NORMAL GAIT

Basic terminologies
 Basic biomechanics
 COG
 BOS
 LOG

 Stability and mobility

 Tibial movement on ankle joint
 Tibial translation at Knee
 Eccentric work of muscles
COG
Moment force
Work, Energy and Power
 Energy optimizations
 Abnormal excessive energy and fatigue

 Physical scientist and biologist

 Work done…force and distance

 Energy potential and kinetic

 Muscle use potential energy in eccentric that is negative work

 Power exchange
 Knee flexion concentric power gain

 Knee flexion eccentric power absorb

 Isometric no power exchange

Cant measure energy in human as vehicle measure

Gait

 Walk and gait ??

 Define Gait??
 Walking pattern
 Complex system
 The ability to initiate or
terminate
Bipedal gait
 Advantage
 Freely move
 Challenging

 Disadvantages
 Hard for CM to move in straight line
 Arc shaped
Gait Cycle - Definitions:
► 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’

 Physiological definition
 Mechanical definition
 Pre requisite
There are (4) major criteria essential to walking.

 Equilibrium:
The ability to assume an upright posture and maintain balance.

 Locomotion:
The ability to initiate and maintain rhythmic stepping

 Musculoskeletal Integrity:
Normal bone, joint, and muscle function

 Neurological Control:
Must receive and send messages telling the body how and when to move.
(visual, vestibular, auditory, sensori-motor input)
Phases of step cycle
 Stance phase -60% (20% double support)
1. Initial contact
2. The loading response
3. Mid stance
4. Terminal stance
5. Pre swing
 Swing phase -40%
1. Initial swing
2. Mid swing
3. terminal swing
Terminology
RLA (phases) Traditional (events)
Stance Stance
 Initial Contact Heel Strike
 Loading response HS → foot flat
 Midstance FF → midstance
 Terminal stance Midstance → heel off
 Pre-swing Heel off → toe off
Swing Swing
 Initial swing Toe off → early accel.
 Midswing Accel. → midswing
 Terminal swing Midswing → deceler.
Gait cycle
Phases of Gait
Step and stride length and stride width
 Gait Cycle - Subdivisions:

A. Stance phase:
1. Heel contact: ‘Initial contact’
2. Foot-flat: ‘Loading response’, initial contact of forefoot w. ground
3. Midstance: greater trochanter in alignment w. vertical bisector of foot
4. Heel-off: ‘Terminal stance’
5. Toe-off: ‘Pre-swing’
Gait Cycle - Subdivisions:

B. Swing phase:
1. Acceleration: ‘Initial swing’
2. Midswing: swinging limb overtakes the limb in stance
3. Deceleration: ‘Terminal swing’
► 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%
► With increasing walking speeds:
► Stancephase: decreases
► Swing phase: increases
► Double support:decreases

► Running:
► By definition: walking without double support
► Ratio stance/swing reverses
► Double support disappears. ‘Double swing’ develops
 The stance period consists of the first five phases:
initial contact, loading response, mid-stance and
terminal stance.
Stance phase
Swing phase
Kinematic Description of Gait
Movement of the joints and segments in space –
Pelvis, Hip, Knee, Ankle
 Sagittal Kinematics
 Frontal Kinematics
 Transverse kinematics
Saggital kinematics
Initial contact
(Heel strike)

 Hip 25-30 flexion

 Knee 0-5
 Ankle 0 (90)

 Muscle work
 Stabilizers
Loading Response Phase
(Heel Strike to Foot Flat)

 KNEE: 0° → 15° flexion

 ANKLE: 0° → 10° plantar flexion
 1st rocker : Calcaneus

 Muscle work
 Quards ---Eccentric
 DF….Eccentric
 T.Antand Post….Eccentric
 Hip extensors
Mid stance
(Foot Flat to mid stance)

 HIP: 25° → 0°
 KNEE: 15° →0°
 ANKLE: 10PF→5°dorsiflexion
 2nd rocker ankle

 Muscle work
 Hip extensors
 Soleus and gastro…eccentric
Terminal Stance
Mid stance to Heel off

 HIP: 0 - 20° Ext.

