NPTE Gait

Gait cycle

Begins with heel strike of one extremity and ends with heel strike of the same extremity

= stride

Step

Beginning of event by one lib until beginning of same event with CL limb

How to remember what hip flexor tightness causes in gait: FLOP

hip FLexor tightness = OPposite side step length reduces

ROM required for gait (hip, knee and ankle)

Hip

Stance: 0-30 flexion and 0-10-20 hyperextension

Swing: 20-30

Knee

Stance: 0-40 flexion

Swing: 0-60 flexion

Ankle

Stance: 0-10 DF and 0-20 PF

Swing: 0-10 DF

Muscle activity in gait cycle: Pretibial muscles

mm: Tibialis Anterior, EDL, EHL (Deep peroneal nn. L4-S1)

Prior to and during heel strike:

-Eccentric -> lower foot down

Prior to and during swing:

-Concentric -> DF to clear toes

Muscle activity in gait cycle: Calf Muscles

mm: Soleus, Gastric, FDL, FHL, Tibialis Posterior

(Tibial nn. L4-S3)

Mid stance:

-Eccentric -> control tibia over foot

Heel off:

-Concentric -> PF

Muscle activity in gait cycle: Quadriceps

mm: Vastus medialis/lateralis/intermedius, RF

(Femoral nn. L2-L4)

Before heel strike:

-Eccentric -> control rapid knee flexion to prevent buckling

Pre-swing:

-eccentric -> slow down tibia

Muscle activity in gait cycle: Hamstrings

mm: Biceps, semitendinosus, semimembranosus (Sciatic nn L4-S3)

Heel strike:

-Eccentric -> protects knee from hyperextension

Swing Phase:

-Concentric -> knee flexion, hip extension

Muscle activity in gait cycle: Hip Abductors

mm: Glute med, glute min and TFL

(Superior Gluteal nerve L4-S1)

Stance:

-eccentric -> control pelvis

Muscle activity in gait cycle: Hip Adductors

mm: adductor longus/brevis, gracilis, adductor magnus (obturator nm L2-L4)

Early and late stance:

- Concentric ->stabilize pelvis

Contractures will ____________ (decrease/increase) ROM of the ___________ (opposite/same) motion in gait

Contractures will decreaseROM of the opposite motion in gait

Example: Hip flexion contracture will lead to decreased hip extension and decreased step length on the OPPosite side

Weakness will ____________ (decrease/increase) ROM of the ___________ (opposite/same) motion in gait

Weakness will decrease ROM of the same motion in gait

Example: Weakness of hip flexors will cause decreased hip flexion and decrease step length on the same side

Muscle activity in gait cycle: Glute max

(inferior gluteal nn. L5-S2)

Stance Phase:

-eccentric -> decelerate forward momentum

Pre-swing phase:

-concentric -> hip extension

Muscle activity in gait cycle: Erector Spinae

Heel strike through toe-off:

-maintain trunk posture

Causes for backward trunk lean

Stance Phase:

-Weak hip extensors

-Hip flexion rigid contracture

Swing:

-hip flexor weakness (lean back to fling leg forward and get further)

Muscle activity in gait cycle: Peroneus longus and brevis

(Superficial Peroneal nn L4-S2)

Stance phase:

-concentric -> maintain medial/lateral stability of foot

Muscle activity in gait cycle: Foot intrinsics

(Tibial nn L4-S3)

Stance phase:

-Concentric -> support plantar fascia

Inadequate hip extension caused by

hip flexion contracture = decreased step length on opp side, (+) thomas test and anterior pelvic tilt

Excessive knee extension (hyperextension) is caused by:

-Quad weakness

-Excessive ankle PF: causes shortened stride length and reduced velocity

Substitutions:

1) premature heel of

2) knee hyperextension

3) forward trunk lean

Vaulting is caused by

-leg length discrepancy

-CL prosthesis is too long

-CL foot stuck in PF

Delayed heel of is caused by

-Weak PF

-Excessive DF mobility

-Tibial nerve palsy (loss of PF)

-Anterior foot pain

Early heel off is caused by

-Limited posterior talocrural capsular mobility

-Tight or spastic PF

-Heel pain

Forward trunk lean caused by

-Weak quadriceps