Lower Extremity Biomechanics

SYSTEMS

Chapter 1

PHYSICS, FUNCTIONAL ANATOMY & THE BIOMECHANICAL PRINCIPLES OF GAIT

Roy H. Lidtke

The basic concepts of physics are seen and used every day. Much of our ‘common sense’ is based upon these concepts. It doesn’t take an equation to make people realize that when they’ve twisted an ankle, it hurts. However, it may help to understand what was involved in the twisting of their ankle and what they could do to prevent it from happening again. It is from this viewpoint that the reader should approach this chapter. Some people become nervous when talk turns to the subject of physics. The very mention of the word brings back thoughts of exams and equations that most of us have forgotten or want to forget.

Many of the words that follow we may recognize from memory, and some will be new terminology that you (the reader) may not be familiar with. However, it is important to remember that it is just terminology. Terminology is a memory process; that is, you memorize a term that you don’t use every day. It is not the term but the concept that is important.

Key Terms and Concepts

There are two key words for discussing human motion: kinematics and kinetics. Kinematics are the variables which describe the motion, and kinetics are the variables which produce the motion. Variables such as position, velocity and acceleration are kinematic variables. Kinetic variables include forces, energy and power. We use these variables every day. We get in our car and drive from point A to point B when the accelerator is depressed, providing more energy and power to the wheels resulting in greater speed towards point B.

The world we live in is based on translation; that is, we want to move or translate our body from point A to point B. This world we understand. However, our body resides in a world of rotation. We still want to translate our body position down the street, but to do that our legs must rotate and swing around an axis that is fixed to our body through our joints (Figure 1.1) (visible in landscape view). To understand human motion, we must, therefore, begin to think in terms of rotation.

Let’s approach this subject by alternately discussing the translational world and the rotational world. (Table 1.1) (visible in landscape view) In the translation world we have a linear distance through which we travel, but in the rotational world, distance becomes an angle. So, instead of discussing a change in position as a distance traveled, we have to state that there has occurred a change in angular position. In the translational world, we say that we stepped forward two meters; but in the rotational world, our hip has rotated 30 degrees.

Figure 1.1 (visible in landscape view) - Computer tracking of the motions of the lower extremity showing the translation of the center of mass of our body from point A to point B. The top line is the pelvis, the second line is the hip, and the center line is the knee with the foot segments at the bottom.

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Table 1.1 (visible in landscape view) Terminology from the translational world with the corresponding equivalent from the rotational world.

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This change in position over time is called velocity. If it took a second to step 2 meters, we would be walking at a speed (velocity) of 2 meters per second. In the rotational world, velocity becomes angular velocity. Angular velocity is determined by the number of degrees per second through which the joint rotates. If an individual started to walk at a faster rate (i.e. a two-foot-long step in half of a second), then this change in velocity is referred to as acceleration. In the rotational world, acceleration becomes angular acceleration, and is a change in angular velocity.

Although the rotational terms are not as intuitive as the translational terms, they are easily understood due to the correlation between the terms. It becomes more complex when we consider mass. Mass is something we are all too familiar with in our translational world. For example, if we eat too much we gain too much body mass. In the rotational world, mass becomes moment of inertia. Most individuals could give their body mass when asked, but not many could give their moment of inertia (See Advanced Concept 1). A moment of inertia is the amount of mass of an object multiplied by the distance that the object is from a rotational axis. A leg with a mass that is swinging around the hip joint axis has a large moment of inertia.

Advanced Concept 1: Local Volume Density

The moment of inertia of an object is calculated using the sum of all of the small pieces of a segment times the square of the distance [∑ mass x (distance)2]. Since it is difficult to break down objects into small pieces, weigh them, and calculate their distance to the rotational center, we use a concept called local volume density. As long as we know the density of the body segment and its volume, we can substitute this into the equation and use the location of the center of mass to calculate the moment of inertia. Much of this work has been done on cadavers and is available in tables for different body segments.

