CHAPTER

48
Characteristics of Normal Gait and Factors Influencing It
THE GAIT CYCLE, THE BASIC UNIT OF GAIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .854 KINEMATICS OF LOCOMOTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .856 Temporal and Distance Parameters of a Stride . . . . . . . . . . . . . . . . . . . . . . . . . . . .856 Angular Displacements of Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .857 MUSCLE ACTIVITY DURING LOCOMOTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .861 KINETICS OF LOCOMOTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .863 Joint Moments and Reaction Forces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .863 Energetics of Gait: Power, Work, and Mechanical Energy . . . . . . . . . . . . . . . . . . .869 FACTORS THAT INFLUENCE PARAMETERS OF GAIT . . . . . . . . . . . . . . . . . . . . . . . . . . .872 Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .872 Walking Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .872 Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .872 SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .873

Habitual bipedal locomotion is a uniquely human function and influences an individual’s participation and interaction in society. Impairments in gait are frequent complaints of persons seeking rehabilitation services and are often the focus of an individual’s goals of treatment. Rehabilitation experts require a firm understanding of the basic mechanics of normal locomotion to determine the links between impairments of discrete segments of the musculoskeletal system and the patient’s abnormal movement patterns in gait. Therapists and other rehabilitation experts are called upon daily to analyze a patient’s movement and determine the cause of the abnormal, often painful, motion. A thorough understanding of normal locomotion and the factors that influence it, as well as an understanding of the functions of the components of the musculoskeletal system, provides a framework for evaluation and treatment of locomotor dysfunctions. This chapter describes the general characteristics of normal locomotion and introduces the clinician to the basic concepts central to all movement analysis. Normal human locomotion consists of stereotypical movement patterns that are immediately recognizable. Yet most individuals also are able to distinguish the gait of close friends and associates by the sound of their footsteps in the hallway. The purpose of this chapter is to describe the common characteristics of normal human locomotion and their variability and to provide insight into how impairments within the musculoskeletal

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Part V | POSTURE AND GAIT

system may be manifested in altered gait patterns. The specific objectives of this chapter are to
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Describe the basic components of the gait cycle Present the temporal and distance characteristics of normal gait Detail the angular displacement patterns of the joints of the lower extremity, the trunk, and the upper extremities Describe the patterns of muscle activity that characterize normal locomotion Briefly discuss the methods for determining muscle and joint loads sustained during normal locomotion and present the findings from representative literature Briefly consider the energetics of normal locomotion and the implications of gait abnormalities on the efficiency of gait

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Gait has been studied for millennia, and the last 50 years have seen an explosion in the research examining the characteristics of gait and the factors that control it. The current chapter is, of necessity, an overview of the characteristics of locomotion that are useful to a clinician and that demonstrate the effect of the integrity of the musculoskeletal system on gait. Several textbooks dealing only with locomotion provide details regarding the movement and methods of its assessment, and insight into the central nervous system’s role in controlling and modifying the movement of gait [28,119,127,159].

THE GAIT CYCLE, THE BASIC UNIT OF GAIT
Gait is a cyclical movement that, once begun, possesses very repeatable events that continue repetitively until the individual begins to stop the motion. The steady-state movement of normal locomotion is composed of a basic repeating cycle, the gait cycle (Fig. 48.1). The cycle is traditionally defined as

the movement pattern beginning and ending with ground contact of the same foot. For example, using the right foot as the reference foot, the gait cycle begins when the right foot contacts the ground (usually with the heel) and ends when it contacts the ground again. Thus a gait cycle consists of the time the reference foot is on the ground (stance) and the time it is off the ground (swing). The movement of both limbs that occurs during the gait cycle is known as the stride.

Double support

Single support

Double support

Single support

Right step Stance

Left step Swing Stride

Figure 48.1: The gait cycle of a single lower extremity consists of a stance and swing period and lasts from ground contact of one foot to the subsequent ground contact of the same foot. It includes two steps that are defined as the period from ground contact of one foot to the ground contact of the opposite foot. A single gait cycle includes two periods of double limb support and two periods of single limb support.

and in the loads applied to each limb [51. heel off. in muscle activity. 48.158]. Heel off ends trunk glide at approximately 40% of the gait cycle and begins terminal stance. the stance and swing phases contribute to that goal in different ways. Thus the gait cycle is characterized by two brief periods. It is important to recognize that loading response includes double limb support and continues into single limb support. Differences exist in timing and movement patterns. 48. CGC. when the swing limb extends toward the ground. and late swing. Late. FF. The final stage of stance. absorbing the shock of impact between the limb and the ground. foot flat. swing finds the swing limb reaching toward the ground. The stance phase has three tasks in locomotion: providing adequate support to avoid a fall. The stance phase can be divided into smaller periods associated with specific functional demands and identified by distinct events (Fig. The stance phase of gait makes up approximately 60% of the gait cycle. when the limb is pulled away from the ground. The swing phase also is divided into early. also known as trunk glide. GC.3).Chapter 48 | CHARACTERISTICS OF NORMAL GAIT AND FACTORS INFLUENCING IT 855 GC 0% FF 15% HO 40% CGC 50% TO 60% Figure 48. toe off. and late periods.3: The swing phase is divided into early swing. as the swing limb passes the stance limb. At contact on the right. the limb absorbs the shock of impact and becomes fully loaded. and ends when the whole foot flattens on the ground. moving from behind the stance foot to in front of it. which ends at 50% of the gait cycle when contralateral ground contact occurs. the right and left limb movements are not mirror images of one another. Midswing continues until approximately 85% of the gait cycle and consists of the period in which the swing limb passes the stance 60-75% Early swing 75-85% Mid swing 85-100% Late swing Figure 48. The gait cycle with respect to the right limb is slightly out of phase with the gait cycle of the left limb. It ends with toe off. The period following loading response is midstance. contralateral ground contact. clinicians must remember that small asymmetries in gait are normal. returning to the ground at approximately 50% of the gait cycle of the right limb. although it lacks distinctive events to delineate these phases (Fig. Early swing continues from 60% to approximately 75% of the gait cycle and is characterized by the rapid withdrawal of the limb from the ground. the left limb is just ending its stance phase. since during this period the trunk glides over the fixed foot. Consideration of the basic functional tasks of the swing and stance phase of gait provides a framework for characterizing the movements in each phase of gait. ground contact. At approximately 10% of the gait cycle on the right. and the remaining cycle consists of single limb support. each lasting approximately 10% of the gait cycle. from 50 to 60% of the gait cycle. or terminal. and providing adequate forward and backward force for forward progress [35. During contact response. Although normal gait is often assumed to be symmetrical. midswing.59]. Although the differences are small among ambulators without pathology.130]. The period immediately following ground contact is known as contact response. is preswing and is characterized by double limb support. The foot flat event that ends contact response occurs at approximately 15% of the normal gait cycle.2: The stance phase is divided into smaller phases that are demarcated by specific events. HO. middle. substantial evidence exists to refute that assumption [13. When evaluating the gait patterns of individuals with asymmetrical impairments. or weight acceptance. preparing for contact. 93.2) [121]. limb. While the overriding goal of locomotion is forward progression. The basic tasks of the swing phase are safe limb clearance. so that the remaining 40% consists of the swing phase.61. in which both limbs are in contact with the ground. the left limb leaves the ground and begins its swing phase. appropriate limb . These are periods of double limb support. TO.

