Gait disorders in

Musculoskeletal
dysfunctions
 GAIT TERMINOLOGIES

 Time and distances are two basic

parameters of motion.
1. Temporal variables
2. Distance variables
TEMPORAL VARIABLES

1. Stance time
2. Single limb support time
3. Double support time
4. Swing time
5. Stride time
6. Step time
7. Cadence
8. speed
DISTANCE VARIABLES

1. Stride length
2. Step length
3. Step width
4. Degree of toe out
Stride duration
 Amount of time spent in completion of
one stride or Gait cycle

 One stride duration for a normal stride

is 1 second.

 Changes occur in stride length during

normal, slow, fast walking.
Stride length
 A stride include two steps, right and left

 stride length is not always equal to length

of two steps as there may be unequal
steps

 Stride length greatly varies among

individual because it is affected by leg
length, sex, age.

 Stride length decreases with increase in

Step length

Linear distance between two successive points of

the opposite extremities.
 Comparison of the right and left steps provides
an indication of gait symmetry, the more equal
are the step length more symmetrical will be the
gait
Step duration

The amount of time spent in

completion of a single step.

 measurements is expressed as
sec/step

 When there is weakness or pain in

an extremity step duration may be
decreased on the effected side while
increased on the unaffected side
cadence

The number of steps taken by a person per unit

time
Cadence=number of steps/sec or min
 Shorter step length will result in increase
cadence at a given velocity
 When a person is walking with cadence between
80 and 120 steps/min, then cadence and stride
length have a linear relationship
 If cadence increases the double support time
decreases and vice versa

 Normal cadence , man=110 steps/min

 Normal cadence, woman=116
Walking velocity
 Is the rate of linear forward motion of the body in
a specific direction
 It can be measured as, cm/sec, meter/min or
miles/hour
 If the direction is not specified than term walking
velocity is called “walking speed”

Walking velocity or speed=distance walked/ time

Distance(cm, m, miles, km)
Time(sec, min, hour)
Step width
 Step width, or
width of the
walking base
 It is measured by
the linear distance
between the mid
point of the heel
of one foot and
the same point of
the other foot.
 Step width
increases if there
is increased
demand for side to
Degree of toe out
It is the angle of foot placement(FP)
and may be found by measuring the
angle formed by each foot line of
progression and a line which
intersect the center of heel and
second toe.

 Normal angle = 7 degree

 Angle of toe-out decreases as the

speed of walking increases
Power generation and
absorption
 Muscle work concentrically and work
positively, produces energy which is
used for gait.

 Muscleswork eccentrically and do

negative work and absorb energy
Biomechanics of Walking
(Gait)

Goal 1
 The first goal of walking is to move
the body forward toward a desired
location and at a desired speed.

Goal 2
 The second goal of walking is to use
the least amount of energy
Goal 3

 Thethird goal is to cause the least

amount of pain for people with
painful foot conditions.

 The brain has a variety of strategies

for achieving this goal
Goal 4

 The fourth goal for walking is for the

foot itself to act as a shock absorber
for dispersing the force of the body
as it lands.
Goal 5

 The fifth goal is for the foot to form a

rigid lever toward the end of the
phase of gait where the foot is on
the ground, in order to provide a way
to propel the body forward.
 Thereare a number of joints in the
foot and ankle that move during
walking. However, two “joints”
serve critical functions during normal
walking.
Ankle and Transverse Tarsal Joints

 These two joints are the ankle joint

and the transverse tarsal joint.

 In fact, the transverse tarsal joint is

not a single joint but rather the
combination of the talo-navicular
and the calcaneo-cuboid joint.
subtalar joint
 Alongwith the subtalar joint, it
allows the foot to have some side to
side motion and thereby
accommodate uneven terrain.
Ankle Joint

 Thisjoint allows the foot to move up

(dorsiflexion) and down
(plantarflexion)
Heel Strike-Early Flatfoot

The anterior compartment is most active

 Tibialis anterior
 Extensor hallicus longus
 Extensor digitorum longus work to gently
lower the foot onto the ground.
Late Flatfoot-Heel Rise

 As the body’s center of gravity

passes over the foot, the posterior
compartment muscles begin to
contract.

