lateral displacement of CG Reduced muscular energy consumption due to
reduced lateral acceleration & deceleration
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Gait Analysis – Forces:
Forces which have the most significant Influence are due to:
(1) gravity(2) muscular contraction(3) inertia(4) floor reaction
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Gait Analysis – Forces:
The force that the foot exerts on the floor due to gravity & inertia is opposed by the ground reaction force
Ground reaction force (RF) may be resolved into horizontal (HF) & vertical (VF) components.
Understanding joint position & RF leads to understanding of muscle activity during gait
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Gait Analysis:
At initial heel-contact: ‘heel transient’ At heel-contact:
Ankle: DF Knee: Quad Hip: Glut. Max&Hamstrings
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Gait
Initial HC‘Heel transient’
HC
Foot-Flat Mid-stance
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Gait
Initial HC‘Heel transient’
HC
Heel-offToe-off
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GAIT
Low muscular demand: ~ 20-25% max. muscle strength
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COMMON GAIT ABNORMALITIES
A. Antalgic GaitB. Lateral Trunk bendingC. Functional Leg-Length DiscrepancyD. Increased Walking BaseE. Inadequate Dorsiflexion ControlF. Excessive Knee Extension
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“ Don’t walk behind me, I may not lead. Don’t walk ahead of me, I may not follow. Walk next to me and be my friend.”
Albert Camus
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COMMON GAIT ABNORMALITIES: A. Antalgic Gait
Gait pattern in which stance phase on affected side is shortened
Corresponding increase in stance on unaffected side
Common causes: OA, Fx, tendinitis
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COMMON GAIT ABNORMALITIES: B. Lateral Trunk bending
Trendelenberg gait Usually unilateral Bilateral = waddling gait Common causes:
A. Painful hipB. Hip abductor weaknessC. Leg-length discrepancyD. Abnormal hip joint
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Ex. 2: Hip abductor load & hip joint reaction force
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Ex. 2: Hip abductor load & hip joint reaction force
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COMMON GAIT ABNORMALITIES: C. Functional Leg-Length Discrepancy
Swing leg: longer than stance leg 4 common compensations:
A. CircumductionB. Hip hikingC. SteppageD. Vaulting
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COMMON GAIT ABNORMALITIES: D. Increased Walking Base
Normal walking base: 5-10 cm Common causes:
Deformities Abducted hip Valgus knee
Instability Cerebellar ataxia Proprioception deficits
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COMMON GAIT ABNORMALITIES: E. Inadequate Dorsiflexion Control
In stance phase (Heel contact – Foot flat):Foot slap
In swing phase (mid-swing): Toe drag
Causes: Weak Tibialis Ant. Spastic plantarflexors
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COMMON GAIT ABNORMALITIES: F. Excessive knee extension
Loss of normal knee flexion during stance phase
Knee may go into hyperextension Genu recurvatum: hyperextension
deformity of knee Common causes:
Quadriceps weakness (mid-stance) Quadriceps spasticity (mid-stance) Knee flexor weakness (end-stance)
* * *
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Other Abnormalities:Overpronation
Pronation is the movement of the subtalar joint (between the talus and calcaneus) into: Eversion (turning the
sole outwards) Dorsiflexion (pointing
the toes upwards) and Abduction (pointing the
toes out to the side Overpronation is often
recognized as a flattening or rolling in of the foot
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Other Abnormalities:Overpronation
Shin Splints Anterior Compartment Syndrome Patello-femoral Pain Sydrome Plantar Fasciitis Tarsal tunnel Syndrome Bunions (Hallux Valgus) Achilles Tendonitis
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Other AbnormalitiesOversupination
Supination is a movement at the foot which is a necessary movement for walking and running amongst other activities
Supination is the movement of the subtalar joint (between the talus and calcaneus) into: Inversion (turning the sole
inwards) Plantarflexion (pointing the
toes away from you) and Adduction (pointing the
toes across your body).
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Other AbnormalitiesOversupination
Oversupination (hyper-supination) is far more rare than overpronation and causes problems for runners and other athletes, as in this position the foot is less able to provide shock absorption. Shin Splints Plantar Fasciitis Ankle Sprains Stress fractures of the tibia, calcaneus and
metatarsals
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Other Abnormalities
Propulsive gait -- a stooped, stiff posture with the head and neck bent forward
Carbon monoxide poisoning Manganese poisoning Parkinson’s disease Use of certain drugs including phenothiazines,
haloperidol, thiothixene, loxapine, and metoclopramide (usually drug effects are temporary)
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Other Abnormalities
Scissors gait -- legs flexed slightly at the hips and knees like crouching, with the knees and thighs hitting or crossing in a scissors-like movement
Brain abscess Brain or head trauma Brain tumor Cerebrovascular accident Cerebral palsy Cervical spondylosis Liver failure Multiple sclerosis Spinal cord trauma Spinal cord tumor
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Other Abnormalities
Spastic gait -- a stiff, foot-dragging walk caused by a long muscle contraction on one side
Brain abscess Brain or head trauma Brain tumor Cerebrovascular accident Cerebral palsy Cervical spondylosis Liver failure Multiple sclerosis Spinal cord trauma Spinal cord tumor
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Other Abnormalities
Steppage gait -- foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking
Herniated lumbar disk Multiple sclerosis Muscle weakness of the tibia Spinal cord injury
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Other Abnormalities
Waddling gait -- a duck-like walk that may appear in childhood or later in life
Muscle disease (myopathy) Spinal muscle atrophy Muscular dystropy Congenital hip dysplasia
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Other Abnormalities
Ataxic or broad-based gait
Alcohol intoxication Brain injury Damage to nerve cells in the cerebellum of the brain
(cerebellar degeneration) Medications (phenytoin and other seizure medications) Polyneuropathy (damage to many nerves, as occurs with
diabetes) Stroke