Tufts DPT Program: Gait Exam Study Guide

When IM>EM

concentric contraction

When EM>IM

eccentric contraction

Initial Contact percentage/traditional name/important features

0% - Heel strike

foot makes intital contact with the ground

Initial Contact: Ankle Sagittal (IM, EM, Compare, angle)

IM: Dorsiflexion (Tibialis Anterior)

EM: Plantarflexion

IM=EM

Angle = 0°

Initial Contact: Knee Sagittal (IM, EM, Compare, angle)

IM: Knee extension (Quads)

EM: Knee Flexion

IM>EM (concentric)

Angle = 5 to 10° flexion

Initial Contact: Hip Sagittal (IM, EM, Compare, angle)

IM: Hip Extension (glute max/med/min)

EM: Flexion moment

IM>EM (concentric)

Angle = 30°

Initial Contact: Ankle (Subtalar) Frontal (IM, EM, Compare, angle)

IM: Inversion (Tibialis posterior)

EM: Eversion

IM=EM

Angle = 2° inversion

Initial Contact: Hip Frontal (IM, EM, Compare, angle)

Neutral

Loading response percentage/traditional name/important features

2-12% - foot flat

eccentric "shock absorption"

Loading Response: Ankle Sagittal (IM, EM, Compare, angle) 2 parts

1.

IM: Dorsiflexion (Tibialis Anterior)

EM: Plantarflexion

IMEM (concentric)

Angle = -8 to 5° Dorsiflexion

Loading Response: Knee Sagittal (IM, EM, Compare, angle)

IM: Knee Extension (quads)

EM: Knee flexion

IM

Loading Response: Hip Sagittal (IM, EM, Compare, angle) 2 parts

1.

IM: Extension moment (glutes)

EM: Flexion Moment

IMEM (concentric)

Angle = 30° flexion

Loading Response: Ankle (Subtalar) Frontal (IM, EM, Compare, angle)

IM: Inversion (Tibialis posterior)

EM: Eversion

IM

Loading Response: Hip Frontal (IM, EM, Compare, angle)

IM: Abduction (Glute medius)

EM: Adduction

IM

Mid Stance percentage/traditional name/important features

12-30% - Same

Trunk passes the ankle (posterior-anterior)

Weight acceptance

Mid Stance: Ankle Sagittal (IM, EM, Compare, angle)

IM: Plantarflexion (Gastroc and soleus)

EM: Dorsiflexion

IM

Mid Stance: Knee Sagittal (IM, EM, Compare, angle)

IM: Knee Extension (quads)

EM: Knee flexion

IM>EM (concentric)

Angle = 5° flexion

Mid Stance: Hip Sagittal (IM, EM, Compare, angle)

IM: Extension moment (glutes)

EM: Flexion Moment

IM>EM (concentric)

Angle = 0° neutral

Mid Stance: Ankle (Subtalar) Frontal (IM, EM, Compare, angle)

IM: Inversion (Tibialis posterior)

EM: Eversion

IM=EM (isometric)

Angle = 2° eversion

Mid Stance: Hip Frontal (IM, EM, Compare, angle)

IM: Abduction (Glute medius)

EM: Adduction

IM>EM (concentric)

Angle = 0° neutral

Terminal Stance percentage/traditional name/important features

30-50%

Heel leaving the ground

Important for forward propulsion. Gastroc and Soleus play an important role.

Terminal Stance: Ankle Sagittal (IM, EM, Compare, angle)

IM: Plantarflexion (Gastroc and soleus)

EM: Dorsiflexion

IM>EM (concentric)

Angle = 10° Dorsiflexion

Propulsion

Terminal Stance: Knee Sagittal (IM, EM, Compare, angle)

IM: Knee Extension (quads)

EM: Knee flexion

IM=EM (stability)

Angle = 5 to 10° flexion

Terminal Stance: Hip Sagittal (IM, EM, Compare, angle)

IM: Extension moment (glutes)

EM: Flexion Moment

IM>EM (concentric)

Angle = 10° extension

Terminal Stance: Ankle (Subtalar) Frontal (IM, EM, Compare, angle)

IM: Inversion (Tibialis posterior)

EM: Eversion

IM>EM (concentric) *supination*

Terminal Stance: Hip Frontal (IM, EM, Compare, angle)

IM: Abduction (Glute medius)

EM: Adduction

IM>EM (concentric)

Angle = 2° abduction

Pre Swing percentage/traditional name/important features

50-60%

Starts at double limb support

Important for getting the reference limb into a "Trailing Limb Posture". This is an important position to begin the sudden change in direction of lower extremity flexion for ealy swing phase of gait.

Pre Swing: Ankle Sagittal (IM, EM, Compare, angle)

IM: Plantarflexion (Gastroc and soleus)

EM: Dorsiflexion

Weight is on opposite limb

Angle = -10° Dorsiflexion

Pre Swing: Knee Sagittal (IM, EM, Compare, angle)

IM: Knee Extension (quads)

EM: Knee flexion

IM

Pre Swing: Hip Sagittal (IM, EM, Compare, angle)

IM: Extension moment (glutes)

EM: Flexion Moment

IM

Pre Swing: Ankle (Subtalar) Frontal (IM, EM, Compare, angle)

IM: Inversion (Tibialis posterior)

EM: Eversion

IM>EM (concentric) *supination*

Angle = 6° inversion

Pre Swing: Hip Frontal (IM, EM, Compare, angle)

IM: Abduction (Glute medius)

EM: Adduction

IM>EM (concentric)

Angle = 5° abduction

Initial Swing percentage/traditional name/important features

60-75%

Important for clearance of the foot through swing limb advancement.