These measures can be normalized by standing height or lower extremity length to compare values from different individuals [27. kinematics describes a movement in terms of displacement. height.107.5 cm [91.74.0 3. the clinician can understand the importance of discrete movements of limb segments or the specific sequencing of muscle activity and can begin to appreciate the significance of specific joint impairments.109. speed. Presented first is a description of the movement characteristics of the stride as a whole followed by descriptions of discrete movement patterns of individual joints. and acceleration.4: Several distance measures help describe a typical gait cycle. and transfer of momentum.01 to 0.152].104] Angle between the long axis of the foot and the line of forward progression Range of Values Reported in the Literature 1.91. Walking speed and age have large and important effects on gait and are discussed later in this chapter. velocity. . KINEMATICS OF LOCOMOTION As noted in Chapter 1. pain.22 to 9. Step width Stride length Foot angle Step length Figure 48.74 0.1 5. so measures of absolute step or stride length. 48. Unless noted otherwise. Many factors affect the kinematic characteristics of gait.81 [57.109. and although velocity and acceleration data are available and may provide useful information. Despite this normal variability.109.4).91. Stride and step lengths depend directly upon standing height.137. this chapter reviews the more commonly cited displacement data. the data reported come from trials in which the subjects walk at their self-selected.05 m Step width (also known as base of support)a Foot angle a 0. although frequently reported.107. By keeping these tasks in mind.70 0.89.61 0. The vast majority of kinematic analyses of gait examines displacement characteristics. Step width TABLE 48. strength and flexibility.1.74. Temporal and Distance Parameters of a Stride A stride consists of the movement of both limbs during a gait cycle and contains two steps. report a mean step length of 0. Judge et al.89. or free. including walking speed.63 0. comfortable. A representative range of values also is presented from the literature [57. weight or body mass index.33 0. these parameters are capable of distinguishing between individuals with and without impairments [75. Estimates of normalized stride length vary from approximately 60 to 110% of standing height [27]. and aerobic conditioning. A step is operationally defined as the movement of a single limb from ground contact of one limb to ground contact of the opposite limb (Fig.856 Part V | POSTURE AND GAIT placement for the next contact.8 5.1 Parameter Stride length Step length Distance Parameters of Stride in Young Healthy Adults Definition The distance between ground contact of one foot and the subsequent ground contact of the same foot The distance between ground contact of one foot and the subsequent ground contact of the opposite foot The perpendicular distance between similar points on both feet measured during two consecutive steps [25. Some measures incorporate the angle of the foot on the ground. age.116] 0.146] 5.11 m [57. DISTANCE CHARACTERISTICS OF THE STRIDE The typical distance parameters of gait are defined in Table 48.116].7 to 6. The literature demonstrates that there is considerable difference in step and stride characteristics among subjects and even among trials of the same subject [50].04 of leg length in young healthy adults [73].137] 0.107.09 to 1.6 [91] Step width is defined variably in the literature. are difficult to interpret.107.73].

39.106.60 0. Many gait disorders lead to altered time and distance parameters.74.to late 19th century allowed the systematic observation of discrete movements of each joint during the complex activity of normal locomotion [5]. The smaller excursions in the frontal and transverse planes are particularly sensitive to differences in measurement procedure. at least in part because sagittal plane motions are the largest and easiest to measure. The ratio between swing and stance time increases toward 1 with increasing walking speed.03 0.109.and intersubject variability in all planes.141 [91. even though such differences often are easily detected by an observer. sensitive to change. can help the clinician to identify the differences in gait patterns between individuals with similar temporal and distance characteristics. Healthy Adults Definition Time in seconds from ground contact of one foot to ground contact of the same foot Distance/time.82–1.91. Despite the variability in magnitudes of the movements. On the other hand.106].07 to 0. and walking speed is between 3 and 4 miles per hour.03 to 0.107] Not reported 0.64 [74.116] 0. Patterns of joint excursions.74.00 0.109. 89. For example. As stance time decreases with less change in swing time.57. but the decrease in cycle duration results in a greater decrease in stance time than in swing time [6.04 and foot angle are less frequently reported but provide an indication of the size of the base of support. The sagittal plane motions of the joints of the lower extremity are the most thoroughly studied and best understood.07 Speed (also known as velocity) Cadence Stance time Swing time Swing/stance ratio Double support time Single support time 0. altered swing and stance times with abnormal swing–stance ratios. a patient with unilateral hip pain and a patient with hemiparesis secondary to a stroke both walk with decreased velocity.137.12 [91.40.23 to 1.Chapter 48 | CHARACTERISTICS OF NORMAL GAIT AND FACTORS INFLUENCING IT 857 TABLE 48.74].89.2 Parameter Stride time Temporal Parameters of Stride in Young.109] 0. Such measures are relatively easy to obtain in the clinic and serve as useful outcome measures.39 0.63–0.109. in the case of unilateral disorders.106. the patterns . Walking speed affects swing and stance time differently. many different disorders produce similar temporal and distance characteristics.73.106. and both demonstrate decreased single limb support time on the affected side and increased double limb support time [106]. Angular Displacements of Joints The growth of photography in the mid.40 [91. double limb support time decreases. TEMPORAL CHARACTERISTICS OF THE STRIDE The temporal characteristics of the stride are defined in Table 48.137] 100–131 [27. Joint displacement data reveal intra. Over the last 50 years improved photographic techniques and the development of the computer have led to ever more precise monitoring of the three-dimensional motion of individual segments.107.107.55. although this is typically computed over several strides. Thus temporal and distance parameters may be helpful in tracking a patient’s progress but are insufficient to characterize a gait pattern fully and to identify the mechanisms driving the movement pattern.109] 0.107. which accounts for some of the increased variability of these motions [67].73. and single limb support time increases. frontal and transverse plane motions of the joints of the lower extremities and the three-dimensional motions of the upper extremities and trunk are less frequently studied. typically decreased speed and stride length and.47.137] 0.109] 0. The normal gait cycle at free speed lasts approximately 1 second. usually reported in m/sec Steps per minute Time in seconds that the reference foot is on the ground during a gait cycle Time in seconds that the reference foot is off the ground during a gait cycle Ratio between the swing time and the stance time Time in seconds during the gait cycle that two feet are in contact with the ground Time in seconds during the gait cycle that one foot is in contact with the ground Values from the Literature 1.53]. Increased walking speed decreases the overall duration of the gait cycle.16 [47.67 [91. These parameters distinguish between normal gait and abnormal walking patterns but are unlikely to identify the differences in gait patterns between the two patients.04 0.63 0. however.116. The difference between running and walking is the absence of a double limb support phase in running.02 to 0. In contrast.106. An increase in either cadence or step length contributes to increased walking speed [6.2 [40. or gait velocity. Included in this list is walking speed. although the variability is greater in the frontal and transverse planes than in the sagittal plane and across subjects than between cycles of a single individual [14.54.152].91. Walking speed is a function of both cadence (steps/minute) and step length.47.11 0.

106].31.) . when contralateral ground contact occurs [80.5).107. reaching maximum flexion late in swing. As noted in Chapter 38. reaching maximum hip hyperextension (approximately 10 ) at close to 50% of the gait cycle. The hip exhibits a single cycle of motion.109.87. albeit usually a few degrees short of maximum extension. SAGITTAL PLANE MOTIONS The classic studies by Murray remain the foundation for understanding sagittal plane motion of the lower extremity [106.and intersubject variability.159]. The cycle repeats at ground contact. the reader is cautioned that the pattern of motion is the focus of the following discussion rather than the specific magnitudes [43. landing in extension. a normal hip exhibits little or no hyperextension range of motion. C Figure 48. Values of peak excursion are mentioned to provide an image of the motion rather than to define an absolute norm. 48. although there is variation in the reported maximal joint positions. The knee exhibits a slightly more complex movement pattern. The knee flexes Ex1 0 20 40 60 80 Percent of walking cycle Ex2 100 B Rotation (degrees) Extension Flexion 40 60 80 100 120 Hip Fl1 Fl Ex 0 25 50 75 Percent of walking cycle 100 Figure 48.110] (Fig.159]. Beginning at ground contact. and hip (Reprinted with permission from Murray MP: Gait as a total pattern of movement. Am J Phys Med 1967. Consequently. the hyperextension reported at the hip during locomotion is the result of pelvic motions in the transverse and sagittal planes.6: In most locomotion studies the hip excursion is described as the angle between the length of the thigh and a room-fixed coordinate system.6. The magnitude of apparent hip hyperextension excursion depends on the point of reference. the hip is in maximum flexion (approximately 25 ) and gradually extends. After reaching maximum extension.5: Sagittal plane excursions of the ankle. at ground contact. More-recent studies confirm Rotation (degrees) Extension Flexion Ankle 70 90 110 130 0 Ex1 20 Fl1 Fl2 Ex2 60 80 40 Percent of walking cycle 100 A Rotation (degrees) Extension Flexion 80 60 40 20 0 -20 Knee Fl2 Fl1 the overall patterns of motion for the hip. the reported hip hyperextension reflects the orientation of the thigh with the trunk or with the roomfixed reference frame as seen in Fig.858 Part V | POSTURE AND GAIT and sequencing of joint movements in gait are remarkably consistent across trials and across subjects [12. knee. 48.106. and ankle.74.32. 46: 290–333. the hip begins flexing again. knee. In most studies. Because studies demonstrate both intra. at 80–85% of the gait cycle.

