This presentation is about the terms and definitions of the gait cycle, muscles involved, compensations etc.

1. Gait Cycle
Hossein Khorrami, Ph.D. DOMP
www.slideshare.net/khorrami4

2. Factors Affect Gait Pattern
• Nervous system, CNS, PNS
• Muscle issues, Tender point, trigger point,
spasm, FM, plantar fasciitis..
• Joint issues, bone, ligament, tendon
• Anatomy
• External
• Other

4. Basic Gait Terms
• Base of gait(walking base,
stride width)
– Standing feet distance or during
walking
– Balance, stability & erect
posture
– 2-4 inches heel to heel

5. Angle of Gait
• Almost 7o
In-toeing Out-toeing

6. • Cadence: Steps or strides-cycles/min
• Walking base: Stride width or distance
between line of feet
• Degree of toe out: ~7o, decreases with speed

8. Gait Phases
• Stance phase: Consists of the entire time
that a foot is on the ground
• Swing phase: Consists of the entire time
that the foot is in the air

9. • gf

11. Stance Phase
• Initial contact(heel strike)
• Foot flat(loading response)
• Mid stance
• Terminal stance(heel off)
• Toe off(pre swing)

12. Stance Intervals
• Initial double support: 10%
• Single support: 40%
• Terminal double support: 10%
• So 40% single & 20% double support

13. Swing Phase
• Initial swing(acceleration)
• Mid swing(vertical tibia)
• Terminal swing(deceleration)

14. Stride Length vs Step Length
• Stride length: Distance between successive
ground contact of the same foot
– Distance from the heel of right foot (starting
position) to the heel of right foot (ending position)
– Average: 150cm(5ft)
• Step length: distance from the heel of right
foot to the heel of left foot
– Average: 75cm(2.5ft)

15. Temporal & Spatial Variables

17. Stance Phase
• Initial contract( heel strike)
– Muscular contractions
• Hip extensors to stabilize the hip
• Eccentric contraction of quadriceps
• Isometric & Eccentric contraction of tibialis anterior

18. Stance Phase
• Loading response(initial double limb support)
– occurs after initial contact until elevation of
opposite limb
– bodyweight is transferred on to the supporting
limb
– Eccentric cont. of tibialis ant, dorsiflexion to
control plantar flexion
– Quads contraction to stabilize knee

19. Stance Phase
• Mid stance
– from elevation of opposite limb until both ankles
are aligned in coronal plane
– Eccentric contraction of G. Medius & calf muscles

20. Stance Phase
• Terminal phase
– begins when the supporting heel rises from the
ground and continues until the opposite heel
touches the ground
– Toe flexor & tibialis ant, concentric hip flexor,
concentric plantar flexors

21. Stance Phase
• Pre-swing(second double limb support)
• from initial contact of opposite limb to just
prior to elevation of ipsilateral limb
• Pre-swing phase(2nd double support)
– Hip flexor to propel advancing limb

22. Swing Phase
• Initial swing ( toe off)
• start of single limb support for opposite
limb
• from elevation of limb to point of maximal
knee flexion
• hip flexors concentrically contract to
advance the swinging leg, concentric
tibialis ant.

23. Swing Phase
• Mid-swing (foot clearance)
• following knee flexion to point where tibia is
vertical
• ankle dorsiflexors contract to ensure foot
clearance

24. Swing Phase
• Terminal swing (tibia vertical)
• from point where tibia is vertical to just prior
to initial contact
• hamstring muscles decelerate forward motion
of thigh

26. Gait Cycle Variables
• Pelvic rotation
– pelvis rotates 4 degrees medially (anteriorly) on swing side
– lengthens the limb as it prepares to accept weight
• Pelvic tilt
– pelvis drops 4 degrees on swing side
– lowers COG at midstance
• Lateral displacement of pelvis
– pelvis shifts over stance limb
– COG must lie over base of support (stance limb)

28. Gait Cycle Variables
• Knee flexion in stance
– early knee flexion (15 degrees) at heel strike
– lowers COG, decreasing energy expenditure
– also absorbs shock of heel strike
– at midstance, the knee extends as the ankle
plantar flexes and foot supinates
– restores leg to original length
– reduces fall of pelvis at opposite heel strike

29. Gait Cycle Variables
• Center of gravity (COG)
– in standing position is 5cm anterior to S2 vertebral
body
– vertical displacement
• during gait cycle COG displaces vertically in a rhythmic
pattern
• the highest point is during midstance phase
• lowest point occurs at the time of double limb support
– horizontal displacement
• COG displaces 5cm horizontally during adult male step

30. Variables
• Ground Reaction Forces(GRF)
– Ankle, knee, hip
• ACL
• Acetabulum
• Upper limb frequency
– Low speed: stepping frequency (2:1 ratio of arm to
leg)
– Higher velocity: stride frequency (1:1 ratio of arm
to leg)

31. Stance Phase
• Initial contract( heel strike)
– Hip external rotation
– Tibia internal rotation
– Ankle- foot, supination plantar flexion

32. Stance Phase
• Loading response(initial double limb support)
– Hip internal rotation
– Knee flexion, 20 degrees
– Tibia internal rotation
– Ankle- foot, pronation plantarflexion

33. Stance Phase
• Mid stance
– Hip neutral
– Knee flexion, 15o
– Tibia neutral
– Ankle- foot, almost neutral, 3o dorsiflexion

34. Stance Phase
• Terminal phase
– Hip external rotation
– Tibia external rotation
– Ankle- foot, supination, 15o dorsiflexion(max)

35. Stance Phase
• Pre-swing(second double limb support)
– Hip external rotation
– Tibia external rotation
– Ankle- foot, supination, 20o plantarflexion

37. Compensations
• Hip tightness
• To keep stride length compensate with:
• more anterior & posterior hip tilt
• Excessive stress of lumbar spine

38. Compensations
• Hi heel shoes
• To keep stride length compensate with:
• more knee flexion
• Excessive stress of knee joint

39. Q-Angle

40. Q- angle
• Normal Q-angle: 10o -15o
• >20o is pathologic
• Male average: 14o
• Female average: 17o

41. • Women naturally have a larger Q-angle than
men
• In addition, women have increased hip
adduction, hip internal rotation, knee valgus,
and the internal rotation during functional
activities such as running and walking as
compared to men

44. Valgus vs Varus

45. Factors Influencing Gait
• Musculoskletal
– muscle, tendon, ligaments
– Joint, bones
– Soft tissue, fascia
• Neurological issues
– Central, basal ganglia, cerebellum,..
– Peripheral

46. Hip Stabilizers

49. G. Medius, dual function