• Chapter 14

    • Chapter 14

    Gait

    Learning Outcomes: Students will be able to:

    1. Effectively describe a gait pattern using accepted terminology.
    2. Describe the specific components of the “Stance Phase” and “Swing Phase” of the gait cycle, including their beginning and ending points for each component.
    3. Identify the involved/active muscles during both gait phases and the specific type of muscle contraction that is occurring.
    4. Analyze deviations from normal gait and identify the causative or compensatory reasons contributing to atypical  gait patterns.

    It is by walking that a person moves from place to place. Gait is the repetitive components of walking that collectively are known as the gait cycle, or the activity that occurs between the time one foot touches the floor and the time the same foot touches the floor again. Stride length is the distance traveled during the gait cycle, and step length is the distance between heel strike of one foot to heel strike of the other foot.

    Each individual has their own unique characteristics that distinguish their style of walk. Those individual characteristics can even be influenced by different moods. Clinical measurements or observations of the components of the gait cycle can be compared against normative values to identify deviations and potential injury risks. The gait cycle has two phases.

    NOTE: There are two different sources that provide terminology for the components of the gait cycle – the Traditional terminology system and the Rancho Los Amigos system. Research on gait is increasingly using Rancho Los Amigos terminology that looks at “periods of time” vs “points in time”. Therefore, we will use Rancho Los Amigos terminology throughout the rest of this section.

    Stance Phase

    Term

    Definition

    Involved Muscles &

    Type of Contraction

    Other Key Points or Observations

    Initial Contact

     (stance phase begins)

    When heel strikes the ground

    Hip: Flexed 30º on contact

    • Extensors begin eccentric contraction to prevent further hip flexion

    Knee: Flexed 5º on contact

    • Extensors contact eccentrically to accept weight/absorb shock

    Ankle: Neutral position

    • Dorsiflexors isometrically hold foot in dorsiflexed position

    Pelvis:

    ---Rotates forward on ipsilateral side

    ---Rotates backward to Contralateral side

    Body is behind stance leg

    Loading Response

    Begins at initial contact  body weight is transferred to leg and entire foot makes contact with the ground.

    Ends when opposite foot leaves the ground

    Hip: Extensors control external flexion torque eccentrically

    Knee: Remains partially flexed, extensors eccentrically absorbing weight/shock

    Ankle: Dorsiflexors eccentrically lower the foot to the ground

    Body starts to move forward over stance leg

    Mid-stance

    Begins when opposite foot leaves the ground

    Ends when body is directly over stance limb

    Hip: Extensors are primarily silent as the body’s momentum moves the hip into extension

    Knee: Extensors become silent as body shifts over the foot and GRF’s are directed through the joint axis

    Ankle: Plantarflexors control dorsiflexion eccentrically

    Body is at highest point in gait cycle

    Pelvis is in neutral position

    Terminal Stance

    Begins as the heel of the stance leg rises

    Ends with initial contact of the opposite foot

    Hip: Extensors are silent as momentum and GRF’s continue further hip extension

    Knee: Extensors are silent as momentum and GRF’s maintain the knee in extension

    Ankle: From a dorsiflexed position, the plantarflexors begin to contract concentrically

    Pelvis:

    ---Rotates backward on ipsilateral side

    ---Rotates upward to Contralateral side

    Body has moved in front of the stance leg

    Pre-swing (stance phase ends)

    Begins with initial contact and weight shifts to the other foot

    Ends just before toes of stance leg leave the ground

    Hip: Flexors contract concentrically to flex hip and bring thigh forward (note: two hip flexors – gracilis and sartorius - contract to flex the knee)

    Knee: Flexors are silent allowing hip flexors to do the work

    Ankle: concentrically plantarflexes to raise the heel off (push off) and reaches full plantarflexion for toe off (propulsion)

    Advancement of leg begins

    Trunk and Upper Extremities: During walking, the arms swing in a rhythmic pattern that is opposite the pattern of the lower extremities. As the hip on one side moves into flexion, the ipsilateral arm moves into extension, and vice versa. The function of the arm swing balances the small rotational movements of the trunk that occur during walking, placing the shoulder girdle in a rotated position opposite the pelvis. Both arm swing and this small amount of trunk rotation contribute to an efficient gait pattern.