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A body does not have just one moment of inertia; it can have one for every rotational center. The body uses this concept to its advantage. A good example is seen in the design of our leg bones. The classic dog bone that has a long tubular shape with large bulbous ends is very similar to our lower limb bones, such as the femur (Figure 1.3). When this long bone with a large mass at each end is swinging around a fixed axis on one of its ends, the way our leg is rotating around the hip in walking, it has a large moment of inertia. As soon as the foot contacts the ground, the rotational axis shifts from being at the end of the bone to being down the long tubular shaft of the bone. The moment of inertia for this new axis is much smaller due to the small mass of the shaft being close to the rotational axis. It is the same bone, but the unique shape of the bone and the change in position of the axis make it behave very differently during walking.

The larger the leg (increased mass and length) the larger the moment of inertia (Figure 1.2).

Figure 1.2 The mass of the foot at a greater distance from the hip (x + y) produces a larger moment of inertia around the hip than it does around the knee with the shorter distance (y).

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Figure 1.3 The classic shape of a long bone with bulbous ends produces different moments of inertia depending upon the orientation of the motion. The bone has a large moment of inertia when the rotational axis is around the end, but is small when the rotational axis goes down the length of the bone, even though the shape and size has not changed.

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A body does not have just one moment of inertia; it can have one for every rotational center. The body uses this concept to its advantage. A good example is seen in the design of our leg bones. The classic dog bone that has a long tubular shape with large bulbous ends is very similar to our lower limb bones, such as the femur (Figure 1.3). When this long bone with a large mass at each end is swinging around a fixed axis on one of its ends, the way our leg is rotating around the hip in walking, it has a large moment of inertia. As soon as the foot contacts the ground, the rotational axis shifts from being at the end of the bone to being down the long tubular shaft of the bone. The moment of inertia for this new axis is much smaller due to the small mass of the shaft being close to the rotational axis. It is the same bone, but the unique shape of the bone and the change in position of the axis make it behave very differently during walking.

For a fixed pivot point such as the axis of a joint, a body segment has only one value for its moment of inertia independent of the forces acting on it. This means that we will not have to concern ourselves too much about the moment of inertia since it is constant for each axis of a joint. In the translational world, we have a variable referred to as momentum. Momentum is the product of mass and velocity. We intuitively understand momentum in situations we encounter. For example, we know that we should not stand in front of a large truck speeding down the highway. When a truck has a large mass and a large velocity, it will have a large momentum. This is also an example of Newton’s First Law of Motion which states that a body stays in motion unless acted upon by an outside force. An application of Newton’s First Law to walking is seen when the foot strikes the ground (Figure 1.4). Before it strikes the ground, the forward swinging leg (velocity) has a mass, and it therefore has momentum. As soon as the foot strikes the ground, the forward velocity of the leg goes to zero as does its momentum (since momentum is equal to mass times velocity).

Figure 1.4 The foot striking the ground can be explained by all three of Newton’s Laws of Motion. An example of Newton’s First Law is the forward moving foot stopping as it strikes the ground (1). The sudden stop of the moving foot is from the force of the foot hitting the ground and is an example of Newton’s Second Law (2). When the foot pushes against the ground, the ground pushes against the foot (3). This is referred to as the Ground Reaction Force (GRF), and is an example of Newton’s Third Law of Motion.

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For the momentum to change so drastically, there has to be a large force acting on the foot. This force is described by Newton’s Second Law of Motion, which states that force is equal to the change in momentum over time. The change in momentum was large when the foot hit the ground. The key word here is change, since the foot went from having a large forward momentum while swinging, to having none at contact. The other key concept to take into account is the amount of time the momentum took to get to zero. Since heel contact occurs very quickly, the force acting on the heel is quite large. The faster we walk, the shorter the heel contact time becomes and the greater the force on the heel. The force acting on the heel is called the ground reaction force (GRF), and is an example of Newton’s Third Law of Motion. Newton’s Third Law states that for every action there is an equal and opposite reaction. The large force at heel strike is being applied to the ground, and the ground is pushing back up on the heel with equal and opposite force. We feel this force as our heel strikes the ground (See Clinical Application: Newton’s Three Laws).

Clinical Application: Newton’s Three Laws of Motion

It is not easy to change the variables of body mass and size in our patients, but we can alter the time variable. If we can increase the amount of time, we can reduce the forces acting on our patients according to Newton’s Three Laws of Motion. We can increase the amount of time simply by slowing down the walking speed. If we walk slower, the momentum and force at heel strike will be smaller. Similarly, if we use materials that take time to compress, or allow for the forward progression of the motion to occur, the foot will have slowed down while the time variable has increased. This is exactly what foam material, motion within a device, or rocker soles do to decrease the force acting on the extremity.