Such obligatory movements interfere with the normal timing and sequencing of joint movements in gait. reaching a maximum at about 5% of the gait cycle.7). the hip tends to extend. A common impairment found in patients following stroke is an inability to disassociate movements. to flex the knee. and the ankle reaches maximum plantarflexion of approximately 20 just following toe off.Chapter 48 | CHARACTERISTICS OF NORMAL GAIT AND FACTORS INFLUENCING IT 859 10 to 20 immediately after contact. and the knee reaches maximum knee extension just before ground contact [20. At free walking speed. Just following toe off. .106. For example. reaching a maximum just after the knee reaches full extension. and foot (C) are much smaller than sagittal plane excursions but show characteristic patterns of movement. producing a foreshortened step and an abnormal foot position at ground contact.88.147. Knee extension resumes. Pelvic motions in the sagittal plane are small.129]. At foot flat the knee begins to extend and reaches maximum extension at about 40% of the gait cycle as the heel rises from the ground. and as a result. knee.151]. However.110.7: Frontal plane excursions of the hip (A). At this time. and ankle reveal that only for a very brief instant following toe off are these three joints moving in the same direction with respect to the ground. 48. As the body glides over the stance foot. knee (B). the ankle dorsiflexes slightly but may remain in slight plantarflexion throughout swing. a patient is compelled to move all three joints of the lower extremity together in the same direction.80. Upper extremity sagittal plane motion also shows a rhythmic oscillation that is related to the movement of the lower extremities. Ground contact occurs with the ankle close to neutral in either slight plantarflexion or slight dorsiflexion [80. Ankle motion also exhibits several reversals in direction. all three joints are pulling the foot away from the ground. Following contact.145. and the ankle is dorsiflexing. The anterior pelvic tilt contributes to the apparent hip hyperextension that occurs in late stance. with no consistent definition of neutral. The hip lies close to neutral abduction at ground contact and then adducts during weight acceptance as the pelvis drops on the contralateral side Joint angle (degrees) 40 Add 30 20 10 0 -10 Abd -20 20 40 60 Gait cycle (%) 80 100 A 45 Add 30 15 0 Abd -15 20 Joint angle (degrees) B Sup Subtalar rotation 40 Gait cycle (%) 60 80 100 Toe off 10° Heel contact 10° Pro 0 20 C 40 60 80 Percent of walking cycle 100 Figure 48. For instance.154]. as the patient extends the knee toward the ground. the hip and knee are flexing. the ankle dorsiflexes. CLINICAL RELEVANCE: ASSOCIATED MOVEMENTS IN AN INDIVIDUAL FOLLOWING STROKE Close examination of the sagittal plane motions of the hip. flexion of the shoulder and elbow parallel flexion of the opposite hip [106. A flexion pattern produces similar conflicts as the hip begins to flex in terminal stance. reaching maximum flexion at about 15% of the gait cycle when the subject achieves foot flat. Hip position in the frontal plane is affected by the motion of the pelvis over the femur and by the orientation of the femur as the subject translates toward the opposite foot to keep the center of mass over the base of support. A flexion pattern stops the ankle plantarflexion and interferes with the normal roll off of late stance. Flexion of the knee begins again and reaches a maximum of approximately 70 in midswing (approximately 75% of the gait cycle). the ankle plantarflexes an additional 5 or 10 . Ankle plantarflexion resumes. FRONTAL PLANE MOTIONS Frontal plane excursions are less well studied and more varied than sagittal plane movements (Fig.87. so that one or two joints move the foot toward the ground as the other(s) pull it away from the ground.109. At other points in the gait cycle the joints move independently. In swing. the hip and knee should be flexing while the ankle continues to plantarflex.106]. and the ankle plantarflex. studies suggest that the pelvis anteriorly tilts whenever either hip is extending [107. in late swing. the patient may flex the knee and hip and dorsiflex the ankle simultaneously in a flexion pattern or extend the knee while simultaneously extending the hip and plantarflexing the ankle in an extension pattern.

Transverse plane rotations of the hip are a function of the transverse plane motion of the pelvis as well as the transverse plane motion of the femur (Fig. Joint angle (degrees) [8. et al.) . Wootten ME. the pelvis drops on the side in late stance. the hip drops on the unsupported side.9: During weight acceptance.11). kinetic.88].74.: Repeatability of kinematic. data consistently demonstrate a motion pattern characterized by eversion. Adduction is amplified as the subject shifts toward the stance side to keep the center of mass over the foot.164].845 30 15 0 20 A 0 40 60 Gait cycle (%) 80 100 Knee Rotation -10 CMC (w) = 0.164].101.861 -20 Ext -30 20 B 40 60 Gait cycle (%) 80 100 Figure 48. The stance hip is in adduction. so that the pelvis rotates forward on the side of the flexing hip. consistent with pronation. Figure 48. Frontal plane motion of the foot recorded during walking reflects the inversion and eversion component of supination and pronation of the foot. Ramakrishnan HK. and electromyographic data in normal adult gait.8). At that instance.10). the individual shifts laterally to keep the center of mass close to the stance foot. 48. following ground contact and continuing until mid to late stance when the hindfoot begins inverting or supinating [26.9).10: Transverse plane motions of the hip and knee. peaking in early swing [8. Reported knee motion in the frontal plane is slight. TRANSVERSE PLANE MOTIONS Transverse plane motions of the limbs and trunk also demonstrate more variability and smaller excursions than those seen in the sagittal plane (Fig. Adduction continues until late stance. Although the position of the hindfoot at ground contact is variable and the magnitude of the reported excursions differs among reports. (Reprinted with permission from Kadaba MP. although forefoot pronation during stance begins after hindfoot pronation has begun [66. when loading begins on the opposite limb.70.71. 48. and the hip moves into abduction (Fig. which is abducted.941 CMC (b) = 0.20. and the pelvis drops on the unsupported side. 48.74.8: At weight acceptance. Forefoot motion is similar to hindfoot motion.123.882 CMC (b) = 0.147] (Fig. 48. 7: 849–860. reaching maximum forward rotation Int 45 Joint angle (degrees) Hip Rotation CMC (w) = 0.860 Part V | POSTURE AND GAIT Figure 48. Pelvic rotation in the transverse plane accompanies hip flexion. with estimates ranging from approximately 2 to 10 of adduction. J Orthop Res 1989.

In the transverse plane.145. medial rotation from ground contact to mid.71. but the forward alignment of the pelvis contributes to lateral rotation of the hip. particularly during stance. and trunk rotation moves out of phase with the pelvis. At the same time. At ground contact the femur is medially rotating. the femur is aligned close to neutral but rotates medially from contact to midstance. and the relative backward position of the pelvis on that side allows the hip to appear hyperextended. the rotation of the trunk is opposite the rotation of the pelvis.74. So the trunk leans slightly to the stance limb at each step [85. the opposite hip is in maximum extension. MOTIONS OF THE TRUNK Studies of the head and trunk reveal that these segments undergo systematic translation and rotation in three dimensions and exhibit both intrasubject and intersubject variability [85. At heel off the opposite is true.147].88. The transverse plane alignment of the pelvis on the extended hip tends to medially rotate the extended hip. This coupled motion assists in shock absorption during loading response [122]. Frontal plane motion of the trunk is consistent with the need to keep the center of mass over the stance foot. there is good consistency regarding the direction of the hip motion. the foot supinates as the tibia rotates laterally. 48. is more erect or extended during single limb support.12). Later in stance. and the knee extends while the body rolls forward onto the opposite limb. the pattern becomes smoother and more stable. The trunk exhibits slight flexion and extension during the gait cycle.114.Chapter 48 | CHARACTERISTICS OF NORMAL GAIT AND FACTORS INFLUENCING IT 861 there is more disagreement about knee motion in swing [8.106. the duration of large bursts of activity for most muscles is quite brief.145].85]. The knee.150]. As the foot pronates. These data also .147]. Figure 48. Hip joint position is the sum of the pelvic contribution and the femoral contribution to joint position.20. MUSCLE ACTIVITY DURING LOCOMOTION Studies that examine the electrical activity of muscles during locomotion have played a central role in defining the role of muscles in producing and controlling locomotion. when the lower extremity functions in a closed chain. and most of these bursts occur at the transitions between swing and stance or between stance and swing.145. with the trunk rotating forward on the side in which the shoulder is flexing [85. The coupling motion of the trunk and pelvis contributes to the efficiency and stability of gait. Although there is disagreement about the hip position at ground contact among the reported data. These data reveal important principles regarding muscle activity during gait. Forward rotation of the pelvis contributes to lateral rotation of the hip. Independent femoral movement provides its own contribution to hip position. At ground contact.74. As the child matures. may lose gait efficiency and require more energy to walk.150].106].or late stance and then lateral rotation until late swing or ground contact [70. Data from Winter and Yack [163] demonstrate the normalized electromyographic (EMG) data for 16 muscles recorded in up to 19 subjects (Fig.114. and is more flexed during double limb support [29. such as patients with Parkinson’s syndrome or patients with low back pain. Lateral femoral rotation then begins and continues into mid swing when medial rotation resumes.106.11: The pelvic position in the transverse plane and the femoral rotation in the transverse plane both contribute to the transverse plane hip joint position during the gait cycle. exhibits transverse plane motion with medial rotation following ground contact and gradual lateral rotation from midstance through most of swing. the tibia medially rotates and allows the knee to flex. although CLINICAL RELEVANCE: THE TRUNK’S CONTRIBUTION TO SMOOTH GAIT The gait pattern of a toddler learning to walk is characterized by large lateral leans with little forward rotation of the trunk and shoulders [9]. First. Patients who lack the ability to rotate the trunk separately from the pelvis. at approximately ground contact [74. Transverse plane motion of the knee is linked to the motion of the foot and to the sagittal plane motion of the knee. too.