Initial Swing: Ankle Sagittal (IM, EM, Compare, angle)

IM: Dorsiflexion (Tibialis anterior)

EM: Plantarflexion moment

IM>EM (concentric)

Initial Swing: Knee Sagittal (IM, EM, Compare, angle)

IM: Knee Flexion (quads)

EM: Knee Extension

IM>EM (concentric)

Angle = 60° flexion

Initial Swing: Hip Sagittal (IM, EM, Compare, angle)

IM: Hip Flexion (Iliopsoas)

EM: Extension moment

IM>EM (concentric)

Angle = 0-35° Flexion

Initial Swing: Ankle (Subtalar) Frontal (IM, EM, Compare, angle)

IM: Eversion (Fibularis)

EM: Inversion

IM>EM (concentric) *eversion*

Angle = everted

Initial Swing: Hip Frontal (IM, EM, Compare, angle)

*Same as Mid Swing*

IM: Adduction (Hip Adductors)

EM: Abduction

IM>EM (concentric)

What you need to know:

During initial and mid-swing, we see the hip adduct from 5 deg abduction, back to neutral at terminal swing. At the same time throughout swing, the hip is moving into internal rotation, and back into external rotation slightly. This is controlled via the hip adductors (which also contribute to hip flexion and adduction).

Mid Swing percentage/traditional name/important features

75-87%

Begins when the foot is next to the opposite limb, and the knee begins to extend while the hip is flexed.

Important for clearance of the foot through swing limb advancement.

Mid Swing: Ankle Sagittal (IM, EM, Compare, angle)

IM: Dorsiflexion (Tibialis anterior)

EM: Plantarflexion moment

IM>EM (concentric)

20° Dorsiflexion

Mid Swing: Knee Sagittal (IM, EM, Compare, angle)

IM: Knee Extension (quads)

EM: Knee Flexion

IM>EM (concentric)

60 into 10° Flexion

*Hamstrings eccentric to slow down the knee*

Mid Swing: Hip Sagittal (IM, EM, Compare, angle)

IM: Hip Flexion (Iliopsoas)

EM: Extension moment

IM>EM (concentric)

Angle = Maintains 35° Flexion

Mid Swing: Ankle (Subtalar) Frontal (IM, EM, Compare, angle)

IM: Eversion (Fibularis)

EM: Inversion

IM>EM (concentric) *eversion*

Angle = everted

Mid Swing: Hip Frontal (IM, EM, Compare, angle)

*Same as Initial Swing*

IM: Adduction (Hip Adductors)

EM: Abduction

IM>EM (concentric)

What you need to know:

During initial and mid-swing, we see the hip adduct from 5 deg abduction, back to neutral at terminal swing. At the same time throughout swing, the hip is moving into internal rotation, and back into external rotation slightly. This is controlled via the hip adductors (which also contribute to hip flexion and adduction)

Terminal Swing percentage/traditional name/important features

87-100%

The last phase of swing in which the hip initially is flexed, and the knee is extended, allowing for the foot to be in front, ready to obtain the forward placed foot for initial contact, to begin the next gait cycle. Just prior to initial contact, the hip extends, lowering the foot into place for initial contact.

Important for preparing the foot to be placed in front for the next cycle of gait.

Terminal Swing: Ankle Sagittal (IM, EM, Compare, angle)

IM: Dorsiflexion (Tibialis anterior)

EM: Plantarflexion moment

IM>EM (concentric)

20° Dorsiflexion

Terminal Swing: Knee Sagittal (IM, EM, Compare, angle)

IM: Knee Extension (quads)

EM: Knee Flexion

IM>EM (concentric)

5 - 10° Flexion

*Hamstrings eccentric to slow down the knee*

Terminal Swing: Hip Sagittal (IM, EM, Compare, angle)

IM: Extension moment (glutes)

EM: Extension moment

Minimal eccentric contraction of hip flexors

Angle = 30° Flexion

Terminal: Ankle (Subtalar) Frontal (IM, EM, Compare, angle)

IM: Eversion (Fibularis)

EM: Inversion

IM>EM (concentric) *eversion*

Angle = everted

Terminal: Hip Frontal (IM, EM, Compare, angle)

IM: Adduction (adductors)

EM: Abduction

IM

All of Stance: Arm and Trunk

During stance phase of the gait cycle, the arm moves forward, in the same direction as the opposite swing limb. The pelvis moves in a downward and back motion, also known as retraction of the pelvis. This is a triplanar motion.

All of Swing: Arm and Trunk

During swing phase of the gait cycle, the arm swings back. The pelvis moves forward and upwards during swing phase. This motion is also called protraction of the pelvis. This is a triplanar motion.