Gait Exam III

How could foot flat contact be associated with excess plantar flexion and excess DF

position of the tibia could be more anterior or posterior than normal on contact

why would quadriceps weakness cause limited knee flexion during weight acceptance but not during single limb advancement

quads are not active during swing limb advancement in normal gait, but during WA would avoid eccentric quad contraction needed

Knee ROM through the phases

0-20-5-0-40-60-25-0

What is TD and MA during initial contact at the knee

TD - extension
MA - quads and hamstrings co-contract

TD and MA during loading response at the knee

TD - extension goes to fleixon
MA - quads eccentrically while hamstrings decline

TD and MA during mid-stance at the knee

TD - flexion goes back to extension
MA - quads concentric until body weight passes, then gastrocsoleus eccentric

max knee extension occurs during what phase

terminal stance

TD and MA during terminal stance at knee

TD - extension
MA - gastrosoleus, biceps femoris short head eccentric

what is the torque demand during pre-swing at the knee and what is it from?

external flexion due to ankle PF interaction torque

Muscle activity during pre-swing at the knee

rectus femoris eccentric

muscle activity at the knee during initial swing

hamstrings, sartorius, gracilis concentric

TD and MA at the knee during mid-swing

external extension (from gravity)
MA - hamstrings eccentrically controlling

TD and MA at the knee during terminal swing

TD: Extension decreases
quads and hamstrings co-contract

Where is GRF relative to the knee in frontal plane? Where does this put the knee? Restricted by what?

medial - puts into adduction
restricted by LCL and lateral capsule

Pt with full knee flexion PROM but lacks 20 degrees of full knee extension, what phases of gait cycle would be impacted?

terminal swing, terminal stance, IC

ROM during stance and swing at the knee in frontal plane

2-3 abduction stance
swing 5 abduction

Functional significance of the knee extension during mid-swing

step length

ROM during stance in transverse plane during IC, early stance, then late stance and swing (knee)

IC - 2-3 LR (locking)
early stance does some medial rotation
late stance/swing back into LR

torque demand in transverse plane during stance at the knee

medial rotation and then into lateral rotation

What is the functional significance of the knee ROM gone through weight acceptance in the transverse plane

shock absorption from unlocking the knee

Limited knee flexion might affect what phases most

loading response, pre-swing, initial swing

Functional significance of limited knee flexion during weight acceptance

loss of shock absorption

What is the functional significance of the limited knee flexion during pre-swing and initial swing

loss of foot clearance

How can ankle spasticity cause limited knee flexion

excess PF spasticity can keep the knee more extended at the tibia on femur

potential causes of limited knee flexion during weight acceptance (5)

quad weakness, knee extensor spasticity, PF spasticity, PFJ pain, decreased proprioception

excess knee flexion likely to affect what phases

stance and terminal swing

What is the functional significance of excess knee flexion during WA and SLS

puts more onto the quads

Functional significance of excess knee flexion during swing

loss of step length/forward progression

PF weakness causing excess knee flexion could affect only what functional activity

SLS (collapse going into mid and terminal stance)

HF contracture during what functional activity could cause excess knee flexion

SLS (can't reach back while extending the knee)

genu recurvatum

hyperextension of the knee

Hyperextension of the knee likely to affect what stages

stance

Functional significance of knee hyperextension

decreased forward progression and shock absorption

Extension thrust (forceful motion of the knee toward extension) affects what stages

LR, mid stance

Weakness at what muscle might cause knee hyperextension? Spasticity of what muscle?

quads - don't want to be put into flexed position for eccentric control

plantar flexion contracture

Functional significance of extension thrust from the knee during WA and SLS

puts less demand on the quads, puts them more onto posterior structures

Weakness at what muscle might cause extension thrust during weight acceptance

quads

Why might compensate with extension thrust for decreased proprioception

provides stability when don't know where the knee is

Excess contralateral flexion affects what part of the reference limb

swing - impairs foot clearance

Excess contralateral flexion will relatively (lengthen/shorten) the reference limb

lengthen

Deviation that could be intended to lower the reference limb to the ground (if it's short)

contralateral knee flexion

Excess lateral vs medial deviation of the distal tibia from the center of the knee....

excess valgus, excess varus

Excess knee valgus affects what stages

stance

What abnormal loading occurs during excess knee valgus

lateral side gets compressed, medial gets lengthened

Excess DYNAMIC knee valgus could be compensation from weakness at what hip muscle and why?

hip abductors, femur goes more inwards

T/F: excess knee valgus can be caused by a structural bony misalignment

true

Pain on what side of the knee joint capsule could cause genu valgum?

medial

How does excess varus cause a change in the GRF?