 KNEE: 0°
 ANKLE: 5° → 10°DF
 At end of terminal stance, Begin
3rd rocker MTP

 Muscle work
 Planter flexors
 No quards and hamstring
Pre swing
(Heel Off to Toe Off)

 HIP: 20° Ext → 0°F

 KNEE: 0° → 40°F
 ANKLE: 10° dorsi flexion → 20°
plantar flexion

 Muscle work
 Planter flexors
 Push off
 Passive knee flexion
Initial swing
Toe Off to early

 HIP: 15 °F
 KNEE: 60°F
 ANKLE: 10° plantar flexion

 Muscle work

 Hip flexors
 Knee flexors
 DF
Mid swing

 HIP: 25 °F
 KNEE: 25°F
 ANKLE: 0°

 Muscle work
 Hip flexors
 Quards
Terminal Swing
Mid-swing-deceleration

 HIP: 25 °F
 KNEE: 0°-5
 ANKLE: 0°

 Muscle
 Hip extensors
 Hamstring
Swing phase
1. Initial quads and hip flexors
2. Pendulum…momentum
3. Hamstring and hip extensors
4. Quads
Muscle Function
1. Trunk
 Counterbalance trunk flexion movement

 Coordinate rotating trunk opposite from pelvis

2. Abdominals
 rotates trunk in opposite direction of pelvis
Muscle Function
3. Hip Flexors
(iliopsoas, TFL, sartorius, rectus femoris, and adductors)
 brief activity at beginning of swing to initiate hip flexion

 silence at mid-swing

 eccentric control of hip extension at terminal stance

4. Gluteus Maximus
 activity begins at TSW, rises during IC

 function with hamstrings to decelerate forward trunk

 Muscle Function
5. Hip Adductors
 stabilize the limb at heel strike

 stabilize the limb during external rotation

6. Hip Abductors
 stabilize pelvis in the frontal plane

 control contra lateral pelvic drop

7. Quadriceps
 active from TSW through MST

 extend knee to place foot just prior to IC

 absorb shock and provide knee stability

Muscle Function
8. Hamstrings
 active from end of swing phase through loading response

 preventing hip flexion at beginning of stance

 assist with knee flexion during swing

9. Tensor Fascia Latae

 active at terminal swing with gluteus to stabilize ITB

 active at end of stance and beginning of swing to

 assist hip flexion

Muscle Function
10. Pre-tibial muscles (Tib. Ant., EDL, EHL)
 – active from initial contact through loading

 response to decelerate ankle plantar flexion

 – active from pre-swing through swing to clear toes

 from floor

11. Gastroc/soleus
 active just after midstance through terminal stance

to decelerate forward progression of the tibia

 stabilizes knee at terminal stance (pulls femur

posteriorly to extend knee)

 Frontal kinematics
Hip & Pelvis
 Pelvic Obliquity

Near midstance, the CM is high.

The swing side of the pelvis drops
Down during swing to lower the CM.

 Hip AB-Adduction
Hip adducts in early stance about 5°,
abducts in late stance about 5°, and
returns to neutral in swing.
Frontal Kinematics
Subtalar
 In early stance, eversion(pronation) unlocks the

midtarsaljoint, allowing shock absorption.

 In late stance, inversion (supination) locks the

midtarsaljoint, allowing a rigid forefoot lever for

heel off.
Transverse axis
Hip, trunk & lower limb
 Pelvic Rotation

The swing leg side of the pelvis rotates 10°

 Trunk Rotation

Lower trunk (below T7/T8 ) rotates with the

pelvis.
Upper Trunk rotates opposite to this (180°)
 Femoral/ Femoral/Tibial

Internal rotation until foot flat, then externally

rotates until toe off, then internally rotates through
swing.
Determinants of Gait :
► Six optimizations used to minimize excursion of
CG in vertical & horizontal planes
► Reduce significantly energy consumption of

ambulation
► Classic papers: Sanders, Inman (1953)
1.PELVIC ROTATION
2.PELVIC OBLIQUITY
 3. Knee flexion in stance phase
 4. Ankle mechanism
 5. Foot mechanism
6. Lateral displacement of body
Gait

Initial HC HC
‘Heel transient’

Foot-Flat Mid-
stance
Gait

Initial HC HC
‘HeelHeel-off
transient’
Toe-off
 Gait analysis

1. Temporal / Spatial

2. Kinematics
•Qualitative Gait analysis
•Observational gait analysis OGA
•Biomechanical evaluation
•GHORT

3. Kinetics

4. Dynamic Electromyography
Temporal and Distance Factors
 Velocity– 1.46 m/second (3.26 miles/hour)
 Step length – 76.3 cm (30.05 inches)
 Cadence – 1.9 steps /second
 Stride length –
 Walking speed – men-110 steps/minute , women-
115 steps/minute
 Gait Parameters
Males Females

