GAIT

Dr/Mohamed Ahmed Raafat

Lecturer of Physical Therapy for
Neurology Disorders and it’s Surgery
South valley University
DEFENETION OF THE GAIT

➢ Translatory progression of body as whole produced by coordinated

rotatory movement of body segment.

➢Simple act of throwing forward (falling forward) & catching oneself.

➢movements that produces locomotion

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 kinematics
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❑ Walking is the result of a cyclic series of movements.
❑ Stride: a complete gait cycle, the sequence of events taking place
between successive heel contacts of the same foot.
❑ Step :(=pace): the sequence of events that occurs within successive
heel contacts of opposite feet, for example, between right and left
heel contacts.
❑Therefore: 1 stride = 2 steps (a left step + a right step )

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BASIC SPATIAL DESCRIPTORS OF GAIT

❑ Stride length is the distance between two successive heel contacts of the
same foot.
❑ Step length, in contrast, is the distance between successive heel contacts of
the two different feet.
❑ Step width is the lateral distance between the heel centers of two
consecutive foot contacts and is on average around 8 to 10 cm
❑ Foot angle, the amount of “toe-out,” is the angle between the line of
progression of the body and the long axis of the foot. About 5 to 7 degrees
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BASIC TEMPORAL DESCRIPTOR OF GAIT
❑ cadence (step rate), the number of steps per minute.
❑ step time (the time for the completion of a right or a left step).
❑ stride time

SPATIAL-TEMPORAL DESCRIPTOR OF GAIT

❑ Walking speed: means distance covered in a given amount of time
❑ calculated by measuring time it takes to cover a given distance, or the
distance covered in a given amount of time, or by multiplying the step rate by
the step length.
❑ units of measure: meters per second (m/sec) or miles per hour (mph).
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❑ For healthy adults, a gait cycle (i.e., two consecutive steps) takes:
✓ slightly more than 1 second and
✓covers approximately 1.44 m (4.5 feet),
✓resulting in a walking speed of 1.37 m/sec.

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at a freely chosen walking speed, women exhibit a slower
walking speed, shorter step length, and faster cadence than men.

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When an increase in walking speed is needed, two strategies are
available:

❑ increasing the stride (or step) length + increasing the cadence

✓ Typically an individual combines both strategies until the longest
reasonable step length is reached.
✓ From that point on, a further increase in walking speed is solely
related to an increase in cadence.

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GAIT CYCLE EVENTS
❑A full gait cycle for the right lower extremity can be divided into
two major phases:
➢Stance phase (from right heel contact to right toe off) occurs as
the right foot is on the ground, supporting the body’s weight.
➢Swing phase (from right toe off to the next right heel contact)
occurs as the right foot is in the air, being advanced forward for the
next contact with the ground.

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GAIT CYCLE EVENTS
❑ Within a gait cycle, the body experiences:
➢ two periods of doublelimb support (when both feet are in contact
with the ground simultaneously)
✓ IST period 0% to 10% of the gait cycle (body’s weight is being
transferred from the left to the right lower extremity).

✓ 2ND period 50% to 60% of the gait cycle and serves the purpose
of transferring the weight of the body from the right to the left lower
extremity.
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GAIT CYCLE EVENTS
➢ two periods of single-limb support (when only one foot is on the
ground)
✓ IST period 20% to 50% of the gait cycle (the left lower extremity
is in its swing phase, being advanced forward).

✓ 2ND period 60% to 100% of the gait cycle (this time on the left
lower extremity. This period of left single-limb support corresponds to
the swing phase of the right lower extremity.

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GAIT CYCLE EVENTS

As gait speed increases,

% of the gait cycle spent in periods of double-limb support becomes shorter

For these athletes, greater speeds are achieved by :

✓ increasing cadence and stride length
✓ by minimizing periods of double-limb support to the point at
which stance and swing phase times are about equal.
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GAIT CYCLE EVENTS
During running,
the periods of double-limb support disappear altogether to be
replaced by
periods when both feet are off the ground simultaneously.

❑ The transition from walking to running normally takes place:

✓ at a step rate of approximately 180 steps/min
✓ or at a speed of approximately 2.1 to 2.2 m/sec (4.8 to 5.0 mph).

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GAIT CYCLE EVENTS
Conversely, at a slow walking speed,
the periods of double-limb support occupy an increasingly
greater percentage of the gait cycle.

❑ A slower gait provides greater stability because both feet are on

the ground simultaneously for a greater percentage of the cycle.

❑ the reduced speed, shorter step length, and slower cadence

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GAIT CYCLE EVENTS

STANCE PHASE SWING PHASE

❑ Five specific events:

Three specific events:
I. heel contact,
I. Early swing
II. foot flat, II. Mid swing
III. mid stance, III. Late swing
IV. heel off (or heel rise) and
V. Toe off
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SUBDIVISION OF STANCE AND SWING PHASES

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 Perry and Burnfield further divide the gait cycle based on three tasks

I. weight acceptance (which includes initial contact and oading

response),

II. single-limb support (which includes mid stance and terminal stance),

I. swing limb advancement (which includes pre swing as well as initial,

mid, and terminal swing).
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DISPLACEMENT AND CONTROL OF THE BODY’S CENTER OF MASS

Walking can be defined as a series of losses and recoveries of balance.