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In the rotational world, momentum becomes angular momentum and it is equal to the moment of inertia multiplied by the angular velocity. Again, this is very hard to understand from our perspective in the translational world we see every day, but it becomes very important when we consider an amputated leg. Since the mass of a non-energy-producing artificial limb is large, the angular momentum becomes large and requires a large amount of force to walk. Because of this increased energy requirement, many patients who undergo below-knee amputations, and who also have underlying diseases such as diabetes mellitus, do not generally live long following the amputation.¹ This is why it is important to protect the foot and salvage as much of the limb as possible in this population. (See Advanced Concept 2: Parallel Axis Theorem).

Advanced Concept 2: Parallel Axis Theorem

The parallel axis theorem is used to calculate the moment of inertia about a body segment.² This theorem states that the moment of inertia about any axis that is parallel to, and a distance (x) away from the axis that passes through the center of mass is equal to the moment of inertia of that segment plus its mass times the distance of the center of mass to the axis of rotation squared (I=Ix+mx2).

In other words, all we need to know is the mass of the segment and the distance to the joint center. To determine how the moment of inertia is changed for a below-knee amputee, we need to know the moment of inertia for the prosthetic (Ix=.06 kg m2), the mass of the prosthetic (5 kilograms [kg]) and the distance to the joint axis. If we calculate this for the knee where the center of mass of the prosthetic is 20 cm, the parallel axis theorem gives us the following:

I= .08 kg m2 + 3 kg(.2)² = 0.2 kg m2

The same prosthetic has a moment of inertia around the hip (where x=60 cm) of the following:

I= .08 kg m2 + 3 kg (.6)² = 1.16 kg m2

So the moment of inertia around the hip is almost 6 times the moment of inertia around the knee. This is why these patients use more proximal muscles to ambulate and they fatigue much quicker when walking.

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Joint Movements

Force is another concept we intuitively understand from our everyday experiences. To open a door, force must be applied. A moment of force is the rotational equivalent of a translational force. A moment is a force acting at a distance from a rotational axis, causing the segment to rotate (Figure 1.5). By definition, when you open a door with a rotating hinge you are applying a moment of force. We intuitively understand that the handle is placed a specific distance from the hinge side of the door so as to apply the greatest leverage, thereby necessitating the least amount of force to move the door. Alternatively, if you attempted to open a door from the hinge side, a much greater force would be necessary. In our body, these moments acting around a joint produce rotational motion of a body segment.

Figure 1.5 A moment of force is a force acting at a distance from a rotational axis.

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There are only two sources that can produce a moment across our joints. One source of a moment comes from the muscles within us that are attached to bones at a distance from a joint’s rotational center. Muscle forces are examples of internal moment, since they arise from inside the body. The other forces come from outside the body and are called external moments. GRF is an example of an external moment and is produced by gravity acting on us. We hit the ground with about 110% to 140% of our body weight when we walk.³, ⁴ The extra 10% to 40% comes from downward momentum and is dependent on speed. More to the point, the ground is pushing up against us by this amount, due to Newton’s Third Law. This force will act on each body segment from the foot, tibia, femur, pelvis, and into the spine. If we did not have the internal muscles to counteract this external force, we would develop shock-induced symptoms, such as back pain after walking.

During walking, the heel strikes the ground first and the GRF is posterior to the ankle joint axis. Since this is a force from outside the body acting at a distance from a rotational axis, it is an external moment (Figure 1.6). This external moment will quickly force the ankle joint to rotate with the distal aspect of the foot accelerating toward the ground. The result would be a noticeable foot slap gait pattern unless there is an opposite internal moment anterior to the ankle joint axis. The tibialis anterior muscle is anterior to the ankle joint axis, and is able to contract so as to produce an internal moment to counteract the GRF acting on the heel posterior to the ankle joint axis. If these two moments are equal and opposite, then there will be no motion. If the GRF is larger, then the distal aspect of the foot will slowly decelerate to the ground controlled by the tibialis anterior muscle (See Advanced Concept 3: Eccentric Contraction). This concept of equal and opposite moments and forces is commonly referred to as static equilibrium. When standing at rest (quiescent standing), forces continue to act across our joints, even though we cannot see them. The internal moments of our muscles are counterbalancing the external forces of gravity. As long as the internal moments are equal and opposite to the external moments, there will be no motion and we stand still. As soon as we initiate muscle contraction, the internal muscle forces overcome the external gravitational forces and we begin to walk. As a rule, human motion is nothing but a sign of unbalanced moments across our joints.