    Swing Phase

    Term

    Definition

    Involved Muscles &

    Type of Contraction

    Other Key Points or Observations

    Initial Swing

    (Swing phase begins)

    Begins when the toes leave the ground

    Ends when the swing foot is opposite the stance or weight bearing foot, and the knee is in maximum flexion

    Hip: Continues flexing (concentric contraction) to bring the leg forward

    Knee: Continues flexing “following along for the ride” from hip flexion

    Ankle: Begins to dorsiflex (concentric contraction)

    Pelvis:

    ---Begins to rotate forward on ipsilateral side

    Body is behind stance leg

    Midswing

    Begins when the swing foot is opposite the stance or weight bearing foot

    Ends when the swing leg is moved in front of the body and the tibia is in a vertical position

    Hip: Is at maximum flexion (concentric contraction) but fades in force as momentum carries the leg forward

    Knee: Is at maximum flexion (to clear the ground) and begins to extend

    Ankle: Is dorsiflexed to neutral position and holding the position isometrically

    Pelvis is in neutral position

    Leg is passing under and moving in front of body

    Terminal Swing

    Begins when the tibia is in a vertical position

    Ends just prior to initial contact

    Hip: Is in flexed position as eccentric contraction of hip extensors begins to decelerate forward flexion 

    Knee: Is extending and the hamstrings begin to contract eccentrically to slow down the forward movement of the leg and prepare for initial contact

    Ankle: Is being held in dorsiflexion isometrically

    Pelvis

    ---Is rotated forward on ipsilateral side

    Leg advancement ends out in front of body

    Abnormal Gait

    Impairments in the motor, sensory, perceptual, or cognitive systems can contribute to abnormal gait patterns. Muscle weakness or paralysis, joint or muscle ROM limitations, neurological impairments, and pain can lead to abnormal gait patterns. Some common gait dysfunctions that result from muscle weakness or paralysis and the shortening of muscles and/or associated connective tissue will be discussed here.

    Muscle Weakness/Paralysis “or” ROM Restriction

    Gait Pattern: Causative or Compensatory

    Gluteus Maximus Weakness Gait

    • Unilateral (Gluteus Maximus Lurch gait)
    • Bilateral (Pregnant Woman gait)

    Note: person can’t risk going into hip flexion without posterior extensor muscles

    • Unilateral: quick trunk extension at initial contact (heel strike) on the involved side to place the COM over the hip joint (compensatory).

    • Bilateral: trunk is continually shifted posteriorly and hips tend to externally rotate for a broader base of support (compensatory).

    Gluteus Medius Weakness Gait (Trendelenburg gait)

    • Causative: contralateral pelvis drop
    • Compensatory: ipsilateral trunk shift
    • Causative: contralateral pelvis drops upon weight bearing of the involved side.

    • Compensatory: trunk shifts to the ipsilateral side to place the COM over the hip joint.

    Hip Flexor Weakness Gait (Circumduction gait)

    • Abducts or swings involved leg outward in a circular motion
    • Compensatory: ipsilateral or involved leg is abducted and the momentum of the walking motion swings the leg forward in a circumduction movement. Contralateral trunk lateral flexion aides in the hip abduction movement.

    Quadriceps Weakness Gait (Genu Recurvatum gait)

    • Forward leaning with extended knee
    • Compensatory: forward lean of the trunk over the involved leg that has been forced into hyperextension (recurvatum). Person may press downward/inward on the involved leg to help force the hyperextension.

    Dorsiflexor Weakness Gait (Slap Foot gait, Drop Foot with Equinus gait)

    • If no dorsiflexion the foot is in a dropped position (Drop Foot) = Steppage gait
    • If can perform weak dorsiflexion = Slap Foot gait
    • Compensatory (Equinus Gait): person will perform high hip flexion to clear the dropped foot from scraping the ground, and then will touch down with the toes, similar to the gait of a horse.

    • Compensatory (Slap Foot gait): during loading response, the weak dorsiflexors can’t effectively lower or decelerate the foot to the ground so the foot slaps the surface.

    Gastroc/Soleus Weakness Gait (Sore Foot gait)

    • Can’t plantarflex to perform preswing or push off.
    • Causative: no plantarflexion at terminal stance or push-off resulting in a shortened step length on the unaffected side.

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