Gait analysis in water

Johan Lambeck PT
EWAC allied health consultant
International Aquatic Therapy Foundation
www.halliwick.eu

Contents

!! Kinetics
•! Fluidmechanics
•! Ground Reaction Forces (GRF)
!! Kinematics
•! Temporal and spatial parameters
•! Joint movements
•! Muscle moments
!! EMG studies

Why biomechanics

!! To understand:
•! the mechanical loads on the body
•! Human adaptation to changes of mechanical constraints
!! To contribute to:
•! A more appropriate prescription of walking in water as
part of rehabilitation programmes

Land vs water

!! Kinetics are quite different
•! Buoyancy forces
•! Drag forces
!! Kinematics are robust
•! Dynamic similarity

!! Dynamic Systems Model
•! The body chooses for effectiveness and efficiency: adaptation
to mechanical constraints within the biomechanical possibilities.

Conflicts

!! Kato et al 2001:
•! In water, the strategy of locomotion is quite different from
that on land

!! Degani & Danna-dos-Santos 2006:
•! Older adults …. using a similar pattern in water than used
on land

Mitarai et al 1972 Effects of buoyancy .

v = velocity. d = density.5 * d * Ap * v2 * c !! Fd = drag force. c = constant factor . Flow impedance / drag force !! Fd= . Ap = frontal plane.

visc / density !! Water: dyn visc = 1. density = 0.0013 !! v air = 14 !! v water = 1 !! 14 : 1 = differences in resistance (range is about 0 – 42) . Kinematic viscosity (v) !! v = dyn.018. density = 1 !! Air: dyn visc = 0.

ISBN 0 7167 5035 X . biomechanically. Robust kinematics (Miyoshi 05) !! Dynamic similarity •! At different speeds and in different environments we try to preserve energy as best as possible. R. Scientific American Library. For this. we need to walk with similar Froude numbers o! Froude number: ratio of inertia forces over gravity forces –! Ref: Exploring biomechanics. New York. animals in locomotion. McNeill Alexander (1992).

there must be elastic similarity. Walking can never be exactly the same the same on land and in water o! Donelan et al 00 . In water elasticity is different. Elastic similarity !! To have dynamic similarity.

Kinetics !! Ground reaction force components •! Vertical o! Magnitude of 2 peaks and the valley o! % body weight reduction o! Initial slope of the GRF curve (impact force) •! Anterior – posterior o! Magnitude o! Impulse (energy through the foot: area of curve) •! Medio-lateral .

Ground reaction forces during walking on dry land and in water Cole & Becker: Comprehensive Aquatic Therapy 2002 .

Ground Reaction Force Harrison 92: measuring platform with pair of scales. fairly accurate Velocities are not mentioned .

1992 .Harrison et al.

arms next to the body (0. Harrison confirmed by Roesler 06 !! Gait conditions •! ISG: slow gait.40 •! 3: manubrium sterni at 1.43 m/s) •! OQG: quick gait. arms out of water (0. young adults n = 70 .55 m/s) •! OSG: slow gait.47 !! Water depth 1.41 m/s) •! IQG: quick gait.34 •! 2: manubrium sterni at 1. arms out of water (0. arms next to the body (0.66 m/s) !! Cohorts •! 1: manubrium sterni at 1.40.

Roesler 2006 .

75 m/s –! Chevutschi 07 .5 m/s !! Fast = 0.55 – 0.66 m/s Roesler 06 !! Slow = 0.43 m/s !! Fast = 0. Water walking velocity !! Comfortable = 0.5 m/s (1.8 m/s »! Masumoto 04 Treadmill !! Slow / normal = 0.93 m/s »! Miyoshi 05 !! Self selected = 0.61 m/s –! Fowler-Horne 00 !! Comfortable = 0.41 – 0.51 m/s !! Fast = 0.8 km/h) »! Barela 06a and 06b !! Slow = 0.55 m/s !! Fast = 0.

Barela 2006b .

Confirmed by Roesler 2006 and . Barela et al 2006a: young adults Barela & Duarte 2006b: elderly Always a positive av GRF in water: always propulsion needed against impedance.

Comparison elderly / adults !! Elderly showed significantly: •! Lower first peak of heel strike •! Lower impact (less steep rise of 1st peak) •! Lower impulse .

Nakazawa 1994. same results as before .

R. 2003: magnitude differs with depth .Nalasco.

Nakazawa 94a Slow = slower than comfortable Fast = faster than comfortable Nakazawa 94b Differences in depth .

Kinematics !! Stride temporal and spatial parameters •! Length •! Duration •! Speed •! Support phase !! Joint ROM .

Temporal and spatial gait parameters Stride cycle water Duration Length Speed Stance Support vs land (s) (m) (m/s) time phase % Barela a adults 150% Same 60% same Longer Slower Barela b elderly 100% same 60% same Longer* Slower* Nakaza. Adults reduce slower Horne d * Elderly had ss longer duration and slower speed than adults . adults Longer wa ! depth Shono Adults Slower Lower treadmill Chevutsc Adults 25% 60% hi less slower Fowler.

contrary to land. Water !! Duration % of stance and swing did not alter despite slower speed. •! > effect of unloading counterbalances the effect of slow walking (Barela) !! Stride frequency and double support phase are reduced •! Shono 04 .

! Body weight decreases with depth (see also e.! Stance time increases with depth 2.Nakazawa 94b 1.g Roesler) 3.! Impulse highest in 40 and 70 cm and only in 1.20 lower than on land .