✓ Ambulation is initiated by allowing the body to lean forward.

✓ For a fall to be prevented, momentary recovery of balance is
achieved by moving either foot forward to a new location.
❖ Once gait is initiated, the body’s forward momentum carries the
center of mass (CoM) of the body beyond the foot’s new location,
necessitating a step forward with the other foot.
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DISPLACEMENT AND CONTROL OF THE BODY’S CENTER OF MASS

body’s CoM is located just anterior to 2nd sacral vertebra,

but the best visualization of the movement of the CoM is by
tracking the displacement of the head or torso.

❑ two sinusoidal patterns of movement that correspond to the

movement of the CoM:
I. the vertical directions
II. side-to-side directions.
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DISPLACEMENT AND CONTROL OF THE BODY’S CENTER OF MASS
I- In the vertical direction,

❑ CoM oscillates up and down to describe two full sine waves

per gait cycle:
✓ Minimum height of the CoM occurs at the midpoint of both periods of
double-limb support (5% and 55% of the gait cycle).
✓Maximum height of the CoM occurs at the midpoint of both periods of
single-limb support (30% and 80% of the gait cycle).
✓A total vertical displacement of approximately 5 cm is noted at the
average walking speed in the adult male.
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DISPLACEMENT AND CONTROL OF THE BODY’S CENTER OF MASS
II- side-to-side directions

✓ Maximum position of the CoM to the right occurs at the midpoint of

the stance phase on the right lower extremity (30% of the gait cycle),

✓maximum position of the CoM to the left occurs at the midpoint of

the stance phase on the left lower extremity (80% of the gait cycle).

✓ total side-to-side displacement of approximately 4 cm.

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total pattern of motion of the CoM during a full gait cycle

o Starting shortly after right heel contact, the CoM is moving forward, upward,
and toward the right foot.
o This general direction of movement continues for the first 30% of the gait
cycle—the body is essentially “climbing and shifting its mass” over the
supporting lower extremity.
o At right mid stance, the CoM reaches its highest and most lateral position
toward the right.
o Just after right mid stance, the CoM continues forward but starts moving in a
downward direction and toward the left side of the body—the body is
essentially “falling away” from the supporting lower extremity.
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total pattern of motion of the CoM during a full gait cycle

o With the left limb in its swing phase, the body depends on the left lower extremity
to make secure contact with the ground to accept the weight transfer and to prevent
a fall.
o Shortly after left heel contact, during the double-limb support phase, the CoM
is located midway between the feet and reaches its lowest position as it continues to
move forward and toward the left lower extremity.
o From right toe off to mid stance on the left lower extremity (80% of the gait
cycle), the CoM moves forward, upward, and toward the left lower extremity,
which is now providing support.
oAt 80% of the gait cycle, the CoM is again at its highest point, but in its most
lateral position to the left.
oShortly after left mid stance, the movement of the CoM shifts downward and
toward the right side of the body. The gait cycle is completed,
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 KINETIC AND POTENTIAL ENERGY CONSIDERATIONS

❑ Although walking appears to take place at a steady forward speed,

the body actually speeds up and slows down slightly with each step.

When the supporting lower extremity is in front of the body’s CoM, the body slows down.
Conversely,
when the supporting lower extremity is behind the body’s CoM, the body speeds up.

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KINETIC AND POTENTIAL ENERGY CONSIDERATIONS
❑ The body reaches its lowest velocity, therefore, at mid stance,
once it has “climbed” on the supporting lower extremity,
❑highest velocity during double-limb support, once it has “fallen
away” from the supporting lower extremity and before “climbing” on
the opposite limb.
Because kinetic energy of the body during ambulation is a direct function of
its velocity

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 FIG. 15.25 Transfer between potential and kinetic energy
during gait. The minimum potential energy exists when
the center of mass (CoM) is at its lowest points (5% and
55% of the gait cycle). The maximum potential energy
occurs when the CoM is at its highest points (30% and
80% of the gait cycle). The reverse occurs for kinetic
energy. This transfer between potential and kinetic energy
is analogous to riding a bicycle that gains speed while
55 going down a hill and loses speed while climbing up the
next hill.
 minimum kinetic energy is present at mid stance (30% and 80% of GC)
✓
✓ maximum kinetic energy is reached at double-limb support (5% and 55%
of GC)

❑ Potential energy is a function of the mass of the body, the gravitational

field acting on the body, and the height of the body’sCoM

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ENERGY EXPENDITURE
➢ measured by the amount of energy used in calories per meter walked per
kilogram of body weight.
➢Typically, energy expenditure is measured indirectly by quantifying
oxygen consumption.
➢ Conservation of energy is achieved by :
✓optimizing the excursion of the CoM,
✓controlling the body momentum, and
✓taking advantage of intersegmental transfers of energy.
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 The metabolic efficiency of walking is greatest at a walking
speed of approximately 1.33 m/sec (3 mph).