67: 402–411.41. and dorsiflexors. exerting a deceleration force on the hip and knee at the end of swing. certain consistent functions for specific muscle groups emerge from the EMG data [10. Studies also demonstrate variability within a single individual. so the actual change in muscle fiber length may be small [49]. Their activity also helps to initiate hip extension during early stance. For example. and the quadriceps activity is essential in controlling this movement. Muscle activity at the knee is characterized by cocontraction of the hamstrings and quadriceps for approximately the first 25% of the gait cycle. quadriceps. The overall length change in the hamstrings during loading response may be negligible.68. Review of the muscle activity of these large muscle groups demonstrates that much of the activity is characterized by an eccentric contraction followed by a concentric contraction. controlling the descent of the foot onto the ground.6 500 400 300 200 100 0 Vastus lateralis N = 15 CV = 44% MEAN = 61. hip flexors. Most of swing proceeds with no muscle activity at the knee joint.862 500 400 300 200 100 0 400 300 200 100 0 300 200 100 0 Medial hamstrings N = 11 CV = 60% MEAN = 64.5 Sartorius N = 15 CV = 54% MEAN = 25.0 300 200 100 0 300 200 100 0 300 200 100 0 0 Adductor magnus N = 11 CV = 55% MEAN = 42. The same pattern is found in the gluteus medius. the gluteus maximus contracts eccentrically as the hip flexes late in swing and then contracts concentrically as the hip begins to extend.118. although at least some of the change in length is a passive stretch and shortening in the tendo calcaneus (Achilles tendon).68.81.163].5 400 300 200 100 0 Rectus femoris N = 16 CV = 46% MEAN = 25. or hamstrings at the transition from stance to swing.103. The gluteus maximus and hamstrings are active prior to and following ground contact.6 Erector spinae 400 300 200 100 0 600 400 200 0 500 400 300 200 100 0 0 Gluteus maximus N = 16 CV = 58% MEAN = 16.5 Lateral hamstrings N = 17 CV = 59% MEAN = 52.74. Electroencephalogr Clin Neurophysiol 1987. During this period.112]. the knee is flexing and then extending.0 20 40 60 % of Stride 80 100 0 20 40 60 % of Stride 80 100 B Figure 48. until loading begins on the opposite side.) demonstrate the considerable variability in muscle activity across individuals.7 400 300 200 100 0 400 300 200 100 0 Lateral gastrocnemius N = 10 CV = 57% MEAN = 79. The gluteus medius contracts just before ground contact and continues its activity through most of stance. since at loading response the hip is extending while the knee is flexing. with the greatest burst of activity from heel off to toe off as the body rolls over the plantarflexing foot. The activity of the hip abductors provides essential frontal plane stability to the pelvis. Despite the variability of muscle activity. but their subsequent length is more difficult to discern. Yack HJ: EMG profiles during normal human walking: stride-to-stride and inter-subject variability. The hip flexors contract in late stance and continue their activity into early swing to slow hip extension and initiate hip flexion. during loading response and early midstance. The plantarflexors also exhibit lengthening and then shortening.0 Part V | POSTURE AND GAIT Gluteus medius N = 17 CV = 42% MEAN = 30. Some individuals exhibit activity of either the quadriceps. The ankle also exhibits co-contraction of the dorsiflexor and plantarflexor muscles. The lengthening contractions that begin many EMG normalized to mean X 100% EMG normalized to mean X 100% .4 400 300 200 100 0 Peroneus longus N = 11 CV = 57% MEAN = 54.9 N = 11 CV = 38% MEAN = 37.4 Soleus N = 18 CV = 31% MEAN = 113 Extensor digitorum longus N = 12 CV = 35% MEAN = 98.12: Electrical activity of lower extremity muscles during gait.155].2 Tibialis anterior N = 12 CV = 28% MEAN = 135. The hamstrings also begin their activity with an eccentric contraction in late swing. (Reprinted with permission from Winter DA.5 A 300 200 100 0 20 40 60 % of Stride 80 100 0 20 40 60 % of Stride 80 100 Adductor longus N = 11 CV = 51% MEAN = 33. The plantarflexor muscles gradually increase their activity from ground contact through most of stance.74. The activity continues at ground contact and through the loading response. especially the rectus femoris. Dorsiflexors of the ankle exhibit slight activity throughout swing to hold the foot away from the ground. but this activity is both variable and smaller in magnitude than the activity at the beginning of stance [7.9 300 200 100 0 Medial gastrocnemius N = 11 CV = 61% MEAN = 113. although there is less than across individuals [23.138.

It is worth noting that at most joints. Similarly. the motion occurring during the concentric contraction continues after the contraction ceases. As a result. DYNAMIC EQUILIBRIUM Researchers and clinicians have long been interested in the forces sustained by the muscles and joints during normal and abnormal locomotion [15. and MX MZ FX FZ I I maX.1) In three-dimensional analysis. the forces applied across joints. as demonstrated in examples throughout this textbook [37]. limb segments where Fi is the force in the ith direction. in the case of locomotion. mai and I I. and the hip flexes after cessation of hip flexor activity. In addition.134]. the assumption used in static equilibrium analysis. For example.144]. the following conditions must be satisfied: FX M maX. Z FY maY. (Equation 48. these tables provide means to calculate moments of inertia of a limb or limb segment from easily obtained anthropometric measurements. I FY maY. states that the unbalanced force on a body is directly proportional to the acceleration of that body. Elite gymnasts tend to possess short and compact bodies (smaller moments of inertia) that allow high angular accelerations producing rapid rotations about horizontal bars and in tumbling routines. A discussion of the kinetics of gait allows consideration of the efficiency of gait. (Equation 48. are known as inertial forces and are intuitively explained by the awareness that it takes more force to push a car to start or stop its rolling than it takes to keep the car rolling. How motion continues in the absence of active muscle contraction is related to the kinetics of the movement. or push. gait consists of complex cyclical movements occurring in a coordinated sequence that is controlled by muscle activity. that acceleration is negligible. However. The larger the mass and the farther the mass is from the body’s center of mass. includes the moments generated by the muscles. in the opposite direction. and then the subsequent concentric contractions begin the joint’s forward movement. is not valid when applied to gait. and joints exhibit large angular accelerations. the properties of mass and moment of inertia can be estimated and entered into the equations of motion to allow solutions. also known as equations of motion. Mi is the moment about the ith axis.96. the hip continues to extend long after the peak activity of the gluteus maximus and hamstrings. F ma.Chapter 48 | CHARACTERISTICS OF NORMAL GAIT AND FACTORS INFLUENCING IT 863 muscles’ activity in gait decelerate each joint. and power generated during a movement and. although methods also exist to compute the moment of inertia of some segments directly [22. . Mass is usually determined from tables derived from cadaver measurements. the conditions for dynamic equilibrium are KINETICS OF LOCOMOTION Kinetics examines the forces. including mass and moment of inertia. Chapter 1 of this text describes the principles used to determine the loads in muscles and on joints during activity. and the ankle continues to dorsiflex after the burst of dorsiflexor activity early in stance. requires large muscle forces. Similarly. moments. stating that an object remains at rest (or in uniform motion) unless acted upon by an unbalanced external force.3) Joint Moments and Reaction Forces As indicated in the preceding sections. and I is the moment of inertia. Newton’s second law of motion. Thus the chief functions of the muscles of the lower extremity during locomotion are to slow one motion and to provide an initial burst. require knowledge of several parameters. the knee continues to extend without significant quadriceps activity. The conditions of dynamic equilibrium are very similar to the conditions of static equilibrium. Newton’s first law defines the conditions of static equilibrium ( F 0.2) MY I Y. and the mechanical power and energy generated. during gait. undergo large linear accelerations. Regardless of the method chosen. i is the angular acceleration in the ith direction. (Equation 48. The acceleration quantities in each of the equations of dynamic equilibrium. Many impairments in gait are related to an individual’s inability to generate sufficient muscular support or to sustain the large reaction forces of gait. two-dimensional examples of static equilibrium problems are provided to analyze the forces in the muscles and on joints during static tasks or in tasks where acceleration is negligible. M 0). and generates significant joint reaction forces. gait entails the repetitive impact loading of both lower extremities in each gait cycle. maZ X. Thus it is easy to recognize that normal locomotion produces large forces between the foot and the ground. The moment of inertia indicates a body’s resistance to angular acceleration and depends on the body’s mass and distribution of mass. To determine the forces on an accelerating body in a two-dimensional analysis. a i is the linear acceleration in the ith direction. Solutions to the conditions of dynamic equilibrium. Throughout this text. the larger is the body’s moment of inertia. The specific relationships between the accelerations and the forces and moments can be determined by applying the principles of dynamic equilibrium.

