Analysis of normal gait
Analysis of normal gaitNamyangju Reha. HospitalDept. of Physical TherapyLee Dong-Jin, PT1Gait Cycle Walking uses a repetitious sequence of limb motion move the body forward while simultaneously maintaining stance stability.
2 page . 2Cycle Divisions
stance phases swing phases . 3Floor Contact PeriodsStance 60% Initial Double Stance 10% Single Limb Support 40% Terminal Double Stance 10%
Swing 40% 4Stride & Step
(heel strike) (step) . (heel strike) (stride) , (stride length), (stride duration), 3.5inch 5~10cm(stride width) . (foot angle) . (cadence, walking rate) 1 90~120 .(, ) (stride) (gait cycle) .
5Stride & Step
Stride() & Step()6Divisions of the Gait Cycle
71 : Initial Contact(heel strike) 0~2% - - Heel Rocker .
: Heel Strike
: Gluteus maximus, hamstring, tibialis anterior, qudriceps(eccentric)
Hip : 30 Flex -Vector :
knee : Ext(2 Flex) - Vector :
Ankle : neutral - Vextor :
Initial contact ankle neutral , knee full ext . ankle Loading response Tibialis ant. m, Extensor digitorum longus m. eccentric contraction . Knee Quadriceps Hamstring group cycle Terminal Swing contraction knee jt . Terminal Swing Limb 25 Hip flex Gluteus maximus Hamstrings Activation pelvis gluteus medius activation.
82 : Loading Response(foot flat) 0 ~ 10% - Initial Double Limb Stance. - IS . - , ,
: Knee,Ankle Flex , Hip jt
: gluteus maximus, quadriceps, biceps femoris, tensor fascia latae
Hip : 30 Flex, Add, I/R - Vector :
Knee : 18Flex, Valgus, Tibia I/R - Vector :
Ankle : 10plantarflexion, Pronation - Vector : - , Tibia Advance
Loading Response Ankle Pretibial m.(Tibialis ant. m, Extensor digitorum longus m, Extensor hallucis longs m.) Plantarflexion . knee 15~18 Flexion Quadriceps Eccentric Contraction . Hip extensor hip jt (Gluteus maximus, Hamstring, Adductor magus), Trunk Hip Flexion .
93 : Mid Stance
10~30% - :MSw~TSw - , Stance . - Knee jt Ankle jt .
: Ankle dorsiflexion, Knee jt , Hip jt
: quadriceps M, Calf M(eccentric)
Hip : 30Flex 5Ext - Vector :
Knee : 18Flex 5Ext - Vector :
Ankle : 7 P/F 4D/F - Vector :
Mid Stance , Ankle Plantarflexion Dorsiflexion . Gastronemius m. Soleus m. Dorsiflexion , Tibia . Knee Extend Quadriceps Extend . L:oading Response Sagital stability Gluteus maximus Hip extensor Hip abductor Hip stability pelvic .
104 : Terminal stance(heel off) 30~50% - : IC - , .
: Heel Push off : soleus, gastrocnemius(eccentric) T.F.L(Hip Flex, Abd)
Hip : hyper Ext, Add, I/R - Vector :
Knee : 0~5Flex, Tibia E/R - Vector :
Ankle : 10D/F, Supination - vector :
Ankle Dorsiflexion . Ankle Tibia stability Calf m. . Soleus Gatrocnemius tibia , . Knee . Hip Tensor fascia latae Pelvic active Hip Hyperextension Hip flexor .
115 : Pre Swing(toe off) 50~60% - : IC - (Terminal Double support) - MP
: Knee Flex
: Calf M Adductor Magnus, Rectus Femoris .
Hip : hyper Ext. Gracillis, Sartorius Flex, Abd, I/R - Vector :
Knee : Flex - Vector :
Ankle : 20plantar flexion - Vector : (MP)
Pre-SwingAnkle Dorsiflexion Plantarflexion . Metatarsophalangeal jt 60 Extend Knee Passive Flexion. Hip Rectus femoris, Sartorius, Adductor longus Neural position Flexion. Femur Adductor longus, Rectus femorius Flexion.