Walking speed is equal to the product of step length and cadence

(step rate).

❑the energy cost of ambulation increases with :

✓ walking speed
✓imposition of a different step length or step rate (abnormal gait)
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KINEMATICS
A. SAGITTAL PLANE KINEMATICS
PELVIS
• short-arc rotations in anterior and posterior directions about a medial-
lateral axis through the hip joints
• During gait at normal speed, the amount of anterior and posterior
pelvic tilt is small (i.e., a total of approximately 2 to 4 degrees)
• At right heel contact, the pelvis is in a near neutral position.
• From 0% to 10% of the gait cycle, a period of double-limb support, a
small amount of posterior pelvic tilt occurs.
• The pelvis then begins tilting anteriorly during the period of single- limb
support, reaching a slight anterior pelvic tilted position just after mid
stance (30% of the gait cycle).
• In the second half of the stance phase, the pelvis tilts posteriorly until
just after toe off.
• During initial and mid swing (60% to 87% of gait), the pelvis again tilts
anteriorly before starting to tilt in the posterior direction in terminal
swing.
• The generally noted greater magnitude of pelvic tilt with faster
walking speed serves to increase functional limb length, which in turn
serves to increase step length.
 HIP
• The hip is flexed approximately 30 degrees at heel
contact
• As the body moves forward over the fixed foot, the hip
extends. Maximum hip extension of approximately 10
degrees is achieved before toe off.
• Flexion of the hip is initiated during pre-swing, and the
hip is at about 0 degrees of flexion by toe
off (60% of gait).
• During the swing phase, the hip further flexes to bring
the lower extremity forward for the next foot placement.
Maximum flexion (slightly more than 30 degrees) is
achieved just before heel contact

• Overall, approximately 30 degrees of

flexion and 10 degrees of extension (from
the anatomic neutral position) are needed
at the hip for normal walking
KNEE
• At heel contact the knee is 5 degrees
flexion
• additional 10 to 15 degrees during the
initial 15% of the gait cycle This slight
knee flexion, controlled by eccentric action
of the quadriceps
• Following initial flexion, the knee
approaches near full extension until
about heel off (occurring at 30% to 40%
of the gait cycle).
• At this point the knee starts flexing,
reaching approximately 35 degrees of
flexion by the time of toe off (60% of
gait cycle).
• Maximum knee flexion of approximately
60 degrees is assumed by the beginning
of mid swing (73% of gait cycle).
ANKLE (TALOCRURAL JOINT)
• heel contact occurs with the talocrural joint in a
slightly plantar flexed position (between 0 and 5
degrees)
• Shortly after heel contact (the first 8% of the gait
cycle), the foot is positioned flat on the ground by a
movement of plantar flexion controlled
eccentrically by the ankle dorsiflexors.
• during stance, up to 10 degrees of ankle
dorsiflexion occurs as the tibia moves forward over
the foot, (from 8% to 45% of the gait cycle).
• after heel off (occurring at 30% to 40% of the gait
cycle), the ankle begins to plantar flex, reaching a
maximum of 15 to 20 degrees of plantar flexion
just after toe off
• During the swing phase the ankle is again
dorsiflexed to a neutral position to allow the toes
to clear the ground
FIRST METATARSOPHALANGEAL JOINT
• At heel contact, the MTP joint is slightly extended. From shortly
after heel contact to heel off, the MTP joint is in a relatively neutral
position.

• Between heel off to just before toe off, the MTP joint extends
approximately 45 to 55 degrees beyond neutral position.
• During the late part of stance phase and initial swing, the joint
flexes and returns to a near neutral position.
FRONTAL PLANE KINEMATICS
PELVIS
• The pelvis rotates through a total excursion of about
10 to 15 degrees as a result of pelvic-on-femoral (hip)
adduction and abduction on the stance limb
• During weight acceptance on the right lower
extremity (i.e., the first 15% to 20% of the gait
cycle), the left iliac crest drops slightly below the
height of the right iliac crest. this drop of the left iliac
crest reflects pelvic-on-femoral adduction of the right
stance hip
• From 20% to 60% of the gait cycle, the left iliac
crest is elevated by concentric activation of the right
hip abductors
• The elevation of the left iliac crest (on the swing limb)
effectively produces abduction of the right stance hip.
Throughout the swing phase on the right, a
similar pattern occurs of initial controlled lowering of
the right iliac crest followed by its progressive
elevation
 POSSIBLE CAUSES FOR EXCESSIVE HIP FRONTAL PLANE
MOTION DURING WALKING
• weakness of the hip abductors,
• Reduced “shortening” of the swing limb
• a discrepancy in limb length
✓positive Trendelenburg sign.
✓ hip hiking on the side of the swing lower extremity compensates for the inability of
the knee and/or ankle of the lower extremity to sufficiently shorten the limb for
clearance of the foot.
✓ A significant limb length difference During periods of double-limb support, the iliac
crest of the longer lower extremity is positioned higher than the iliac crest of the
shorter lower extremity.
KNEE
• knee is relatively stable in the
frontal plane, allowing only a
very small amount of angular
movement
• the knee to be in an average of
1.2 degrees of abduction
(valgus) at the time of heel
contact, This alignment remained
unchanged throughout the stance
phase.
• the knee typically abducted an
additional 5 degrees during initial
swing phase. Maximum abduction
occurred when the knee was near
its maximum flexion angle
SUBTALAR JOINT
• The subtalar joint is inverted approximately 2
to 3 degrees at the time of heel contact