Figure 1.6 Foot at heel contact with tibialis anterior muscle firing eccentrically, producing an internal moment to counterbalance the external GRF.

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Advanced Concept 3: Eccentric Contraction

By knowing the location of the GRF with respect to the rotational center of a joint, we can determine not only which muscle is active, but also what type of contraction that muscle must be undergoing in order to produce the observed motion. Using the example of heel strike, the external moment is posterior to the ankle joint axis at the heel. This results in an external plantarflexion moment at the ankle joint that in non-pathological situations is counterbalanced by the internal dorseflexion moment of the tibialis anterior muscle. Since the foot continues to plantarflex to get the forefoot to the ground, the internal moment must be eccentric, meaning the muscle elongates while it is working. Eccentric contraction is usually seen early in contact when a body segment needs to decelerate. This type of muscle contraction accounts for most of the overuse injuries seen by clinicians.

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By knowing the magnitude, direction and distance of the moment of force from a joint’s rotational center, we can determine how that body segment will respond. The GRF is a vector that points toward the center of gravity, also referred to as center of mass, of a body. In humans, the center of gravity is usually situated in the pelvis just anterior to the second sacral vertebra at about 55% body height.⁵,⁶ To measure the external moments, we use a force plate which gives the GRF acting on our body due to our mass and gravity (i.e. our weight). A bathroom scale is a simple version of a force plate. The more elaborate force plates found in gait analysis laboratories are large rigid plates that usually have an array of electronic devices which can break down the GRF vector into its component vectors. There are three component vectors which combine to make the GRF vector; one for each of the 3 dimensions (Figure 1.7).

Figure 1.7 The GRF has 3 component vectors. The up and down or z vector represents our weight while the x and y vectors are typically considered shearing force vectors on the bottom of the foot and are dependent on the coefficient of friction. Think about what happens when your foot hits a patch of ice on the ground. The frictional forces representing x and y cannot push back against the foot and we go flying!

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Free body analysis is a way of studying equilibrium by looking at all of the forces and moments that are acting on a body segment (See Advanced Concept 4: Position of the Force Vector and Advanced Concept 5: Center of Mass). To do this, we isolate the body segment and draw all of the forces that are acting on this segment at a particular time (Figure 1.8). The diagram does not have to be to scale, but all of the force vectors must be positioned in the correct direction. By using this as a starting position, many questions about what a muscle is doing, or how it may change in the immediate future, can be answered. Modeling the body this way using the information from equipment such as force plates outside the body is referred to as inverse dynamics. That is, we go backwards in time after the person walked over the force plate and calculate what happened. Establishing a model of the body and then trying to determine what would happen in the future is known as forward dynamics (see Advanced Concept 6: Dynamic Model of the Ankle Joint and Figure 1.10).

Advanced Concept 4: Position of the Force Vector

A moment of force is dependent on the angular position of the force vector. The actual equation is as follows:

M = F x d x sine è

In this equation, è is the angle of the force vector to the axis of motion. To maximize the moment, the force vector should be oriented perpendicular to the axis, since the sine of 90 degrees is one. The equation is then M = F x d. Any angle less than 90 degrees will be slightly less than one in the equation, and will diminish the magnitude of the moment. For example, a force vector of 500 Newtons (N) angled at 45 degrees and 1 cm from a rotational axis would produce a moment of:

M = F x d x sine è = 500N x .1m x sine 45 = 35.36 N m

Orient the vector to 90 degrees and the equation becomes:

M = F x d x sine è = 500N x .1m x sine 90 = 50 N m

Knowing the anatomical location of the rotational axis will help in the design of an orthosis, prosthesis, or even surgical approach if the goal is to balance the moments across a joint segment.