Precise calculations of velocity and accelerations of the body or of any limb segment requires careful measurement of the displacement. the dynamic equilibrium conditions apply: FX maX. the mass (m) and moment of inertia (I) are entered directly into the calculations. F. and velocity is the change in displacement over time. the equations of motion in dynamic equilibrium can be used to calculate a body’s acceleration from all of the forces on the body. Videographic data are collected at a rate of 60 Hz (hertz. or cycles per second) and manipulated so that the linear and angular accelerations of the leg–foot segment are determined for every 1/60 of a second EXAMINING THE FORCES BOX 48. then velocity and acceleration can be determined. where forces cannot be measured directly. JX and JY are calculated from: FX FMX FY FMY maX JX maY JY W maY maX . M I 0 l3 max l1 W where ( maX). or electromagnetic tracking devices [87. allows estimation of the forces on the human body and requires direct determination of the acceleration. the joint reaction forces. so that the equations of motion can finally be solved for the applied forces. M I where: aX. respectively. Once the muscle force is determined. the equation can be solved for the muscle force. However. The inertial forces contribute to moments about the knee joint so that taking moments about the knee. This approach is useful to determine the response of an airplane or rocket to an applied force. ( maY).1 provides an example of the equations of motion for the leg–foot segment during the swing phase of gait. Appropriate signal processing of the displacement data and mathematical calculations yield satisfactory estimations of velocity and accelerations of the body of interest.124]. and the examples of two-dimensional analysis throughout this book demonstrate the use of inverse dynamics. if a body’s displacement is known over time. zero. the motion equation is (W I l1) (FM l2) [( maX) l3] [( maY) l4] m W FM J l1 l2 the mass of the leg and foot combined the weight of the leg and foot combined the muscle force the joint reaction force the moment arm of the weight of the leg–foot the moment arm of the muscle Since the accelerations and anthropometric parameters. Chapter 1 reminds the reader that acceleration is the change of velocity over time. aY.864 Part V | POSTURE AND GAIT Theoretically. the equations of motion are used more often to determine the forces on the body when the accelerations are known. W and I. This approach. These equations can be rewritten as FX may l4 J l2 Fm maX 0. Application of inverse dynamics in static equilibrium is straightforward because the accelerations are. 111. FY maY. known as inverse dynamics.1 EQUATIONS OF MOTION IN TWO DIMENSIONS FOR THE LEG–FOOT SEGMENT DURING EARLY SWING l3 l4 the moment arm of the inertial force ( maX) the moment arm of the inertial force ( maY) Since the limb segment accelerates during gait. and ( I ) are known as inertial forces. FY maY 0. Therefore. and are the x and y components of the linear accelerations and angular accelerations. which can be accomplished by a number of techniques including high-speed cinematography. in the case of human movement. A thorough discussion of the methods and challenges in these techniques is beyond the scope of this book. Examining the Forces Box 48. suffice it to say that the necessary acceleration values are available. by definition. Using anthropometric data from Dempster [37].106. can be measured or determined from available data. videography.

98.141].0–2. The moment changes direction in midstance at about the time the hip extensors cease their activity and the flexors become active. However.136].33.75 3. 42. To avoid the problem of indeterminacy. 48.13: Free body diagram of the leg–foot segment during stance includes the forces: weight of the leg-foot (W). The internal moment at the hip joint at ground contact and contact response is an extension moment. The equations of motion are solved repeatedly for the muscle force (F) at each increment of time. consistent with hamstring activity. I moment of inertia. knee. Values reported here are intended to demonstrate that regardless of the actual magnitude.3. including the estimates of the body segment parameters of mass and moment of inertia. Thus there is more than one muscle applying force at the knee joint. and the reader is urged to read the literature carefully to identify which moment is reported. ground reaction force (GRF). and they are applied frequently in locomotion research to approximate the muscle and joint reaction forces [24. 48. Authors report either the internal [156] or external moment [80.Chapter 48 | CHARACTERISTICS OF NORMAL GAIT AND FACTORS INFLUENCING IT 865 M J −Iα −ma W GRF Figure 48. the EMG data described earlier in this chapter provide convincing evidence that there is co-contraction of the hamstrings and quadriceps during late swing and early stance and sometimes at the transition from late stance to early swing as well.13).14. sophisticated mathematical solutions for indeterminate systems exist.3 Reported Peak Joint Reaction Forces during Normal Gait in Units of Body Weight Anderson et al. A similar procedure is applied to the stance phase of gait. and entered into the equations. The knee demonstrates a small and brief flexor moment at ground contact.r. The limitation of this approach is that it prevents calculations of the forces in specific muscles and at the joints. researchers often solve only the moment equations.25 Duda et al.or three-dimensional analysis. all of the joints of the lower extremity sustain large and repetitive loads during locomotion. and ankle in the sagittal plane during normal locomotion are reported in Fig.5 Simonsen et al.a n.166].1 assumes that only one muscle group is active. as well as the analytical approach used to complete the calculations [1.r.149]. many studies report the joint reaction forces in the body during the gait cycle [2. but the external forces on the foot also include the ground reaction forces (Fig. The direction and magnitude of these forces must be known to solve the equations of motion during stance and can be measured directly by force plates.5 1. where m mass. [2] Hip Knee Ankle a Komistek [83] 2. These data reveal wide variation in the forces reported at each joint. . knee. a linear acceleration. the accuracy of the displacement data and the procedures to determine accelerations. Running and jumping produce even larger muscle loads and joint reaction forces [18. The moment at the hip in swing is minimal until late swing when the hip extensors resume activity.83. Seireg and Arvikar [136] 5. The characteristics of the ground reaction force during gait are discussed in the following section. calculating the external moments applied to the limb by external forces such as weight and ground reaction forces and inferring the internal moments applied by the muscles and soft tissue [77].7 6 Not reported.7–2. inertial forces ma and I . but then a larger and more prolonged extensor moment that is consistent TABLE 48. and angular acceleration.136. Using inverse dynamics. Typical internal moments generated at the hip.25 7 5 Hardt [60] 6 2. and ankle reported in the literature are presented in Table 48.3 1. As noted in Chapter 1 and elsewhere in this book.3. consistent with the EMG activity of the gluteus maximus and hamstrings. The example presented in Examining the Forces Box 48. joint reaction force (J). but joint moments provide insight into the primary roles of muscle groups during gait and support the roles already suggested by EMG. 84. Several factors influence these calculations. [42] 3 n.15.36. producing a dynamically indeterminate system. the use of two.60. [141] 6 4.5 4 4 2.30. muscle force (M).86]. Peak joint reaction forces at the hip.