• Immediately after heel contact, rapid

eversion of the calcaneus begins and continues
until mid stance (30% to 35% of the gait
cycle), where a maximally everted position of
approximately 2 degrees is reached.

• a relatively neutral position of the calcaneus is

reached at about 40% to 45% of the gait
cycle, at approximately heel off

• Between heel off and toe off, calcaneal

inversion continues until it reaches a value of
approximately 6 degrees of inversion
 Horizontal Plane Kinematics
Information currently available about lower extremity
kinematics in the horizontal plane during walking is
provided by only a limited number of studies.

To improve the accuracy of these measurements, some

investigators fixed rigid metal pins in the pelvis, femur,
and tibia of their subjects. Attached to these metal pins
were markers that allowed video cameras
to track bone movement.
In some studies only the movement of the bony
structures in space was observed; reports from other
studies described the relative motion that took place at
the joint itself
 PELVIS
During walking, the pelvis rotates in the horizontal plane around a vertical axis of rotation
through the hip joint of the stance limb. The following description of pelvic rotation is based on
a top view for a right gait cycle:

At right heel contact the right anterior-superior iliac spine (ASIS) is forward
compared with the left ASIS.

❑ For the initial 15% to 20% of the gait cycle, the pelvis rotates in an internal
(counterclockwise) rotation.
❑ Throughout the rest of stance on the right lower extremity, an external (clockwise)
rotation of the pelvis occurs as the left ASIS progressively moves forward along
with the advancing left swing limb.

❑ At right toe off, the right ASIS is now behind the left.
❑ During swing of the right lower extremity, the right ASIS progressively moves forward.
 HIP
Both the femur and the pelvis rotate simultaneously.
At right heel contact, the right hip is in slight external rotation based on the
relative posterior position of the contralateral (left) ASIS.

A net internal rotation movement of the right hip occurs during most of stance
on the right lower extremity, as the contralateral (left) ASIS is brought forward.

➢ A maximum internally rotated position is achieved by 50% of gait.

➢ External rotation of the right hip occurs from 50% of gait until mid swing, as
the right lower extremity is advanced forward. From mid swing to right heel
contact, a slight amount of right hip internal rotation takes place.
 KNEE
There are two studies of particular interest that used
intracortical pins attached to the femur and tibia as a
means to precisely document horizontal plane rotation of
the knee during ambulation. Clearly, the amount and
direction of the horizontal plane rotation of the knee is
highly variable.

overall trend toward internal rotation during the stance

phase, data by Benoit and colleagues11 indicate an
average overall pattern of knee external rotation.
 ANKLE AND FOOT
Horizontal plane rotation of the talocrural
joint is slight and not considered here. The
primary movements of the subtalar
joint (inversion and eversion) are in the
frontal plane and are described earlier
Summary of Horizontal Plane Kinematics
❑ The direction of horizontal plane rotation of the major
bones of the lower extremity and subtalar joint during
walking, using different sets of data
❑ The pelvis, femur, and tibia rotate internally, well after
heel contact (i.e., through about 15% to 20% of the gait
cycle).

❑ This mass internal rotation is accompanied by subtalar

joint eversion.
❑ As described in an everting subtalar joint tends to
increase the pliability of the midfoot region, including
the transverse tarsal joint.
❑ A pliable midfoot serves to cushion the impact of
limb loading.

❑ After about 15% to 20% of the gait cycle, the pelvis, femur,
and tibia all begin to externally rotate until toe off.
Simultaneously to this external rotation of the
pelvis, femur, and tibia the subtalar joint begins moving
toward inversion, which tends to increase the stability
of the midfoot region.
❑ This stability enables the midfoot to serve as a rigid
lever in terminal stance and pre-swing, allowing the
plantar flexors to lift the calcaneus without the
midfoot collapsing under the body’s weight.