Flex stance swing Barela etal. 2006a: young adults Barela & Duarte 2006b: elderly .

Conclusions young adults !! Quantitatively all joint show roughly the same patterns. however in water: •! More plantar flexion of the ankle (body leans slightly backward) •! Reduced flexion of the knee first 15° stance (less weight acceptance needed) •! Increased flexion of the hip in swing (buoyancy effect) o! Shared by Miyoshi 00 and others .

Miyoshi T. 2003 swing Barela 06 Comparison stance phases adults .

however in water: •! More plantar flexion of the ankle (body leans slightly backward) •! No clear heel strike but “foot strike” •! Increased knee flexion at begin and end •! Increased hip flexion in the whole cycle !! Degani 06/07 did not find differences between young adults and the elderly . Conclusions elderly !! Quantitatively all joints show roughly the same patterns.

Comparison elderly / adults !! Elderly significantly: •! Smaller overall ankle ROM •! More knee flexion at initial contact •! Less dorsiflexion ankle at initial swing •! Less knee flexion at initial swing •! More hip flexion at initial swing o! > less movements in ankle and knee. compensated by the hip + less weight catching .

Shono et al 2005: walking faster changes knee ext / or knee flexion .

Pöyhönen 02 .

Hoffman.reflex (H-reflex) Pöyhönen 02 .

rectus femoris variable between subjects . less peaks: less phasic and more tonic activity (synergistic to maintain balance.EMG comfortable walking young adults !! In water (Barela 06): •! Flatter patterns. to keep propelling against drag) •! Gastrocnemius same pattern as on land !! In water (Chevutschi 07) •! Patterns in terms of peak amplitude and shape the same as on land •! Erector spinae more and soleus less active in water.

Barela & Duarte 2006b: Barela et al 2006a: adults elderly .

Nakazawa 1994a Healthy adults 1.30 depth Speed not quantified Biceps femoris Vastus medialis Tibialis Anterior Gastrocnemius Soleus .

Nakazawa 1994b .

Nakazawa 94 !! Inter-muscular coordination patterns change when walking in water or walking with different speeds !! No difference between non-loaded and loaded walking (10% added weight) !! BF is more active in water (propulsion) !! BF and Gas reacted more to velocity. Sol and VM less .

2007) .EMG activity during walking on dry land and in water 2 (Chevutschi et al.

EMG activity patterns during walking on dry land and in water (pilot study. unpublished. Pöyhönen) . Kotka. Courtesy T. Finland.

Muscle activity during walking on dry land and in water (Masumoto et al 2004) .

5 m/s Fast speed: 0.8 m/s Depth: Xypoid Flowmill / treadmill Masumoto et al 2004 . Moderate: 0.65 m/s Slow speed: 0.

. GM. VM. Conclusions Masumoto !! Walking in water with current •! Abd. TA " 70% land !! Walking in water without current •! Abd. GM. RF. GA. PA. VM. BF " 30-50% land •! TA " 60% land •! > Shono 2001: walking on the flowmill is very similar to walking through the pool . GA " 40-60% land •! BF. PA.

6 5.9 3. Petrofsky 2002 Quadri Tib ant Glut m.3 18.1.2 2.1 5.1 5.6 W122.5 1.8 10.2 km/h 5.1 W122.6 2.5 3.6 W91.6 4.4 11.2 1. 1.6 km/h = 0.6 46. Gastroc amplitude EMG EMG EMG EMG L.8 3.1 13.9 1.8 2.8 L.44 m/s .6 km/h 7. 1.5 38.3 2.1. 1. 1.2 W91.5 8.8 2.8 17.

= 35% weight start Barela elder = = + + + + Nakazawa = + . . = + = + start Petrowski . = Nakazawa = = + = = 50% weight Chevutschi + averaged Kottka + . . . . . . = = 122 cm Masumoto . . . - . .Water vs Gastrocn Tib ant Biceps fem Vastus m/l Rectus land St sw St sw St sw St sw fem St sw Barela adult = = = + + .

Erector L1 Rectus abd Glut max Tensor fl Soleus St sw St sw St sw St sw St sw Barela adult . - . + . + end Barela elder + + end Nakazawa - Nakazawa + Chevutschi + - Kottka Petrowski - Masumoto .

Conclusions GRF !! In water •! A decrease of magnitude and impact of the vertical GRF o! Depends on depth and velocity •! The a-p GRF is always positive / propulsive .

Conclusions Kinematics !! Stride time increases in water •! % same increase of both stance and swing !! The comfortable velocity in water is about 50% of land velocity !! Stride length does not alter !! Joint angles are roughly identical in water and on land with small changes because of buoyancy and drag effects !! Increase of speed: knee angles more in the flexion range .

Conclusions EMG !! Muscles show les peaks. signals are flattened in water !! Poly-articular muscles increase activity more than mono-articular when walking faster (BF and Gas as opposed to VM and Tib ant) !! Till 50% immersion: hardly a change in muscle activity !! In general no consistent oucomes in EMG research .

.

Shono wt al 2005 .

Myoshi. 2003 .

Miyoshi 05: moments during stance Dahsed line = land All thick lines: additional 8 kg load .

on land 2 peaks •! Constant hip extension during stance •! Of hip extension increase with velocity . Conclusions Miyoshi !! Moments •! Of plantar flexion significantly decreased •! Of knee extension shows 1 peak at late stance.

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