126 : Initial Swing(acceleration) 60~73% - Toe off . - .
: Knee, Hip Flex
: biceps femoris, sartorius, gracillis, tibialis anterior, iliacus
Hip : gracillis 20Flex
Knee : biceps femoris 60 Flex
Ankle : 20P/F tibialis anterior Neutral .
Intial SwingPretibial m.(tibialis ant. m, Extensor digitorum longus m, Extensor hallucis longus m.) Long toe extensor Ankle Plantarflexion . Mid Swing Dorsiflexion Plantarflexion . Knee hip flexion flexion, , hip liacus, biceps femoris, Sartorius, gracilis flexion.
137 : Mid Swing
70~85% - , Knee jt . - ( )
: Ankle dorsiflexion, Hip Flex
: Hip Flexor, Pretibial m
Hip : 30Flex
Knee : Ext
Ankle : Neutral , Tibialis anterior isometric C
Mid Swing Pretibial m.(tibialis ant. m, Extensor digitorum longus m, Extensor hallucis longus m.) Activate . Tibial bone knee extension Hamstring Knee Extension . Gracilis Sartorius, Iliacus mid swing Hamstring thigh .
148 : Terminal Swing(deceleration) 85~100% - Tibia . -
: Hip, Knee , Knee Ext, Ankle D/F
: Hamstring, Quadriceps, Pretialis m.
Hip : Hastring Flex
Knee : Hastring MSw Ext Knee jt , Quadriceps Knee Ext
Ankle : Tibialis anterior netutal 5P/F
Ankle Pretibial m.(tibialis ant. m, Extensor digitorum longus m, Extensor hallucis longus m.) Gait Cycle Initial contact contract . knee Quadriceps Initial Contact Knee Extend. Hamstring Gluteus maximus thigh Hip Flexion . Hamstring Thigh Knee , Hip Flexion .
15Head, Trunk, Pelvic
- 2.5 ~ 4.5 cm - : LR , PSw (DS ) - : TSt, MSw (SS )
- 4.5cm - stance .
- : 23cm/sec - : 14cm/sec - : 2cm/sec
Hip jt
Sagjital plane - pelvic drop 4
2. Coronal plane - anterior tilt 4
3. Transverse plane - rotation 10 (displacement), DS(double support, ) ,SS(Single support, )(T10)16vertical displacement of trunk during a stride indicated by head height
(stride) 17Lateral displacement of trunk during a stride
(stride) ( ) (double limb stance) . (Rt. Single limb stance) . 18Motion of the pelvis during walking
19Head, Trunk, Pelvic
Erect spine - IC - TSt
Multifidus, Rotatores, QL m. - IC
External obliques - MSw, TSt
Rectus abdominis
Gluteus maximus, Gluteus medius - TSw MSt - LR .
20Arm
Shoulder jt - IC Ext 8 - TSt Flex 24
2. Elbow jt - IC Flex 44 - IC shoulder jt Ext 20
supraspinatus, upper trapezius . - IC TSw
2. middle, posterior deltoid - Flex
3. Latissimus dorsi, Teres major - shoulder jt Ext(LR) - shoulder jt Ext(PS) , (Counter force) .21Arm swing during normal free walk
, TS(shoulder jt Flex) IC(shoulder jt Ext)
22 1. Terminal Swing(Initial Contact, heel strike)1. Hamstring - Hamstring MSt TSw - Hip Flex - Knee Hyper-Ext . - TSw Hamstring .
2. Hip Extensor ( Adductor Magnus, Gluteus Maximus) - Hamstring . - Quadriceps Knee Ext Hamstring . - Tibialis anterior Ankle Dorsiflexion .
23 2. Loading Response(foot flat)1. Hip joint - Hip Extensor( Adductor Magnus, Gluteus Maximus inferior) Femur Hip,Knee, Ext - Hip Abductor ( Gluteus Matimus superior, Gluteus medius) Femur .
