Mowder-Tinney 2020 1

Gait Introduction

J.J. Mowder-Tinney PT, PhD, NCS, CSRS, CEEAA, C/NDT

jjmowder@gmail.com

Learning Objectives

Review key components of

normal gait

Identify the critical components of

normal movement of gait

Phases of Gait

• The entire period during which the foot is on the ground • 60% of gait

Stance Phase

• Begins when the foot is lifted from the floor until the heel is placed down • 40% of gait

Swing phase

• Both feet touching and seen in each phase

Double stance

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Normal Gait

• A pattern of walking or the manner of bearing weight forward

• Gait is the pattern of walking and walking ability

• Normal pattern assumes variety of forms

Gait

A series of losing and regaining balance resulting in forward motion

Most of muscle activity is gait deceleration

• Eccentric activity decelerates• Isometric activity stabilizes• Concentric activity accelerates

Critical to pay attention to the type of contraction that is required from the muscle

Gait Description

Where do you start? Are you consistent?

What terminology do you use?

Did you include arm swing, trunk

alignment, head/eye movement?

What is the priority deviation? What is

causing it?

How would you design your

intervention?

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Prioritize

Hip and knee control is critical

If stance is key then think about the benefit of a good sit pivot versus stand

pivot.

The majority of our focus will be on stance phase since that is the key to swing.

It is all about STANCE PHASE!

Gait Terminology

Traditional RLAHeel Strike/HC/IC Initial Contact

Heel Strike → Foot Flat Loading Response

Foot Flat → Midstance Midstance

Midstance → Heel Off Terminal Stance

Heel Off → Toe Off Preswing

Toe Off → Early Swing (Acc) Initial Swing

Early Swing (Acc) → Midswing Midswing

Midswing → Late Swing (Dec) Terminal Swing

Normal Gait

Image from: http://www.footworksorthotics.co.uk/running/dynamic-gait-analysis/

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QUICK REVIEW

• Note your reading and the video link will provide you a quick review of the terminology

• https://www.youtube.com/watch?v=1u6d1CX7o9c

• https://www.youtube.com/watch?v=QAnEhz6Eqn4

INITIAL CONTACT LOADING RESPONSE

HIP: 20⁰ of flexion KNEE: 5⁰ of flexion

ANKLE: Neutral

HIP: 20⁰ of flexion KNEE: 15-20⁰ of flexion

ANKLE: 5⁰ PF

Critical Aspects to Consider: Heel first contact

Critical Aspects to Consider: Stability – trunk and hip, controlled knee flexion and ankle

plantar flexion

MID-STANCE TERMINAL STANCE

HIP: 0⁰ KNEE: 5⁰ of flexion

ANKLE: 5⁰ of DF

HIP: 20⁰ of apparent hyperextension KNEE: 5⁰ of flexion ANKLE: 10⁰ of DF

Critical Aspects to Consider: Limb and trunk stability,

Controlled tibial advancement

Critical Aspects to Consider: Trailinglimb – stretch of hip flexor and PFs, controlled DF with a resultant heel

rise

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PRE-SWING INITIAL SWING

HIP: 10⁰ of apparent hyperextKNEE: 40⁰ of flexion

ANKLE: 15⁰ of PF

HIP: 15⁰ flexionKNEE: 60⁰ flexion

ANKLE: 5⁰ PF

Critical Aspects to Consider: passive knee flexion and ankle PF from release

of stretch on hip flexor and PF

Critical Aspects to Consider: Foot clearance, knee flexion

60⁰

MID-SWING TERMINAL SWING

HIP: 25⁰ flexion KNEE: 25⁰ flexionANKLE: neutral

HIP: 20⁰ flexionKNEE: 5⁰ flexion ANKLE: Neutral

Critical Aspects to Consider: Foot clearance, ankle DF to neutral, hip

to 25, and tibia vertical

Critical Aspects to Consider: knee to neutral, Eccentric control of advancement

Maximum PROM

Required

• Hip• Flexion 30° just prior to Initial Contact• Extension 10-20 ° Terminal Stance

• Knee• Flexion 40-60° Midswing (Hip neutral)• Extension 0° Terminal stance

• Ankle• Flexion 10° DF Midstance to terminal

stance• Extension 20° PF Preswing

• MTP• Extension 60° hyperextension Preswing

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Muscle Activity/power

ECCENTRIC in BLUE CONCENTRIC in RED

Joint Stance Swing

HIPGlut MaxGlut Med

HamstringsIliopsoas

KNEEHamstrings

QuadricepsHamstrings

ANKLEPlantarflexors*Eccentric midstanceConcentric terminal

Anterior TibialisPeroneals

Common Joint Deviations for CVA

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More to Come….

T h is P h o t o b y U n k n o w n A u t h o r is l ic e n s e d u n d e r C C B Y - S A - N C