Further investigation, such as that performed by

Reischl and colleagues, is needed to clearly elucidate
the exact relationship that exists between the timing
and magnitude of pronation of the foot and rotation of
the tibia and femur
 ‫‪Thank you‬‬
‫وجزاكم هللا خير الجزاء‬
ENERGY-SAVING STRATEGIES OF WALKING
five kinematic strategies
serve to decrease energy cost
reduce the displacement of the CoM

❑Vertical displacement of the CoM is reduced by the combined actions of the first four strategies.
❑ The fifth strategy serves to reduce the side-to-side displacement of the CoM (Table 15.5).
❑ six determinants of gait originally described by Saunders and colleagues in 1953.
VERTICAL DISPLACEMENT OF THE CENTER OF MASS
❑Horizontal plane rotation of the pelvis

advances the entire swing LL minimizing

forward Amount of hip flexion & extension
needed for a given step length

LL remaining closer to a vertical orientation

throughout the gait cycle

the lowest points of the CoM trajectory are raised, which

reduces the downward displacement of the CoM.
 VERTICAL DISPLACEMENT OF THE CENTER OF MASS
• Sagittal plane ankle rotation makes use of the configuration of
the ankle-foot complex (see Fig. 15.27C)
At heel contact
functionally elongating
the alignment of the ankle
the lower extremity.
places the large protruding calcaneus
in contact with the ground,

Near the end of stance, L L is elongated by

as the hip extends plantar flexion of the ankle
and the knee begins to flex (i.e., heel rise).
VERTICAL DISPLACEMENT OF THE CENTER OF MASS

• Stance phase knee flexion

LL Limiting
is in its most vertical orientation upward displacement of CoM
VERTICAL DISPLACEMENT OF THE CENTER OF MASS
• Frontal plane pelvic rotation
During stance phase, :
the contralateral iliac crest falls as the ipsilateral iliac crest rises.
Throughout a complete gait cycle, therefore, the iliac crests
alternately rise and fall like the ends of a seesaw,
but the point just anterior to the second sacral vertebra (i.e., the
point representing the body’s CoM) remains relatively stationary,
as would the pivot point of a seesaw.
❑ The downward displacement of the CoM is reduced by
✓ horizontal plane pelvic rotation and
✓ sagittal plane ankle rotation.

❑ upward displacement of the CoM is reduced by

✓ stance phase knee flexion and
✓ frontal plane pelvic rotation.
 ‫‪Thank you‬‬
‫وجزاكم هللا خير الجزاء‬
 Determinants of Gait

• 6 specific features that increase the efficiency

of walking and running gaits

• All reduce unnecessary movement of the

upper body, either vertically, or horizontally
in the lateral axis
ENERGY-SAVING STRATEGIES OF WALKING

six kinematic strategie reduce the displacement of the CoM

decrease energy cost.

• Vertical displacement of the CoM is reduced by the combined

actions of the first five strategies.
• The sixth strategy serves to reduce the side-to-side displacement of
the CoM (Table 15.5).
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 DG1: Pelvic tilt
• Reduces the vertical movements
of the upper body, and thereby
increases energy efficiency.
• The pelvis slopes downwards
laterally towards the leg which is
in swing phase. i.e. rotation about
an anterior-posterior axis
• Only anatomically possible if the
swing leg can be shortened
sufficiently (principally by knee
flexion) to clear the ground.
• Where this is not possible (e.g.
through injury), the absence of
pelvic tilt and pronounced
movements of the upper body are
obvious.
VERTICAL DISPLACEMENT OF THE CENTER OF MASS
• Frontal plane pelvic rotation
During stance phase, :
the contralateral iliac crest falls as the ipsilateral iliac crest rises.
Throughout a complete gait cycle, therefore, the iliac crests
alternately rise and fall like the ends of a seesaw,
but the point just anterior to the second sacral vertebra (i.e., the
point representing the body’s CoM) remains relatively stationary,
as would the pivot point of a seesaw.
 DG2: Pelvic rotation

• Rotation about a vertical

axis enables a given step
length to be achieved with
less vertical excursion of
the trunk.

• Alternatively, longer step

lengths can be achieved for
the same vertical
movement.
VERTICAL DISPLACEMENT OF THE CENTER OF MASS
❑Horizontal plane rotation of the pelvis

advances the entire swing LL minimizing

forward Amount of hip flexion & extension
needed for a given step length

LL remaining closer to a vertical orientation

throughout the gait cycle

the lowest points of the CoM trajectory are raised, which

reduces the downward displacement of the CoM.
 DG3: Knee flexion in stance
phase
• As the hip joint passes
over the foot during the
support phase, there is
some flexion of the
knee.
• This reduces vertical
movements at the hip,
and therefore of the
trunk and head.
VERTICAL DISPLACEMENT OF THE CENTER OF MASS

• Stance phase knee flexion

LL Limiting
is in its most vertical orientation upward displacement of CoM
 DG4: Ankle mechanism

• At foot strike, the

effective length of the
leg is increased by the
projection of the
calcaneus behind the
ankle.

