Human Gait I. II. Introduction A.

Gait - repeating cycles of lower limbs as they propel the body forward in coordinated fashion Normal gait cycle A. Movement of one limb through stance phase and swing phase 1. Stance phase: 60% of cycle a. Begins when heel strikes the ground b. Ends when big toe of same limb leaves the surface 2. Swing phase (40%) a. Beings when big toe leaves the ground b. Ends when heel hits the surface B. Definitions 1. Heel strike: instant heel touches the ground (loading response 2. Foot flat: entire plantar surface of the foot is in contact with ground 3. Mid-stance: body is directly over limb 4. Heel off: instant heel leaves the ground 5. Pre swing (toe-off): instant big toe leaves the ground 6. Early swing: immediately after toe leaves the ground 7. Late swing: just prior to heel touching the ground Pelvic stabilization during gait A. Pelvis wants to tilt/sag to the side of the swing limb 1. Prevented by contraction of muscles on the opposite limb (stance limb) a. Gluteus medius and minimus innervated by superior gluteal nerve b. Contract isometrically to stabilize joint Pelvic rotation during gait A. Lateral rotators (piriformis, obturator internus, obturator externus, quadratus femoris) rotate pelvis so that food doesnt turn medially with each step Upright posture A. Vertical line of gravity passing through center of body mass (just anterior to sacral promontory, passes posterior to hip joint and anterior to both knee and ankle joints 1. Body stable in this position due to tautness of ligaments 2. Backward leaning of trunk - limited by iliofemoral ligament 3. Posterior knee joint capsule, cruciate as and collaterals prevent hyperextension of knee when standing 4. Tendency to sway forward at the ankle prevented by constant contraction of soleus muscle Muscle activity during gait A. Heal strike: 1. Gluteus maximus and hamstrings contact isometrically to prevent jack knifing forward 2. Ankle dorsiflexors (tibialis anterior, extensor digitorum and extensor hallucis) contract eccentrically to allow for controlled foot lowering 3. Gluteus medius and minimus contract isometrically stabilize pelvis B. Foot flat: 1. Glu medium/minimus contract isometrically 2. Quadriceps contract eccentrically to ctrl amt of unwanted knee flexion C. Mid-stance 1. Glu medius/minimus contract isometrically

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2. Plantarflexors (gastrocnemius, soleus, TP, FHL) contract eccentrically to prevent unwanted dorsiflexion at ankle D. Heel -off 1. Plantarflexors contract concentrically to provide thrust of propulsion of leg in forward direction 2. Glu medius/minimus continue to contract isometrically E. Pre swing/ toe-off 1. Plantarflexors continue to contract concentrically to provide thrust of propulsion of leg in forward direction 2. Iliopsoas contract concentrically to bring thigh forward F. Early swing 1. Ankle dorsiflexors contract concentrically to dorsiflex ankle so foot clears the ground 2. Iliopsoas contract concentrically 3. Quads (esp rectus femoris) contract isometrically to prevent excessive flexion at knee G. Late swing 1. Ankle dorsiflexors contact isometrically to hold ankle in neutral position in readiness for heel strike and to keep toes from stubbing ground 2. Hamstrings contract eccentrically to slow forward momentum of leg at knee just prior to heel strike. Eccentric contraction acts at hip to slow forward momentum of trunk to prevent jack knifing Gait abnormalities A. Lesion of superior gluteal nerve on one side: paralyze gluteus medius and minimus and TFL and leads to excessive pelvic tilt on opposite side 1. Bilateral lesions waddling gait (Trendelenburg gait) - polio B. Nerve to Iliopsoas muscle - cant walk because limb cant swing forward C. Tibial nerve lesions -> hamstring paralysis 1. Forces patient to lean back during heel strike D. Femoral nerve paralyses quadriceps: cant prevent support limb from bending since no extension E. Tibial nerve lesion in popliteal fossa - calf muscles 1. Lean backwards and take short steps 2. Cant plantar flex so they drag lesioned limb along ground using hip flexors shuffling gait F. Deep fibular nerve lesions: hits dorsiflexors 1. Increase flexion at knee so toes clear ground high stepping gait 2. Place foot on ground all at once instead of heal strike to foot flat G. Obturator nerve lesion hits adductor muscles lesioned side limb to be abducted during swing phase (swings out laterally)