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Advanced Concept 5: Center of Mass

The center of mass for a static human is located in the central part of the pelvis anterior to the sacrum. However, in extreme conditions, such as gymnastics and high jumping, the center of mass can shift outside of the body. (Figure 1.9) How is this possible? One way to answer this is to think of a doughnut with a hole. Where is the center of mass of the doughnut? It is in the middle of the hole. When you add up the mass and location of each section of the doughnut, the resultant is in the hole outside of the mass. Each section of the body such as the arms, legs and torso has its own center of mass. Since the overall mass of the body is made up of these parts, the center of mass will move as each of the individual parts change position. So by positioning the arms, legs and back, an athlete can perform what appears to be amazing feats through altering the center of mass.

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Figure 1.8 Free body diagram of the knee during terminal swing showing the various rotational forces acting across it.

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Figure 1.9 Image of a high jumper showing the center of mass outside of the body.

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The term dynamics implies that changing positions or motions exist. As soon as the position changes, we can start adding time into the equations. Joint power and energy are two more kinetic variables that can yield insight into the dynamics of gait. Joint power is equal to the moment multiplied by the angular velocity. So, if a basketball player wanted to produce a more powerful jump, the moment of force and the rotational speed would need to be increased. Not much can be done about the external moments from gravity, but the internal muscle moments can be altered. The larger the muscle, the greater will be the force. The angular acceleration can be manipulated by increasing the speed at which push off occurs. This is exactly what a professional basketball player works on when trying to improve his skill. Muscle masses are large, the bones are long, and the faster that he can run down the court, the greater the propulsive power.

This increased velocity along with body size is also what determines the energy. Kinetic energy is equal to one half the mass multiplied by the velocity squared, so kinetic energy is dependent on size and speed. Potential energy is the weight multiplied by the height, and is entirely dependent on size. Walking and running are examples of kinetic and potential energy being manipulated to achieve forward progression. A human’s center of gravity located within the pelvis moves up and down during walking. The center of gravity is at its highest point in mid-swing, so its potential energy is at the largest value it will achieve during that cycle. However, the vertical velocity of the center of gravity at the top of the curve is at the lowest value as the upward movement slows and reverses. Therefore, its kinetic energy is at its lowest in mid-swing. As someone falls forward, he places the swing leg anterior to catch himself. The free-falling body means that the center of mass is getting closer to the ground, therefore the potential energy is decreasing. While this is happening, the kinetic energy has increased as the velocity of the body’s free-fall increases until the forward leg strikes the ground and exerts a force to slow the body down. Walking is an orchestrated free-fall maneuver in which potential energy and kinetic energy are out of phase with each other (Figure 1.11). This exchange of energy is controlled by the muscles within the leg, producing the power and the force needed to slow the free-fall down, and eventually reversing it to produce upward propulsion.

Advanced Concept 6: Dynamic Model of the Ankle Joint

Looking at the kinetics of someone standing on a force plate can help with our understanding of how to model a body segment. The first question we may ask is: What is the net moment around the ankle joint? Since the person is in static equilibrium, we know the net moment is zero. What is the net muscle moment? We know that the internal muscle moment has to be equal and opposite to the external GRF. The next step is to get the external information from the force plate and draw a free body diagram (Figure 1.10).

The subject weighs 60 kg, so the force plate is reading 588 N (60 kg x 9.8 m/s2 whereas m/s equals milliseconds.) In static stance, the GRF is posterior to the hip joint, anterior to the knee, and just anterior to the ankle joint axis. So 588 N of force is coming from the subject’s center of mass through the hip, knee and ankle and into the plate. Since the GRF is anterior to the ankle joint, it would try to dorsiflex the foot unless there was an internal muscle moment posterior to the ankle joint trying to plantarflex the foot. The Achilles tendon attached to the gastrocnemius and soleus muscles is a large plantarflexor of the foot just posterior to the ankle joint. So these muscles must contract at least the body weight in static stance just to keep us from falling forward. In an equation it would look like the following:

M(ankle) = F(Achilles) - GRF = 0

This is an oversimplified model of the ankle joint. By adding more information to the model we can get a more accurate representation. The foot has a mass of around 0.9 kg and much of it lies anterior to the ankle joint axis. So its weight (0.9 kg x 9.8 m/s2 = 8.82 N) must be taken into the following equation:

M(ankle) = F(Achilles) - GRF + mass foot = 0

F(Achilles) = 588N 8.82N = 579.2 N

The muscles attached to the Achilles tendon must contract with body weight to keep the subject upright. Now what happens when the subject is asked to go on his toes? The net moment around the ankle joint has to become a net plantarflexor moment. This is primarily from the triceps surae muscle group.