Step Length (cm) 79 66

Stride Length (cm) 158 132

Cadence (steps/min) 117 (60-132) 117 (60 132

Velocity (m/sec) 1.54 1.31

Walking Base (cm) 8.1 7.1

Foot angle 7 6
GAIT
Muscle strength

► Planter flexors 5

► Quards 3plus
► Hip extensors 3plus
► Hip flexors 2 plus
Kinetics
 GRF
 COP
 Muscle Torque
Kinetics
 Ground Reaction Forces
The equal-and-opposite force the floor exerts on the
body during stance
Best measured with a force plate
Forces are typically resolved into:
Vertical Compression (z)
Anterior-Posterior Shear (y)
Medial-Lateral Shear (x)
Gait Analysis – Forces:
► Forces which have the most significant Influence
are due to:
(1) gravity
(2) muscular contraction
(3) inertia
(4) floor reaction
Gait Analysis – Forces:

► The force that the foot exerts

on the floor due to gravity &
inertia is opposed by the
ground reaction force
► Ground reaction force (RF)
may be resolved into
horizontal (HF) & vertical
(VF) components.
► Understanding joint position &
RF leads to understanding of
muscle activity during gait
 Kinetics center of pressure

 Represents the centroid of foot forces on the floor

 This is an idealization, because pressures are distributed

all over

 When measured by a force plate, it is more correctly

called the point of application of the GRF
Force Platform
The reaction force
produced by the ground is
called the Ground
Reaction Force (GRF),
which is basically the
reaction to the force the
body exerts on the
ground.

Gait Analysis: Techniques and

April 30, 2007
Recognition of Abnormal Gait
 Electromyography

0.051mm, insulated, hooked wires

25 Gauge Needle

Gait Analysis: Techniques and

April 30, 2007
Recognition of Abnormal Gait
 Control Mechanisms of Gait
Spinal cord
1. Pattern generation
2. Reflex action
3. Execute other rhythmic movements concurrently
Brainstem and cerebellum
4. Improve coordination of activation patterns
5. Weight support
6. Active propulsion
Control Mechanisms of Gait
Basal ganglion
1. Dynamic stability
2. Initiates movement
3. Terminates movements
Cortex
4. Adoptable motor control system to meet goals in
different types of environments
 Essential Requirements for Successful
Locomotion

Progression
 Coordinated and rhythmic pattern of muscle activation in legs
and trunk
 Requires the ability to initiate and terminate locomotion
 Guide locomotion towards end points that are no t necessarily
visible
Stability
 Appropriate posture for locomotion
 Dynamic stability
Adaptation
 Adaptations to avoid obstacles, navigate uneven terrain, and
change speed and direction as needed
ABNORMAL GAIT
Abnormal Gait Syndromes
 In general gait deviations fall under four headings:

 Those caused by weakness

 Those caused by abnormal joint position or range of
motion
 Those caused by muscle contracture
 Those caused by pain
Abnormal Gait Types
 Pain
 Antalgic gait

 Gonalgic gait

 Podalgic gait

 Leg length discrepancy

 Short leg

 Musculoskeletal
 Trunk bending

 Anterior trunk bending

 Posterior trunk bending
 Lateral trunk bending
 Hyperlordosis
Abnormal Gait
Hip region Knee region

Hip hiking Knee Flexion

Hip flexion contracture contracture
Psoatic weakness Quadriceps weakness
Vaulting Knee joint stiffness
Hip joint stiffness
Toe in gait
Toe out gait Ankle region

Toe walking
Equinaus walking
Flat foot
Planterflexiors weakness
Abnormal Gait
 Neurological abnormal gait
 Cerebellar Ataxic
 Sensory ataxic
 Vestibular ataxic
 Parkinson gait
 Propulsive gait
 Steppage gait
 Scissors gait
 Myopathic gait
 Hemiplegic gait

 Hysterical gait
Abnormal Gait: Pain
 Antalgic Gait: Painful hip
 Gonalgic Gait: painful knee

 Podalgic Gait: painful foot

 Decrease single limb support period

(less time on bad leg)

 Limp adopted

 To avoid pain
 Avoid weight-bearing
 Very short stance phase
Short Leg Gait/ leg length discrepancy

 True short leg

 False Short leg

 Pelvis raised
 Foot supinated

 Scoliosis

 Below 1 inch no modification

 Shoe modification
Trunk bending
 Lateral trunk bending
 Anterior trunk bending
 Posterior trunk bending

 Hyper lordosis gait

Lateral trunk bending
Trenlenberg’s sign
Anterior trunk bending
Posterior trunk bending
Increase lumbar lordosis
Hip Hiking
Vaulting
 Hip region
 Hip flexion contracture…….Increase lumbar lordosis
 Psoatic weakness ….Pelvis raised

 Hip joint stiffness

 Toe in gait …..Internal Rotators
 Toe out gait……External Rotators
 Excessive knee flexion or Crouched Gait