2. Knee Joint - Quadriceps Heel Rocker Knee jt Flex weight bearing .
3. Ankle Joint - Tibialis anterior LR eccentric , weight bearing Knee Flex heel rocker .24 3. Mid Stance & Terminal Stance(heel off)1. Soleus - , Forefoot Plantarflexion. - Tibia Femur Knee Ext Hip jt Ext. - TSt
2. Gastrocnimius - Soleus , Knee Flex . (2 jt )
3. Flexor Digitorum - Forefoot , , PS . 25 1. Pre Swing1. Hip adductor ( Adductor longus) - Addutor longus Hip abduction , Hip Flex.
2. Rectus femoris - PS Knee hyper Flex , Hip jt Flex .
3. Tibialis anterior - PS Plantarflexion .
26 2. Initial Swing1. Sartorius, Iliacus, Gracilis - Femur .
2. Biceps femoris(short head) - Knee Flex. foot lift .
3. Tibialis anterior - PS IS , Pantarflexion .27Loading Response(foot flat)What is Loading Response
28Why is Loading response ? 10% ,
.
Eccentric work .
1/10 . .
Motor Control Poor .
Motor Control LR .
LR motor control .
, , .
(Motor control)Eccentric work . 29Why is Loading response ?Mobility : , , , , , , , Agnosia, Apraxia Mobility .
Stability : . - , . - eccentric contraction Stability .
Conntrolled Mobility : . - Mst Knee jt Foot Hip .
(adhesion): 1 (3,1,2); , , Agnosia() apraxia()
30What is Loading response ?Gait cycleStanceSwingWeight AcceptanceSingle Limb SupportInitial ContactLoading ResponseMid StanceTerminal StancePre Swing31What is Loading response ?LR - TSw ( 1cm)
LR - .
LR - shock absorption - preservation of progression - weight-bearing stabilityPreservation 32What Happens During Loading Response ? (leg)Hip jt : 30Flex - Transverse : E/R I/R . - Coronal : slight adduction .
Knee jt : 0 ~ 10Flex - LR HyperExtension 10Flexion.
Ankle jt : Neutral ~ 10 P/F ~ Neutral
Subtalar jt : Eversion (Pronation)
Talar jt : Extension
33What Happens During Loading Response ? (arm&trunk)Contralateral leg : Pre Swing
Ipsilateral leg : Ext Felx swing
Contralateral arm : Ext .
Trunk : ElectContralateral : Ipsilateral :
34What Happens During Loading Response ? (Vector&Torque)Hip jt : Torque into Flexion, Adduction, I/R
Knee jt : Torque into Flexion
Ankle jt : Torque into P/F Torque into D/F Vector .Torque (moment)35Loading Response Neutral Vector line
Force Vector : Hip (), Knee , Ankle()
LR Vector line cranial-dorsal caudal-ventral .
Pelvic Scapular Post. Elev , Ant. depr groove .
groove LR .PosteriorElevationAnteriorDepression
Groove 36Proposal for Facilitation of Loading Response (1) - ~ Hip : 30Flex, Knee : 15Flex, Ankle : Neutral - ~ Leg : Ext , Trunk & Head : Neutral
Approximation for Knee & Ankle - Heel Kinematic chain . - . Proposal 37Proposal for Facilitation of Loading Response (2)
Weight Shift(LR)
- , ventral .
- .38Proposal for Facilitation of Loading Response (3)Weight shift(LR)
- dorsal . - Eccentric perfomance . - : , . - Knee & Ankle Shock absorption . - Wedge eccentric Knee extensor .
39Standing LR
Contact
1. Right hand - starting : Iliac crest Approximation
- end : Greater trochanter fossa Hip Ext. Rotator
2. Left hand - starting : Tibia Inner part tibia .
- end : Tibia Int. Rotator .
40Sidelying LR
Contact
1. Starting - Vector Approximation - forefoot .
2. End - forefoot . - Pelvic Ant. depr.
Quadriceps, Ext. Rotator, Abductor Thigh .41Normal Gait
42ReferenceJacquelin Perry . GAIT ANALYSIS Normal and Pathological Function, 1992Adler SS, Beckers D, Buck M. PNF in practice. 2nded , Springer, 2000David J. Magee . Orthopedic Physical Assessment. 3rded . W. B. Saunders. 1998
43Thank You!
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