How much force is required from the Achilles tendon (the tendinous insertion of the triceps surae) to raise the heel off the ground? To answer this question, we need to know where the forces are located. For our subject, the distance from the ankle joint to the insertion of the Achilles tendon is 8 cm. The GRF is shifted to the ball of the foot at heel off and this is 16 cm from the ankle joint. Given that the center of mass of the foot is 8 cm anterior to the ankle joint, we can solve the problem with the following equations:

M(ankle) = (F( Achilles) x distance) - GRF( 2 x distance) + (weight foot x distance) F(Achilles) = (GRF x d - weight foot x d) / d = 588N(0.16m) - 8.82N(0.08m) /0.08m F(Achilles) = 1167.18 N

The Achilles tendon must pull with twice the body weight to raise the heel off the ground so that we can stand on our toes. The above example is a simple forward dynamic model of the ankle joint. We can use inverse dynamics to test this model by having the subject stand on a force plate and calculate the internal and external moments from the plate.

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Figure 1.10 Free body diagram of the ankle joint showing the force from the Achilles tendon (FA) posterior to the ankle joint axis and the force from the mass of the foot (FM) with the GRF anterior to the axis.

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Figure 1.11 Phasic relationship between Kinetic Energy (K.E.) and Potential Energy (P.E.) during walking.

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Muscles as Power Producers

The ability of a muscle to produce power depends upon many variables. The first is the Physiological Cross Sectional Area (PCA). The PCA is the measure of the number of muscle fibers (sarcomeres) that are parallel with the angle of pull of the muscle (Figure 1.12A). The PCA can be calculated by taking the mass of the muscle and dividing it by the muscle density times the physiological length of the muscle. Most muscles have a density of 1.063 g/cm3.⁷ By knowing the size and orientation of the fibers, we can determine how much power they can produce.

This orientation is referred to as the pennation angle. The pennation angle affects a muscle’s ability to produce power by changing the PCA of the muscle. Pennate muscle fibers are at a slight angle from the long axis of the muscle (Figure 1.12B). As a muscle undergoes concentric contraction, the pennation angle changes from being parallel to the axial pull of the muscle to being perpendicular to the long axis of the muscle (Figure 1.12C). This demonstrates the concept of length-tension ratios. Generally, muscles are the strongest at their physiological resting length. As the muscle contracts or extends, the fibers’ ability to produce power is decreased. The length-tension ratio of muscle indicates that each muscle has an optimal functioning position, and once it moves away from this position its ability to produce power is reduced. (See Clinical Application: Optimal Functioning Position).

Figure 1.12 A) The PCA of a muscle showing sarcomeres. B) The bi-pennate muscle, like the gastrocnemius, with pennate muscle fibers at an angle to the axial pull of the tendon. C) As the muscle shortens, the pennation angle changes with more of the fibers oriented perpendicular to the direction of the pull.

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Clinical Application: Optimal Functioning Position

By understanding the concepts of PCA, pennation and length-tension ratio, we can understand the concept of the optimal functioning position of a joint. Most muscles are in their physiological resting length when the joint is in a neutral position, usually somewhere in the middle of its range of motion. As the joint begins to move in one direction, muscles on one side of it will shorten and muscles on the other side will stretch. The joint capsule and ligaments will sense this change, and these same muscles will contract to slow down the motion and reposition the joint.

If the joint is functioning to one side of the range of motion, then the ability for these muscles to contract sufficiently is reduced, often resulting in injury. By repositioning the joint and muscle to their optimal functioning position with orthoses or shoe modifications, many of these injuries can be reduced.