indicating the overall role of the muscles to support the body and to prevent collapse during weight bearing.14: Internal moments at the hip.15: The support moment is the sum of the moments at the hip (MH ).866 Part V | POSTURE AND GAIT Hip Flexion/Extension Moment 25 Flx % Nm/(BW•LL) 15 5 0 -5 Ext -15 20 40 60 Gait cycle (%) 80 100 CMC (w) = 0. Ramakrishnan HK. A small dorsiflexion moment at ground contact and contact response reflects the dorsiflexor activity controlling the descent of the foot onto the ground.981 C 40 60 Gait cycle (%) 80 100 Figure 48.44. just as the flexion moment at the end of swing slows the rapid knee extension. kinetic. and ankle (MA ) needed to support the body weight during stance.64]. recent studies provide convincing evidence that these muscles contribute some of the propulsion moving the body forward [21. The net support moment during stance is positive.15) [63.94].156]. et al. 7: 849–860.) MK with quadriceps activity. the knee exhibits a small flexor moment that is attributable to activity of the gastrocnemius.125. Winter describes a support moment for the stance phase of gait that is the sum of the internal sagittal plane moments in which all of the moments that tend to push the body away from the ground or support the body are positive (Fig.986 CMC (b) = 0. Wootten ME. and smaller moments are more sensitive to measurement errors. Although there has been disagreement about whether the plantarflexors MA Figure 48. Data suggest that although the net support moment is consistent across B 40 60 Gait cycle (%) 80 100 Ankle Flexion/Extension Moment 10 Flx % Nm/(BW•LL) 0 MH -10 Ext -20 20 CMC (w) = 0. knee. In midstance. and EMG data in normal adult gait.132]. A very small dorsiflexion moment following toe off pulls the foot and toes away from the ground.992 CMC (b) = 0. and ankle in the sagittal plane.960 CMC (b) = 0. (Reprinted with permission from Kadaba MP. However. Moments in the frontal and transverse planes are smaller than those in the sagittal plane.975 A 15 % Nm/(BW•LL) Flx 5 0 -5 Ext -15 20 Knee Flexion/Extension Moment CMC (w) = 0.113. knee (MK ). Moments in the transverse and frontal planes also are reported and appear to be important in the mechanics and pathomechanics of locomotion [4.944 actually propel the body forward [120]. including the location of the joint axes and the kinematics of the movements [17. less consensus exists regarding the magnitude and even the pattern of these moments. J Orthop Res 1989. 48. It is followed by a steadily increasing and prolonged plantarflexion moment controlling advancement of the tibia through the rest of stance. A small extension moment helps control knee flexion at the end of stance and in early swing. .: Repeatability of kinematic.

To generate adequate support during the stance phase of gait. this patient may increase activity of the hip extensor muscles and of the soleus to increase the hip and ankle contributions to the net support moment (Fig.106. Todd F: Kinetics of human locomotion. applying a ground reaction force to each foot. The vertical ground reaction force under one foot is characterized by a double-humped curve (Fig. 23–44. joint pain. A reduction in walking speed. Soleus Figure 48. Similarly. consequently. and large joint reaction forces contribute to pain in patients with joint pathology such as arthritis. individuals without pathology demonstrate variability in the individual joint moments. The vertical ground reaction force also is characterized by a brief but high peak just following ground contact. eds. (Reprinted with permission from Meglan D.142].2 uses dynamic equilibrium to demonstrate how acceleration of the center of mass of the body alters the ground reaction force. Gamble JG. each foot applies a load to the ground and the ground pushes back.17). CLINICAL RELEVANCE: GROUND REACTION FORCES AND JOINT PAIN Vertical ground reaction forces contribute significantly to joint reaction forces. The ground reaction force typically is described by a vertical force as well as anterior–posterior and medial–lateral shear forces. The two peaks are greater than 100% of body weight and occur when the body accelerates upward. the center of mass moves from side to side as the individual passes from stance on the right to stance on the left [106]. 1994. may be an effective way to reduce joint loads and. 48.) Gluteus maximus center of mass. CLINICAL RELEVANCE: A PATIENT WITH QUADRICEPS WEAKNESS A patient with quadriceps weakness lacks the ability to support the knee actively during the stance phase of gait. 48.17: Ground reaction forces during gait. The valley between the peaks is less than 100% of body weight and occurs during single limb support. which reflects the impact of loading [140]. Human Walking. and their vertical ground reaction forces demonstrate smaller peaks and valleys as the result of smaller vertical accelerations[139.133]. These changes may represent appropriate adaptations to protect a painful joint and to maintain overall function. The magnitude and direction of this ground reaction force changes throughout the stance phase of each foot and is directly related to the acceleration of the body’s Figure 48. producing a reduction in accelerations. 120 100 80 60 40 20 0 -20 20 40 60 80 100 Vertical Ant-Post Med-Lat Gait cycle (%) GROUND REACTION FORCES With every stride.Chapter 48 | CHARACTERISTICS OF NORMAL GAIT AND FACTORS INFLUENCING IT 867 Force (% N/BW) walking trials.16: An individual may increase the activity in the soleus and the gluteus maximus to support the knee in extension by preventing forward movement of the tibia or the femur. respectively.16). . The ground reaction force is measured directly by force plates imbedded in the walking surface. Philadelphia: Williams & Wilkins. Examining the Forces Box 48. indicating that individuals with normal locomotor systems may exhibit flexibility in the ways they provide support [157]. The center of mass of the body rises and falls as the individual moves from double support when the center of mass is low to single support when the center of mass is high [69. In: Rose J. Patients with arthritis walk more slowly [76].

Whether described as a single force vector or as three individual components. is positive. and the GRF is less than body weight. They reflect forces associated with the shift of the body from side to side between the supporting feet. anterior–posterior. acceleration. the ground reaction force generates external moments on the joints of the body in all three planes (Fig. FY FY W GRF maY maY maY W 0 GRF maY 0 a a When the body is accelerating toward the ground. these forces exhibit normal intra. and medial–lateral ground reaction forces. contributing to the forward propulsion of the body. The posterior and anterior shear components of the ground reaction force also demonstrate a consistent pattern in normal locomotion. The second half of the stance phase is known as the acceleration phase of the gait cycle. forward progress is impossible. decelerating the foot. Although plots of the ground reaction forces demonstrate rather stereotypical shapes. Because there is little friction between the foot and the ice. . the ground applies an anterior shear force on the foot. In midstance. and forward progress is impaired. In the absence of any posterior and anterior shear forces.and intersubject variability [51. The force vector applies external moments to the joints of the lower extremities about all three axes. Realistic computation of joint moments and forces during gait GRF Figure 48. the acceleration. The ground reaction force vector is the sum of the individual components of the ground reaction force. provides a direct demonstration of the role of the acceleration of the body’s center of mass in generating the vertical ground reaction force (GRF). aY. and the GRF is greater than body weight.18). W. aY. is negative. Walking on ice demonstrates the importance of these posterior and anterior shear forces.18: The ground reaction force vector (GRF) is the sum of the vertical. 48. W. it is important to recognize that like kinematic variables.868 Part V | POSTURE AND GAIT EXAMINING THE FORCES BOX 48. the posterior and anterior shear forces between the ground and the foot are small when walking on ice. The medial and lateral shear forces during gait are smaller and more variable than the vertical forces or posterior–anterior shear forces.2 THE CONTRIBUTION OF ACCELERATION TO THE VERTICAL GROUND REACTION FORCE Using the dynamic equilibrium condition. consequently this period is known as the deceleration phase. The ground exerts a posterior force on the foot during the initial portion of stance.61]. When the body accelerates upward away from the ground. FY maY.