• This is brought about by

dorsiflexion at the
ankle
 DG5: Forefoot mechanism

• During the final part of

the support phase, the
forefoot serves to
increase the effective
length of the leg lever.

• This is brought about by

plantarflexion at the
ankle
 VERTICAL DISPLACEMENT OF THE CENTER OF MASS
• Sagittal plane ankle rotation makes use of the configuration of
the ankle-foot complex (see Fig. 15.27C)

At heel contact
the alignment of the ankle functionally elongating
places the large protruding calcaneus the lower extremity.
in contact with the ground,

Near the end of stance, L L is elongated by

as the hip extends plantar flexion of the ankle
and the knee begins to flex (i.e., heel rise).
 DG6: Reduced lateral pelvic
displacement

• Is minimised by having a
narrow walking base i.e.
feet closer together than
are hips.
• Therefore less energy is
used moving hip from
side to side (less lateral
movement needed to
balance body over stance
foot.
• Enabled by valgus
angulation at the knee
 SIDE-TO-SIDE DISPLACEMENT OF THE CENTER OF MASS
✓ CoM shifts side-to-side and remains within the dynamic BOS provided by the
feet.
✓ amplitude of this lateral displacement, partially reflected by step width, is
largely a function of frontal planehip motion (i.e., hip abduction and adduction). .

The normally adopted 8- to 10-cm step width during ambulation

reduces side to-side displacement of the body,
primarily as a strategy to reduce energy expenditure.
✓ Theoretically a step width greater than 8 to 10 cm provides greater stability at
a cost of increased energy expenditure. Persons with balance disorders, for
example, often choose to walk with a wider base of support as a means to
improve their stability.
❑ The downward displacement of the CoM is reduced by
✓ horizontal plane pelvic rotation and
✓ sagittal plane ankle rotation.

❑ upward displacement of the CoM is reduced by

✓ stance phase knee flexion and
✓ frontal plane pelvic rotation.
ENERGY-SAVING STRATEGIES OF WALKING

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121
 ‫‪Thank you‬‬
‫وجزاكم هللا خير الجزاء‬
 MUSCLE ACTIVITY
during gait

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ERECTOR SPINAE
the lumbar region, show two well-defined periods of activity:

❑ Ist period is from slightly before heel contact to about 20% of the GC
cycle.
❑2nd period is from 45% to 70% of GC , which corresponds to opposite
heel contact.

control the forward angular momentum of the trunk relative to

the hips shortly after heel contact for each step.

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RECTUS ABDOMINIS

❑ Ist period occurs at between 20% and 40%

❑2nd between 70% and 90% of the gait cycle

stabilizes the pelvis and lumbar spine

and
provides a stable fixation point for the hip flexor muscles,
principally the iliopsoas and rectus femoris
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 HIP EXTENSORS MUSCLE
❑ begins at terminal swing
serves two purposes:
1) initiating hip extension and
2) preparing the musculature for weight acceptance at the beginning of stance.
❑ At heel contact
• prevent forward “jackknifing,” or uncontrolled trunk flexion, over the femur.
This “jackknifing” would occur if
the forward displacement of the trunk were to continue at a steady velocity
while the forward translation of the pelvis normally slightly but suddenly
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slowed at heel contact
 HIP ABDUCTORS
gluteus medius, gluteus minimus, and tensor fascia lata
Consider the important action of these rotators in the rapid change of
direction during walking or running.

Eccentric activation of the external rotators

may be especially important to the
control of the internal rotation of the lower limb in early stance.

Inadequate strength or control may result

excessive internal rotation of the
of femur, +
the external rotators
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excessive foot pronation
KNEE EXTENSORS
As a group, the quadriceps

❑ 1st : active in the very late stage of the swing phase in preparation for
heel contact.
❑ 2nd : shortly after heel contact. Eccentric activation
control the knee flexion serves to (shock absorber)
that takes place in the cushion the rate of
first 10% of the gait cycle. weight acceptance on the LL

❑ 3rd : The quadriceps then acts concentrically to extend the knee and support
the weight of the body during mid stance.
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 The primary function of the rectus femoris in gait occurs in
the transition from stance to swing phase
and appears directed at
assisting with initiating hip flexion as well as controlling
knee flexion

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 HIP FLEXORS
iliopsoas

❑ before toe off and remains so through initial swing (between 30%
and 50%) of the gait cycle is likely initially eccentric.