more medial to the knee so the axis of the knee is further away

Which side of knee joint gets compressed and lengthened in excess knee varus

lengthened lateral, compressed medial

Excess knee varus occurs during which phases

stance

Degenerative joint changes on the medial tibiofemoral joint could cause what knee deviation

excess varus

Hip ROM in the sagittal plane all phases

30f-30f-10f-10E-0-25f-35f-30f

TD and MA (and what type of contraction) during initial contact (hip)

TD into flexion
MA hip extensors eccentric

Thigh is at 0 during which stage of stance

mid-stance (hip in 10 flexion because of APT)

TD and MA during mid-stance at hip

flexion changes to extension
MA: extensor activity diminishes

TD and MA during terminal stance at hip

TD extension
MA TFL anterior fibers restraining hip extension eccentrically

adductor longus and rectus femoris contract during which phase

pre-swing

TD and MA during pre-swing at hip

TD - extension decreases
MA - adductor longus and RF concentric

TD and MA during initial swing at hip

TD neg
MA hip flexors concentric

TD and MA during mid-swing (hip)

TD - flexion due to tibial advancement interaction torque
MA - hamstrings eccentrically controlling

TD and MA during terminal swing (hip)

TD - neg
MA - hamstrings, hip extensors, hip abductors eccentric

What muscles activate during 20-60% of gait cycle in frontal plane at hip

20-50%: hip abductors concentric
50-60%: hip adductors and contralateral abductors eccentric

ROM from 0-20, 20-60, 60-100 in the frontal plane at hip

0-20: adducts 5
20-60 abducts to 5
60-100 adducts back to neutral

GRF and torque during stance in the frontal plane at hip

GRF medial
adduction torque

MA during 0-20% in the frontal plane at the hip

glut med/max and TFL eccentric

What muscles active in the frontal plane during initial swing and terminal swing at hip

ISw: hip flexors and adductors concentric
TSw: abductors eccentric

0-20 in transverse plane: pelvis, femur, and net hip ROM?

pelvis 5 forward
femur MR
Net MR

20-60 in transverse plane: pelvis, femur, and net hip ROM

pelvis 5 backwards
femur LR
net MR

60-100 in transverse plane: pelvis, femur, and net hip ROM

pelvis 5 forward
femur MR
net LR

TD and MA in transverse plane during 0-20% (hip)

TD MR
MA LRs

TD and MA in transverse plane during 20-60% (hip)

TD LR
MA MRs

limited hip flexion could affect what phases

initial contact (30)
loading response (30)
swing phases (25-35-30)

functional significance of limited hip flexion during weight acceptance

lose rockers and interferes with KF and PF

functional significance of limited hip flexion during swing limb advancement

interferes with foot clearance

hip flexor weakness might lead to limited hip flexion in which phase

initial swing (concentric hip flexor activity)

hip extensor weakness might lead to limited hip flexion in which phases

weight acceptance

excess hip flexion likely to impact step length from which phase

terminal stance (10 hip extension)

steppage gait likely to see what at the hip and why

excess flexion to help with clearance

Functional significance of excess adduction during weight acceptance and SLS

decreased stability

scissor gait likely to see what at the hip

excess adduction (close to a tandem pattern)

reference limb abductor weakness would cause excess adduction in which phases

0-20% and 20-50%

excess adduction could be a compensation for weakness of what muscles during swing limb advancement

weak hip flexors (trying to pull the limb forward with the adductors)

excess adduction and abduction can impact what phases

all (minor deviation)

excess abduction has what impact on horizontal displacement and energy demand

increases both

might do excess abduction during swing limb advancement with a long or short reference limb

long

might do excess abduction during stance with a relatively long or short reference limb

short

What is a structural deformity that could lead to excess abd/adduction?

scoliosis

Compensate for limited knee flexion/weak hip flexors with excess abduction during which stage

initial swing

lateral rotation shortens or lengthens the limb

shortens

loose packed position in transverse plane for hip

lateral rotation

How could external rotation of the hip compensate for a PF contracture?

can rotate externally to help with advancing the tibia (similar to excess eversion compensating for a lack of DF)

Compensating for a long reference limb would you medially or laterally rotate the hip to achieve foot clearance?

laterally rotate

Compensating for a short reference limb would you medially or laterally rotate the hip

medially

Excess femoral anteversion might be corrected at the hip with

medial rotation

If quads are weak, what femoral transverse correction could be done? What does this achieve?

medial rotation, locks the knee

How does medial rotation at the hip cause more knee stability?

Increases screw home mechanism (locking the knee)

phases involved with an ipsilateral hip hike

swing phases

ipsilateral pelvic hike could compensate for what at the hip, knee, and ankle

limited HF, KF, and excess PF

Contralateral pelvic drop could be during which phases

stance

stages involved in ipsilateral pelvic drop

all phases (swing primarily)