Like the hip.104]. and Mechanical Energy Normal locomotion appears to be a remarkably efficient movement. Basic Biomechanics of the Musculoskeletal System. is equal to angular displacement over time ( t) and therefore: P and P W t (Equation 48. 48. Philadelphia: Lippincott Williams & Wilkins. Inability to roll over a painful toe or the interrupted forward progress of the body’s center of mass. the ankle generates considerable positive power at the end of stance when the plantarflexors contract concentrically. because the knee suddenly hyperextends. In the normal foot. 48. the product of joint moment and angular velocity: P M (Equation 48. Work.21. the knee has only a brief period of power generation. the product of moment (M) and angular displacement ( ): W M (Equation 48.58] (Fig. Frankel VH. 222–255. Thus concentric muscle activity generates power. and is the angular velocity of the limb segment.6) must include the three components of the ground reaction force or the force vector. A pogo stick (PogoTM) provides a useful example of positive and negative power. when muscles are generating power and doing positive work. where work is the product of force and displacement. The location of the ground reaction force with respect to the foot indicates the path of the center of pressure through the foot. walking at a selfselected cadence. 2001. W t). A full understanding of the power generation and absorption in twoand three-dimensional analysis is still emerging and holds promise for providing more-direct insight into the mechanisms of gait deviations. and energy is absorbed by its spring.97. knee. (Reprinted with permission from Sammarco GJ. and work is done on the segment [162]. Analysis of joint powers provides increasing understanding of the role of muscles in propelling and controlling movement during locomotion [21. and eccentric activity absorbs power. Individuals with locomotor impairments expend more energy during ambulation than individuals without impairments [16. producing only a small amount of power.7) M t (Equation 48. M is a joint moment.. 3rd ed. These demonstrate that positive power generation. These data suggest that the hip flexors and extensors and the plantarflexors contribute important energy to the lower extremity during normal locomotion. occurs at the hip at loading response as the hip extends and again at the end of stance as it flexes. in rotational motions such as the joint movements in locomotion. it is negative when the body absorbs energy during eccentric muscle activity and is positive when the body generates energy during concentric muscle activity. the spring releases its energy and performs work on the child. the weight of the child does work on the pogo stick. Individuals without impairments. . In contrast.130]. Power is a useful indication of the muscles’ role in controlling motion. Power also can be described as work (W) per unit time (t) (i.19: Progression of the center of pressure during locomotion. eds. The joint powers at the hip. or does work. . the center of pressure progresses in a relatively straight line from the posterior aspect of the plantar surface of the heel through the midfoot and onto the forefoot where it deviates medially onto the plantar surface of the great toe [56. work done on or by the pogo stick (Fig. In landing. or in angular terms.19).5) Figure 48. require less oxygen consumption than when walking at lower or higher cadences [65. and ankle during gait derived from two-dimensional analysis are pictured in Fig. The efficiency of locomotion depends on many factors. In: Nordin M.e. but in takeoff.) Angular velocity.143]. pushing the child and pogo stick off the ground.4) 57% 55% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 2% where P is power in watts. Hockenbury RT: Biomechanics of the foot and ankle. are examples of gait deviations that produce changes in the pattern of the progression of the center of pressure.Chapter 48 | CHARACTERISTICS OF NORMAL GAIT AND FACTORS INFLUENCING IT 869 JOINT POWER Mechanical power is the product of force and linear velocity or. including the mechanics of the muscular control of gait described earlier in this chapter and the conservation of mechanical energy that results from the synergistic movement of the limb segments. Energetics of Gait: Power.125. Both of these periods are characterized by concentric muscle contractions.20). 48.

the spring is released. knee.100]. 23–44.870 15 Gen 10 5 0 -5 Abs -10 0 20 Part V | POSTURE AND GAIT Power (% W/BW) Hip 40 60 Gait cycle (%) 80 100 Power (% W/BW) 15 Gen 10 5 0 -5 -10 -15 Abs -20 0 20 40 60 Gait cycle (%) 80 Knee 100 Power (% W/BW) 50 Gen 40 30 20 10 0 Abs -10 -20 0 20 40 60 Gait cycle (%) 80 Ankle 100 Figure 48. active hip flexion appears to provide the forward propulsion needed to swing the limb forward. as well as their mechanisms of compensation [38.) Figure 48. Philadelphia: Williams & Wilkins. Human Walking. As an individual is unable to generate power through plantarflexion for forward progression.99.100]. CLINICAL RELEVANCE: JOINT POWERS IN INDIVIDUALS WITH GAIT DYSFUNCTIONS Joint powers during free-speed walking are altered in elders and in individuals with weaker lower extremity muscles [38. The decrease in plantarflexion power and concomitant increase in hip flexor power generation noted in elders and in individuals with weakness may help to explain the decrease in velocity and step length reported in these individuals. B. A. (Reprinted with permission from Meglan D. 1994. These .20: Energy storage and release. As weight is removed. Weight bearing on the Pogo stick™ compresses its spring and work is done on the stick. and ankle from two-dimensional analysis. In: Rose J. eds.21: Joint powers at the hip. and the Pogo stick™ does work on the body. Gamble JG. Todd F: Kinetics of human locomotion. lifting it into the air.

Chapter 48 | CHARACTERISTICS OF NORMAL GAIT AND FACTORS INFLUENCING IT 871 patients may benefit from exercise to improve plantarflexion force production. namely potential and kinetic energy.9) where m is the body’s mass. g is the acceleration due to gravity. consequently. since the change in the body’s total energy is zero. . Potential (PE) and kinetic (KE) energy are related to the distance of a body’s center of mass from the earth and to the body’s linear and angular velocity. assisting in the trunk’s forward progression. At its lowest point. and h is the distance from the body’s center of mass to the earth. Mechanical energy. As the roller coaster descends the track it gains speed. and is its angular velocity. also provides insight into the efficiency of gait. potential and kinetic energy are transformed from one form to the other with no loss of energy. Studies of the mechanical energy of the limb segments during gait suggest that an exchange of kinetic and potential energy can account for most of the energy change in the distal leg at the beginning and end of swing [126. an ideal system requires no work to continue moving. Since power is a function of the velocity of a limb segment. This finding is consistent with a diminished capacity to transfer energy through the knee joint [115]. the hamstrings absorb energy at the end of swing. and that energy is transferred to the trunk at ground contact. I is its moment of inertia. Energy flows between adjacent limb segments during locomotion in much the same way that energy flows between the vaulter and the pole during a pole vault or among children playing “crack the whip. potential energy is maximized and kinetic energy is minimized.22: In an ideal roller coaster.161]. Thus treatments directed toward reducing joint stiffness or rigidity may lead to improved gait efficiency in these individuals. When the cars are at their peak height. These analyses provide more insight into the mechanics of the gait abnormalities than can be provided solely by clinical observation and lead to more. These studies demonstrate the efficiency of gait and how dependent the efficiency is on walking speed. This energy exchange improves when walking at free speed and is greater at steady-state walking than at the initiation of gait [95. a limb segment that has a low angular velocity also has low power generation or absorption and. v is its linear velocity. MECHANICAL ENERGY The cyclic movement inherent in locomotion and the ability of the muscles to store energy contribute to the inherent efficiency of normal gait. Potential energy (PE mgh) is maximum when the roller coaster is farthest from the ground. The ability of the muscles to absorb and generate energy contributes to the overall efficiency of gait and explains how many of the movements can proceed without muscle contraction. increasing its kinetic energy while it is losing potential energy as it moves closer to the ground. the roller coaster’s potential energy is minimum and its kinetic energy is maximum. facilitating the initiation of swing. A patient with arthritis producing a stiff knee is unable to transfer energy from the plantarflexors to the thigh.” Examination of the energy flow between limb segments reveals that the energy generated by the plantarflexors at push off is transferred passively to the leg and thigh. The use of joint kinetics in conjunction with EMG is also useful in evaluating the complex gait deviations in individuals with central nervous system disorders such as cerebral palsy.8) where m is the mass of the body. CLINICAL RELEVANCE: ENERGY TRANSFER AMONG LIMB SEGMENTS IN ABNORMAL GAIT Energy transfer among limb segments depends on the power generated and absorbed at joints and requires precise coordination among the moving segments. at the same time the kinetic energy (KE 1/2 mv2) is at its minimum. so that an ideal roller coaster continues in motion indefinitely (Fig. 48.22). as indicated by the following relationships: PE mgh (Equation 48. In an ideal system. a patient with Parkinson’s disease.102]. Since the work done on a body equals the change in total energy. and KE 1 mv 2 2 1 I 2 2 (Equation 48. has difficulty transferring energy through the lower extremity and into the trunk because the joints lack the freedom of movement to allow the sequential movement patterns of the joints of the lower extremity. conservation of energy dictates a complete transformation between potential and kinetic energy.informed treatment decisions [117. which is characterized by generalized rigidity. has less ability to transfer energy from one segment to another. The transfer of energy from segment to segment depends on the normal sequencing of the angular changes described earlier in this chapter. Max PE Min KE Min PE Max KE Figure 48. A study of patients with multiple sclerosis demonstrates an inverse relationship between the metabolic cost of walking and the patients’ ability to rapidly flex and extend the knee.128]. Similarly.