❑ followed by a concentric action initiate hip flexion just before toe off
despite the continued hip flexion into terminal swing, the hip flexor muscles
are active only in the first 50% of the swing phase

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ANKLE AND FOOT
TIBIALIS ANTERIOR (two periods of activity)

❑ 1st : At heel contact, a strong eccentric activation is present to decelerate

the passive plantar flexion of the ankle.
✓caused by the weight of the body being applied on the most posterior section of
the calcaneus.
✓ If unopposed by the eccentric activation of the tibialis anterior and other ankle
dorsiflexors, this large, passive plantar flexion torque results in the gait deviation
referred to as “foot slap.”
(characteristic sound made by the foot slapping the ground just after heel contact )
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ANKLE AND FOOT
TIBIALIS ANTERIOR (two periods of activity)

❑ 2nd : during the swing phase. To produce sufficient dorsiflexion of the

ankle to clear the toes from the ground.
✓ Extreme weakness of the tibialis anterior and the other ankle dorsiflexors
typically results in a “drop foot” during the swing phase.
✓ As a mechanism of compensation, the individual typically excessively
flexes the knee and hip during swing.
✓ Other compensatory maneuvers, such as vaulting, hip circumduction, and
hip hiking, may also be adopted to clear the toes from the ground.
132 Ttt: posterior ankle- foot orthosis that passively maintains ankle dorsiflexion during swing
ANKLE AND FOOT
EXTENSOR DIGITORUM AND EXTENSOR HALLUCIS LONGUS

❑ Similar to the tibialis anterior, the extensor digitorum longus and extensor
hallucis longus decelerate plantar flexion of the ankle at heel contact.
❑ the toe extensors assist with dorsiflexion of the ankle and extend the toes
to ensure that the toes clear the ground.
• Minor activity of the extensor digitorum longus and extensor hallucis longus
during push off may provide stability to the ankle through coactivation with
the ankle plantar flexors

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FIBULARIS MUSCLES
fibularis brevis and longus

❑ 10% of the gait cycle to just before toe off.

✓In addition to their function as plantar flexors, these pronator (evertor)
muscles help counteract the strong inversion effect caused by activation of the
tibialis posterior and other deep posterior muscles.
✓
❑ fibularis longus also assists in the kinematics of the foot by holding
the first ray rigidly to the ground, which provides a firm base of support
for the action of the foot as a rigid lever during the terminal stance and
pre-swing phases of gait.
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 GROUND REACTION FORCES
❑ Def/
During ambulation, forces are applied under the surface of the foot every time a
person takes a step.
Conversely, foot forces
The forces applied to the ground by the foot are called foot forces.
❑ These forces are of equal magnitude but opposite direction. (Newton’s Third
Law—the law of action and reaction— states that forces are always present in
pairs, equal in magnitude and opposite in direction.)

❑GRF follows a Cartesian coordinate system, with the forces being expressed
along three orthogonal axes: vertical, anterior-posterior, and medial-lateral.
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VERTICAL FORCES

❑ The vertical forces are those directed perpendicular to the supporting surface.
❑ peak twice in a given gait cycle.
✓Forces are slightly greater than BW at the time of early stance and again
after heel off.
❑ During mid stance, the ground reaction forces are slightly less than BW.
❑ This fluctuation in force is a result of the vertical acceleration of the body’s
CoM.
(Force is a function of mass and acceleration: F = ma.)

137
 VERTICAL FORCES

❑ In the early part of stance, the body’s CoM is moving downward .

✓ VGRF greater than one’s body weight, therefore, is needed to initially decelerate
the downward movement of the body and then accelerate it upward.
(This is similar to jumping on a bathroom scale and briefly reading a weight that is higher than
static body weight.)
❑ At mid stance, VGRF are less than body weight as a result of a relative
“unweighting” caused by the upward momentum of the body gained during the
early part of stance.
❑ at push off The higher VGRF reflects the combined push provided by the plantar
flexors + the need to reverse the downward movement of the body that occurs in
late stance.
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140
 ANTERIOR-POSTERIOR FORCES
❑ the anterior-posterior direction, shear forces are applied parallel to the
supporting surface.
❑ At heel contact APGRF is in the posterior direction.
✓ So, sufficient friction is required between the foot and the ground to
prevent the foot from slipping forward (picture the classic cartoon of a person
falling to the ground after slipping on a banana peel).
As the magnitude of the GRF in the horizontal direction increases with longer
steps and a faster walking speed, requirements for friction between the foot
and the ground to prevent the foot from slipping increase.
✓ Strategies to prevent slipping are minimizing the distance between foot location and
the CoM of the body and reducing walking speed.
This is why people often take shorter and narrower steps when walking on an icy
surface— they are decreasing the demand for friction by keeping the feet nearly directly
under the CoM.
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ANTERIOR-POSTERIOR FORCES
❑ During the second half of stance phase, APGR is directed anteriorly, with
the foot applying a posteriorly directed force to the ground to propel the
body forward.
✓ The magnitude of the propulsive force depends on walking speed and,
especially, attempts to accelerate.
✓ Inadequate friction between the foot and the ground at this time often
causes the foot to slide backward without propelling the body forward.
(This explains the difficulty experienced when one accelerates quickly while
walking on a slippery surface.)

142
 ANTERIOR-POSTERIOR FORCES

❑ The peak APGRFis typically equal to about 20% of body weight.