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Our final concern is the amount of fatigue of the muscle. As muscles fatigue, they lose their ability to contract sufficiently and power is lost. Once the ability to produce sufficient power is reduced to the point that the muscle cannot counteract the forces of gravity, excess motion will occur across that joint segment. Without the ability of the muscle to slow down and reduce the motion, the soft tissues, and eventually the bone, will absorb the external energy. The final result will be pathological failure of whichever tissue or structure is positioned to absorb the energy.

Types of Muscle Contraction

There are three types of muscle contraction: concentric, eccentric and isometric (Figure 1.13). A concentric muscle contraction occurs when the muscle is contracting and the length is getting shorter. This is usually associated with acceleration and is often seen during propulsion. An example of this is seen in the gastrocnemius muscle at heel-off, during which the foot is plantarflexing as the muscle shortens. The opposite of concentric contraction is eccentric contraction. An eccentric contraction occurs when the muscle is getting longer but is still firing. This is usually associated with deceleration and is seen during the contact period. An example of this is seen in the tibialis anterior at heel strike. During the initial contact period, the tibialis anterior muscle is eccentrically contracting to allow the front of the foot to slowly come to the ground. The final form of muscle contraction, isometric, occurs when the muscle is not changing length while it is contracting. During isometric contraction, the muscle maintains its position. Isometric contraction is often seen when stability is needed. An example can be seen in the postural muscles around the hip such as the gluteus medius during mid-stance. In order for the one limb to swing through in mid-stance, the pelvis must be stabilized around the stance side hip. This is accomplished through isometric contraction of the hip abductors.

Figure 1.13 Types of muscle contractions. A) Concentric contractions in which the muscles shorten while firing. B) Eccentric contractions produce elongation of the muscle while it is firing. C) Isometric contractions in which the muscle is firing but the position is not changing.

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Mechanical versus Physiological Work

Energy is the ability to perform work. The definition of mechanical work is the application of force producing a displacement or movement. When a person is asked to stand on his toes, muscles contract and displace the body upward as the ankle joint plantarflexes. The muscles have thus produced power, energy, and work as we have just defined it. However, once a person gets on his toes, the muscles no longer keep moving; they have reached the end-range of motion of the ankle joint’s plantarflexion ability. By definition, this means that there is no more displacement and the work goes to zero. After several minutes of holding that position, our muscles would fatigue. Our muscles are obviously working to hold this position. Visually, we do not see any motion, but internally our muscle fibers are working during this isometric contraction. Our muscles are still doing physiological work.

Levers, Fulcrums and Application to the Gait Cycle

Human gait is a magical balance of controlled bipedal falling. With every step taken, there is a very brief period of free-fall that does not result in loss of balance as the process is one of controlled and redirected energy. The balance between the types of muscle contraction, positions of the joints, and the forces can only be understood if we break the cycle down into smaller sections. One way of doing this is to look at where the fulcrum is as the body rocks over the foot fixated on the ground. We call this fixated period the stance phase of the gait cycle, and it occupies about 60% of the cycle’s overall time. The opposite of this is the swing phase where the foot is swinging forward. This phase occupies the remaining 40% of the time. When taken together, the swing phase and the stance phase is called a stride and goes from heel strike of one foot to the heel strike of the same foot. A step, on the other hand, goes from heel strike of one foot to heel strike of the opposite foot. In walking, there are two periods of double limb support during which both feet are on the ground. The first occurs after initial contact before the trailing limb begins to swing through, and occupies 10% of the overall time (Figure 1.14) (visible in landscape view). The other period occurs just before the toes come off the ground when the swing foot strikes the ground, and it is also 10% of the overall time. The two periods are equal since the first contact period of one foot is always the second toe-off period of the opposite.

Figure 1.14 (visible in landscape view) - Graphical representation of a complete stride for walking and for running where H.S. is heel strike and T.O. is toe-off. Note that during stance phase of walking there are two periods of double limb support in which two feet are on the ground, while in running there are two periods of double float during the swing phase in which neither foot is touching the ground.

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We can use events such as double limb support to give us a timing sequence that can be used, regardless of the person. At initial contact, the fulcrum of the load is at the back of the heel. This is often referred to as the first rocker or heel rocker (Figure 1.15) (visible in landscape view). The weight of the body is coming down the leg and into the ankle while the major muscle acting is the tibialis anterior, through the process of eccentric contraction. This type of configuration is referred to as a second class lever. That is, the load is between the work and the fulcrum (Figure 1.16) (visible in landscape view). The second class lever. That is, the load is between the work and the fulcrum (Figure 1.16). The second class lever configuration is very similar to a wheelbarrow and is a very efficient lever system. This means that the tibialis anterior muscle has a mechanical advantage and does not have to do nearly as much work as it would have to if the attachment was in a different configuration (Figure 1.17).