smaller joint excursions. although these differences are on the order of 2–4 . Similarly. and maximal oxygen uptake all help explain the diminished walking velocity seen with age [19. decreased strength of the quadriceps. The same study also reports that females exhibit a statistically greater extension moment at the knee at initial contact and a greater flexion moment in preswing with increases in power absorption or generation at the hip. stroke. Patients with dysfunctions associated with low back pain. and stride length increase with increased walking speed and decrease with decreased speed [6. Walking Speed Gait speed affects several parameters of gait performance. Consequently. few studies provide direct comparisons.135. and anterior cruciate ligament tears all frequently exhibit altered gait patterns that include decreased step length. and decreased walking speed.105]. particularly in the muscles around the knee [103. joint moments and joint reaction forces increase with increased walking speed [11.62. and studies vary in the magnitude of changes reported. Despite the overwhelming data demonstrating changes in gait with increasing age.62. and hip flexors. Increased mechanical work and power at the knee and hip also accompany increased walking speed [21. Gender Although most observers would report differences between the gait patterns of males and females.148]. Increased walking speeds also lead to increased ground reaction forces [6. it is unclear whether the alterations commonly seen in gait in the elderly are the normal consequence of aging or reflect the functional deficits resulting from impairments associated with neuromusculoskeletal disorders commonly found in elders [34. Increases in joint excursions at the proximal joints are related to the increase in stride length associated with increased speeds [31].160].4 lists commonly reported changes in gait with aging. Factors considered here are gender. plantarflexors. Yet when the distance characteristics of the gait cycle are normalized by height. Treatment of gait dysfunctions in elders requires consideration of the contributions made to the dysfunction by discrete impairments in the neuromusculoskeletal and cardiorespiratory systems.165]. decreased walking speed produces reductions in step length.45. as witnessed by the development of gait in the toddler and the apparent deterioration of gait in older adults.106. the clinician must attempt to discern what characteristics of the gait pattern are attributable to the gait speed alone. but many of the other changes reported with aging also are consistent with the changes reported earlier in this chapter for walking speed alone [46]. Angular excursions also appear to increase with increased walking speed. The authors suggest that these differences in kinetic measures may help to explain the higher incidence of knee osteoarthritis in women. although these changes are small and differ with the speed and joint examined [31. Women walk with higher cadences than men and shorter strides [13.82]. and what characteristics are the result of the patient’s impairments. Even the decrease in walking velocity reported with age appears to depend on an individual’s level of fitness and other factors besides age itself. While the gradual acquisition of stable bipedal ambulation is a normal part of human development. muscle activity during free-speed walking is more reproducible than that at speeds slower or faster than free speed [23. the nature of the relationship between age and locomotor function remains unclear.34. and ground reaction forces [48. and age. many of the changes that occur with aging appear to be secondary changes associated with walking speed.108.153].106].52. . However. Age Age appears to affect gait rather dramatically. Specifically.106]. knee. step length.166]. but additional research is required to confirm these findings and demonstrate a clinical association. there appears to be a general increase in the duration of muscle activity with increased walking speed. are the gait deviations exhibited by these patients merely the consequence of their walking speed? If a goal of treatment is to improve the gait pattern.72]. speed. Increased speed appears to increase the variability of some temporal and spatial gait parameters such as step width [137].80].872 Part V | POSTURE AND GAIT FACTORS THAT INFLUENCE PARAMETERS OF GAIT Several factors influence gait performance and must be considered by clinicians evaluating and treating a person with a locomotor dysfunction.78.79. Coexisting joint impairments. hip and knee passive ranges of motion. As noted in the discussion of the temporal and distance characteristics of gait. and the clinical significance of these differences is negligible [80]. joint excursions. Table 48. A study directly comparing 99 males and females of similar ages reports statistically different joint kinematics. The ages of the elders studied range from approximately 60 years to over 100 years.90. One of the most consistent findings with age is a decrease in free-walking speed [48. Although the relationship between muscle activity and walking speed is somewhat complex.90. and ankle.25] and changes in the pattern of muscle activity. Because decreased walking speed is associated with decreased step length and joint excursion.52.80.73. females demonstrate a similar or slightly larger stride length [45. hemiparesis. CLINICAL RELEVANCE: WALKING SPEED IN INDIVIDUALS WITH GAIT IMPAIRMENTS Many abnormal gait patterns found in individuals with impairments are characterized by decreased walking velocities.99]. 92. cadence.45.

5. Cairns B: A three dimensional kinematic and dynamic model of the lower limb. 34: 153–161.4 Speed Cadence Commonly Reported Changes in Gait in Older Adults Change with Increased Age Decreased [48. present and future. joint movement continues after muscle activity has ceased. J Biomech 1989.92. Andrews JG: Methods for investigating the sensitivity of joint resultants to body segment parameter variations. The principle of dynamic equilibrium is used to explain the derivation of muscle and joint reaction forces. 33: 1217–1224.73. Arch Phys Med Rehabil 1999. Impairments in the neuromusculoskeletal system decrease the efficiency of gait. Andriacchi TP: Dynamics of knee malalignment. In most cases. urement procedures. Joint excursions are largest in the sagittal plane and exhibit stereotypical patterns and sequences.72] Decreased [46. Battye CK.153] Increased [48. and the clinician is cautioned to keep these factors in mind when judging the walking performance of an individual. Assaiante C. Pandy MG: Static and dynamic optimization solutions for gait are practically equivalent. The kinetic variables reveal that locomotion generates large muscle and joint forces.48. 32: 211–226. Alkjaer T.78. Their activity is typically brief.90. Like the kinematic variables. including gender. and hip flexors. the hip. 3. as well as joint power and mechanical energy. Similarly. and joint moments. Consequently. In normal locomotion. and ankle rarely move together toward or away from the ground. 25: 395–403. 7. Gait Posture 2001. 4: 125.and intersubject variability. reducing the amount of work the muscles must perform to achieve the movement. Andriacchi TP. J Biomech 2000. 80: 930–934. Dyhre-Poulsen P: Comparison of inverse dynamics calculated by two. 9. Kinetic analysis also demonstrates the remarkable efficiency of normal locomotion in which energy is stored and released. and joint power. J Biomech 1996. Giddings CJ. regardless of age. knee. Della Croce U. Anderson FC. 10: 261–268. Alexander EJ: Studies of human locomotion: past. 2. plantarflexors.79. The kinematic variables presented in this chapter include the more global parameters of time and distance as well as the discrete displacement patterns of joints. but kinetic parameters also are quite sensitive to differences in meas- References 1. 4. Med Biol Eng 1966. Finally this chapter discusses factors that influence walking patterns. J Biomech 1977. . and age. representative values from the literature are presented to provide the reader with a frame of reference for normal locomotion. Kerrigan DC: Rectus femoris: its role in normal gait. the kinetic variables exhibit intra. Activity of the major muscle groups of the lower extremity is reviewed. Naumann S.160] Decreased [72. J Mot Behav 2000. Orthopedic Clinics of North America 1994. Annaswamy TM. characterized by initial eccentric activity followed by concentric activity. Galante JO: Walking speed as a basis for normal and abnormal gait measurements. Simonsen EB.72.72. The discussion reveals a complex interdependence between walking speed and age effects on gait. 10. muscle forces. SUMMARY This chapter reviews the kinematic and kinetic variables of normal gait. Andriacchi TP. Woollacott M. 22: 143–155.62. Ogle JA.62. 29: 651–654.160] Step/stride length Double support time Joint angular excursions Muscle activity Joint powers CLINICAL RELEVANCE: EVALUATION AND TREATMENT OF GAIT DYSFUNCTION IN ELDERS Data describing the gait of elderly individuals reveal that many of the changes thought to be characteristic of aging can be explained by a reduction in walking speed.and intersubject variability that reflects the normal variability of individuals and populations. Amblard B: Development of postural adjustment during gait initiation: kinematic and EMG analysis. Although all of these variables are subject to intra.160] Increased [46. 8. including strength of the quadriceps.108] Unchanged [48] Increased [48] Decreased generation in hip extension and plantarflexion and increased generation in hip flexion [72. 13: 73–77. walking speed. joint moments.and three-dimensional models during walking.Chapter 48 | CHARACTERISTICS OF NORMAL GAIT AND FACTORS INFLUENCING IT 873 TABLE 48. a clinician must alter the standards of “normal” used to judge the adequacy of gait. 6. Joseph J: An investigation by telemetering of the activity of some muscles in walking. The gait patterns of elders walking at reduced speeds are not comparable to the patterns of subjects walking at faster speeds. J Biomech 2001. treatment may be most successful when directed toward those factors that contribute to diminished speed.108.108.73.79. Apkarian J. The kinetic variables described in this chapter include ground and joint reaction forces.

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