Gait Cycle
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Transcript of 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
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• 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
Gait Cycle - Definitions:
Gait Cycle - Definitions:
• 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
Gait CycleGait Cycle
Gait CycleGait Cycle
• 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
Gait CycleGait Cycle
• 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
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
Cycle DivisionsCycle Divisions
• 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
Cycle DivisionsCycle Divisions
• 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
Cycle DivisionsCycle Divisions
• 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
Cycle DivisionsCycle Divisions
• Midstance– Subtalar joint – supinates• Locks midtarsal joints, makes foot a rigid
lever• Preparing for efficiency during propulsion
– Talocrural joint – dorsiflexes
Cycle DivisionsCycle Divisions
• 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
Cycle DivisionsCycle Divisions
• 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
Cycle DivisionsCycle Divisions
• 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
Cycle DivisionsCycle Divisions
• 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
Cycle DivisionsCycle Divisions
• 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
Cycle DivisionsCycle Divisions
• 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
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
Muscle Activity in the Gait Cycle
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
Muscle Activity in the Gait Cycle
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
Muscle Activity in the Gait Cycle
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
Muscle Activity in the Gait Cycle
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
Muscle Activity in the Gait Cycle
• This momentum is checked by the hamstrings prior to heel strike
• Dorsiflexors and the ankle act throughout the swing phase
Muscle Activity in the Gait Cycle
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
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
• Foot Intrinsics– Stance phase
• Concentric contraction – support plantar fascia
Muscle Activity in the Gait Cycle