Hamstring spasticity

Excessive knee flexion

Knee buckles
 Knee region

 Quadriceps weakness ……anterior trunk bending

 Knee joint stiffness

Ankle region

 Toe walking…….Tight TA
 Equinaus walking……Tight DF

 Flat foot

 Planterflexiors weakness …..lack of push

Abnormal Gait
 Neurological abnormal gait
 Sensory ataxic
 Vestibular ataxic
 Cerebellar Ataxic

 Parkinson gait
 Propulsive gait

 Steppage gait
 Scissors gait

 Myopathic gait
 Hemiplegic gait
 Hysterical gait
Proprioceptive Loss: Sensory
Ataxia

 Wide, irregular, uneven steps

 Unsteady, wide based gait
 Throw feet forward and out and bring them down
first on heels and then toes (double tapping sound)
 Watch ground
 Positive Romberg (cannot stand with feet together
and eyes closed)
 Friedrich ataxia
Vestibular system
 Gait unsteadiness
 Inability to walk down stairs independently
 Decreased ocular fixation during motion leading to
sense that world is “jiggling”
 May be unable to drive, or need to stop walking to
read a sign
 “Vestibular Ataxia”
 Vertigo or nystagmus with standing/walking
Balance Loss due to Cerebellar problems

 Wide based
 Unsteadiness
 Irregularity of steps
 Lateral veering

 Motor ataxia
 Eye open Romberg sign
 ATAXIC GAIT

An unsteady
Uncoordinated
Wide base
Feet thrown out
FESTINATING/PARKINSONIAN GAIT

Involuntarily moves

Short steps
Accelerating steps

Difficult to start
Difficult to stop
Parkinson Gait
 Shuffling: small stepped gait without arm
swing with high speed.

 Festinating: short quick stepped gait with

stooped posture due to displaced centre of
gravity.

 Freezing: sudden brief inability to move

during mid stance.
 Flat foot strike instead of heel strike
Propulsive Gait

• Stiff neck and head

• Excessive force to
propel body

• Upper trunk stiffness

Steppage or foot drop
 Steppage Gait

Foot drop

Leg is lifted high so

Toes can clear the ground

Foot slap at initial contact

 Waddling gait or Myopathic Gait

Abductor weakness

Trenlenberg sign positive

Pelvis drop opposite

Trunk swaysame

Lurching Gait
Wadding gait
Scissor Gait

Legs cross midline

Adductors Spasticity

Toe walk
Planter flexor spastic

Spastic Cerebral palsy

Hemiplegic Gait
► Foot clearance

► Hip flexor weakness

► Pelvis retracted
 Hysterical Gait
HIP
 Hip flexion excessive……Contracture
 Limited HF……weakness …..Tight HE

 HE limited…..HF contracture
 External rotation…..Pelvis retracted
 Hip hiking……Weak DF, Spastic extensor

 Circumduction….weak HF
Deviations at Hip
Position Deviation Description Possible cause
Heel strike to FF Excessive flexion More than 30 Contracture

Limited HF Less than 30 Weakness of flexors

FF to MS Limited HE Not neutral HF contracture

Internal rotation Spastic
External rotation Pelvis rotation
Abduction Spastic
Adduction Spastic
Swing Circumduction Semicircle Weak HF
Hip hiking Quadus lamborum Extensor spastic
Excessive hip
flexion More than 30 Foot drop
 Deviations at Knee
Position Deviation Description Possible cause
Heel strike Excessive KF Buckles Spastic flexors

Foot flat Knee hyperextend Hyperextend Weak Quads, Spastic

Quads
Mid stance Knee hyperextend Hyperextend As above

Push off Excessive KF More than 40 Flexor contracture

(CVA)
Limited KF Less than 40 Spastic Quads
Swing
Excessive KF More than 65 Flexor withdrawl ,
Dysmetria

Limited KF Less than 65 Extensor spasticity ,

Circumduction
 Deviation at Ankle

Position Deviation Description Possible cause

Initial contact Foot slap Foot slap Weak DF
Toes first Tip toe Spastic PF , Length

Foot flat Entire foot Weak DF, Neonatal

Mid stance Excessive positional Tibia does not Ecc.Weak PF or tight
PF advance move
Heel lift Not with ground Spastic PF
Excessive DF Tibia more advance Weak PF,KF or HF
contracture
Toe clawing Grab floor Spastic flexor, grasp
reflex
Push off No roll off Insufficient weight Weakness of PF
shift
Swing Toe drag Insufficient DF Weak DF
Varus Inverted Spastic invertors
Deviation of Trunk
Position Deviation Description Possible cause
Stance Trunk lateral lean Trenlenberg gait Weak Abd

Backward trunk Hyperextension at Weak GM

lean hip

Forward trunk lean Forward Weak Quad