 This contraction of the calf muscle

serves to control the body
movement as it goes forward, so
that the body does not fall forward.
Gait initiation begins in:
Muscles Action for gait initiation
 Activation of erector spinae for
standing posture
 Hip extensors/flexors
 activation of the tabilais anterior and
vastus lateralis muscles
 inhibition of the gastrocs muscles,
 bilateral concentric contraction of
the tabilais
 Abduction of the swing hip
GAIT INTIATION
 Support limb hip and knee flex a few
degrees 3-10 degree,

 The Gait initiation activity ends when either

the stepping or swing extremity lifts off the
ground or when heel strike the ground.

 Total duration of the initiation phase is

about 0.64 seconds.
Path of Center of Gravity

 Center of Gravity (CG):

 midway between the hips
 Few cm in front of S2

 Leastenergy consumption if CG
travels in straight line
CG
 Path of Center of Gravity

A. Vertical displacement:
 Rhythmic up & down
movement
 Highest point: midstance
 Lowest point: double support
 Average displacement: 5cm
 Path: extremely smooth
sinusoidal curve
 Path of Center of Gravity

B. Lateral displacement:
 Rhythmic side-to-side
movement
 Lateral limit: midstance
 Average displacement: 5cm
 Path: extremely smooth
sinusoidal curve
NORMAL WALKING

 For normal walking:

 Hip: ROM approx. 20-30 degree of
flexion and extension
 Knee: ROM, 0 degree to 60 degree of
flexion
 Ankle: ROM, 25 degree planter
flexion to 7 degree dorsiflexion
*** If ROM of the above joint are not sufficient than
considerable deviation will occur from the normal
gait
Preferred Rate of
Ambulation
 Free or comfortable walking speed
 Self-selected pace
 Rate at which the normal individual
is most energy efficient
 Range: ~2.5 - 4.0 mph (cadence of
~75 - 120 steps per minute)
 varies from individual-to-individual
Walking Rates - Historical
Perspective
 Historically walking rates classified
as:
 Slow: ~75 - 90 steps per minute
 Medium: ~90 - 105 steps per minute
 Fast: ~105 - 120 steps per minute
Energy Cost vs. Rate
Summary & Interpretation

 Oxygen expenditure is least while

walking at a rate somewhere
between ~85 to 110 steps per
minute irrespective of stride (or step)
length

 Individualstend to gravitate toward

a self-selected pace which is most
energy efficient for that individual
Enter - The Idea of a
‘Preferred Rate’
A preferred rate of ambulation is
a self-selected walking pace that an
individual assumes that is most
energy efficient
Clinical Implication
 Since there is apparently a rate-
dependent issue that drives gait
efficiency the PT should understand
that going slower than and faster
than the preferred rate will lead to
inefficiency and potential stress on
the cardiovascular and motor control
systems
The Control of Gait
 Motor control options:
 ‘Manual’ control theory - thinking about
having to take a step each time you
want to advance the foot forward
 ‘Automatic control theory - an automatic
control system that accounts for gait
mechanics without having to think about
foot placement and other metrical
details
Central Pattern Generator
(CPG)
 CPG - a group of synaptic
connections probably at the spinal
cord level which are triggered by an
event or condition

 When a threshold is met via a

triggering mechanism the CPG
appears to be activated and takes
over automatic control of gait
metrics - i.e., you don’t have to think
Evidence
 Spinalized(cord transected) cats
suspended over a treadmill will walk
with an alternating, striding
quadripedal gait

 Human quadriplegics have also

“walked” this way
CPG and Supraspinal
Influence
 Gait perturbations
 Example: Someone walks across your
path from the side that you didn’t see
 There’s a need to take immediate
corrective action to avoid a collision
 Supraspinal centers appear to over-
ride the CPG and switch to a ‘manual
control’ strategy
What Triggers a CPG?
 There seems to be a close
relationship between activating a
CPG for gait control and preferred
rate of ambulation

 In
other words, there is a rate-
dependent relationship between
normal gait mechanics and its
control mechanism