✓ The larger the step length, the greater the shear forces because of the greater
angle between the lower extremity and the floor.
✓ Inertial properties of the body, such as momentum, also contribute to APGRF.
✓ PGR at heel contact slows the forward progression of the body.
AGRF AT TOE OFF body is momentarily accelerated forward (as a result
of an anteriorly directed ground reaction force).

143
 ANTERIOR-POSTERIOR FORCES
Note that
the propulsive force of one lower extremity
is applied simultaneously with
the braking force of the opposite lower extremity
during the times of
double-limb support
✓ When one walks at a constant velocity, the propulsive force occurring late in
stance balances the braking force occurring early in stance.

✓ Slowing down requires a greater braking force than propulsive force, and
speeding up requires the opposite.
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MEDIAL-LATERAL FORCES
❑ The magnitude of the ground reaction force in the medial-lateral direction is
relatively small (i.e., less than 5% of body weight) .
❑ During the initial 5% or so of the gait cycle, a small, lat.GRF is produced to stop
the small lateral-to-medial velocity of the foot that is typically present at the time
of heel contact.
❑ During the rest of stance phase, however, the CoM of the body is located medial
to the foot (see Fig. 15.24), causing a laterally directed force to be applied to the
ground by the foot and therefore a medially GRF.
✓ These medially directed ground reaction forces throughout stance phase initially
decelerate the lateral movement of the CoM.
✓ Then, these ground reaction forces accelerate the CoM medially toward the
contralateral lower extremity, which is swinging forward and preparing to make
the next foot contact with the ground.
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 MEDIAL-LATERAL FORCES
❑ Although the action of the medial-lateral ground reaction forces may not be
easily felt during normal gait, they can be readily felt during walking while taking
very large steps or when jumping from side to side.
✓ In fact, greater peak values in medial-lateral ground reaction forces are often
seen in individuals with wider step widths.
o The need for friction can again be appreciated by observing someone walking on ice.
Individuals walking on icy surfaces reduce their step widths almost as if they were walking on a
tightrope. This learned adaptation is intended to keep the body’s CoM directly over the feet to
minimize the medial-lateral ground reaction forces and therefore the need for friction.
o Ice skaters make use of these medial-lateral ground reaction forces to propel
their bodies forward. This is achieved by using a blade that digs into the ice,
providing an adequate resistance for propulsion.
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PATH OF THE CENTER OF PRESSURE
(The term pressure is used to describe the ground reaction force related to its
specific area of application.)

❑At heel contact, the CoP is located just lateral to the midpoint of the heel.
❑It then moves progressively to the lateral midfoot region at mid stance,
❑and to the medial forefoot region (under the first or second metatarsal head)
during heel off to toe off.
❑ The location of the CoP helps to explain the tendency for the ankle and foot to
plantar flex and evert, respectively, at heel contact (Fig. 15.33). Both tendencies
are partially controlled by eccentric activation of ankle muscles, namely the ankle
dorsiflexors, including the tibialis anterior.

148
 JOINT TORQUES AND POWERS
❑ During gait, GRF applied under the foot generate an external torque on the
joints of the lower extremities. Fig. 15.34.
❑ During the loading response on the right limb, :
behind the ankle ankle PF
GRF Behind knee GRF knee FLEX
anterior to the hip. hip FLEX
❑To prevent collapse of the lower extremity,
these external torques
are resisted by
internal torques
created by the activation of the ankle dorsiflexors, the knee extensors, and the hip extensors
149
JOINT TORQUES AND POWERS
❑ the activation of muscles creates most of the internal torques that control
joint motion, especially in midrange positions.
❑This internal torque is associated with concentric muscle activation when
the joint moves in the direction of the muscle’s action;
❑in contrast, internal torque is associated with eccentric muscle activation
when the joint moves in the direction opposite the muscle’s action.

152
 Internal torques can also be created by
passive forces
generated by
the deformation and recoil of connective tissues, such as the
capsule, tendons, and ligaments.

❑ Many gait deviations associated with muscle weakness rely heavily

on passive tensions created at the end range of a joint’s position for
the internal torques required for ambulation.

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GAIT DYSFUNCTIONS
Most of us take for granted our ability to walk. The fact is, unless we have
personally experienced an injury or a physical impairment, we do not think of
walking as a difficult task.

The information provided thus far in this chapter, however, reminds us of the
complexity of walking. Many actions must occur simultaneously at each part
of the gait cycle for ambulation to take place with maximum efficiency.

Normal gait requires sufficient ROM(joint) and strength(musclskeletal) at

each participating joint.
Walking also requires sophisticated control of movement through CNS.
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❑ THE COST OF GAIT DEVIATION IS, TYPICALLY, INCREASED ENERGY
EXPENDITURE + APPLICATION OF ABNORMAL STRESSES TO THE BODY.
 ‫‪Thank you‬‬
‫وجزاكم هللا خير الجزاء‬