Figure 1.15 (visible in landscape view) - A) The first rocker is at heel contact and the fulcrum is at the heel. B) The second rocker is after forefoot loading and the fulcrum moves to the ankle joint. C)The third rocker is after heel off and the fulcrum moves to the ball of the foot.

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Figure 1.16 (visible in landscape view) - A first class lever is similar to a teeter-totter in which the load and the applied force are on opposite sides of the fulcrum. A second class lever is similar to a wheel barrow with the load between the fulcrum and the applied force. The third class lever is similar to the second class lever, but the load and the applied force positions are exchanged so that the force is between the fulcrum and the load. The third class lever is the least efficient of the three levers (the triangle represents the fulcrum).

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Figure 1.17 Heel rocker showing insertion of the tibialis anterior tendon as a second class lever.

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As soon as the forefoot strikes the ground, the body begins to rotate over the foot which is fixated to the ground. The fulcrum now moves to the ankle joint. This period is often referred to as the second rocker or ankle rocker (Figure 1.18). The load is moving forward from the heel to the forefoot as the body is moving over the foot fixated to the ground. As soon as the load (body weight) passes anterior to the insertion of the tibialis anterior tendon, any mechanical advantage is lost as the configuration changes to a third class lever. The loss of the mechanical advantage is not a significant problem during this part of the normal gait cycle since most of the work is being produced by forward momentum of the body moving over the foot fixated to the ground.

Figure 1.18 Ankle rocker showing the changes in the position of the load vector alters the mechanical advantage of the insertion of the tibialis anterior tendon to that of a third class lever.

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The final phase is known as the third rocker (forefoot rocker) during which the heel comes off the ground and the fulcrum moves from the ankle to the ball of the foot (Figure 1.19). Initially, the fulcrum stays at the ankle as it begins to plantarflex in order to bring the heel off the ground. In this configuration the work is being undertaken at the Achilles tendon, the fulcrum is at the ankle, and the load is on the forefoot. This is a first class lever and it is not as efficient as the second class lever. To regain the mechanical advantage so that the muscles do not have to do as much work, the ankle must stabilize so that the fulcrum moves to the ball of the foot at the metatarsal heads. This is now a second class lever again, and the effect of the muscle contracting is to transfer the energy into the floor, so as to propel the body forward.

Figure 1.19 Once the ankle is stabilized during propulsion, the fulcrum moves forward (forefoot rocker) and the insertion of the Achilles tendon produces a second class lever again.

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Analysis of the timing sequence of events allows further division of the gait cycle into smaller phases during which specific functions occur. Keep in mind that while the percentage of time spent in each phase is given, they are approximations. Each individual may have differing times, and each step may vary among the same individual.

Initial or heel contact phase occurs when the foot makes contact with the ground and it occupies from 0% to 2% of the gait cycle (Figure 1.20) (visible in landscape view). The heel contact phase contains the initial shock of the heel striking the ground. The next phase is called loading response, and it corresponds with the double limb support phase occupying the first 10% of the gait cycle. This is the period during which the load is moving from the heel to the forefoot as the fulcrum begins to move from the heel to the ankle. The loading response period ends at opposite toe-off. The single limb support that occupies the middle 40% of the gait cycle can be broken down into mid-stance and terminal stance phases. Mid-stance occurs between 10% and 30% of the gait cycle and is the first half of the single limb support. It is marked by toe-off of the opposite (swing) foot and ends at heel-off of the stance foot. This is the ankle rocker part of the gait cycle as the load is being transferred across the foot from the ankle to the forefoot.

Figure 1.20 (visible in landscape view) - Graphical representation of the gait cycle showing the corresponding phases of each foot. Load. Resp. = Loading Response.

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The second half of the single limb support phase is called terminal stance, and it occurs during 30% to 50% of the gait cycle. It is marked by heel-off of the stance foot