Gait Cycle- Gait pattern and some postural dysfunctions.pptx

This is about the gait cycle, how to visualize and assess gait pattern and, upper and lower crossed syndrome and more...

1. Gait Cycle Hossein Khorrami, Ph.D. DOMP www.slideshare.net/khorrami4

2. Factors Influencing Gait Musculoskletal muscle, tendon, ligaments Joint, bones Soft tissue, fascia Neurological issues Central, basal ganglia, cerebellum,.. Peripheral

3. Factors Affect Gait Pattern Nervous system, CNS, PNS Muscle issues, Tender point, trigger point, spasm, FM, plantar fasciitis.. Joint issues, bone, ligament, tendon Anatomy External Other

4. Basic Gait Terms Base of gait(walking base, stride width) Standing feet distance or during walking Balance, stability & erect posture 2-4 inches heel to heel

5. Angle of Gait Almost 7 o In-toeing Out-toeing

6. Step length Stride length Cadence: Steps or strides-cycles/min Walking base: Stride width or distance between line of feet Degree of toe out: ~7 o , decreases with speed

7. Stride Length vs Step Length Stride length: Distance between successive ground contact of the same foot Distance from the heel of right foot (starting position) to the heel of right foot (ending position) Average: 150cm(5ft) Step length: distance from the heel of right foot to the heel of left foot Average: 75cm(2.5ft)

8. Gait Phases Stance phase : Consists of the entire time that a foot is on the ground Swing phase : Consists of the entire time that the foot is in the air

9. gf

10. Stance Phase Initial contact(heel strike) Foot flat(loading response) Mid stance Terminal stance(heel off) Toe off(pre swing)

11. Stance Intervals Initial double support: 10% Single support: 40% Terminal double support: 10% So 40% single & 20% double support

12. Swing Phase Initial swing(acceleration) Mid swing(vertical tibia) Terminal swing(deceleration)

13. Temporal & Spatial Variables

14. Stance Phase Initial contact( heel strike) Muscular contractions Hip extensors to stabilize the hip Eccentric contraction of quadriceps Isometric & Eccentric contraction of tibialis anterior

15. Stance Phase Loading response(initial double limb support) occurs after initial contact until elevation of opposite limb bodyweight is transferred on to the supporting limb Eccentric cont. of tibialis ant, dorsiflexion to control plantar flexion Quads contraction to stabilize knee

16. Stance Phase Mid stance from elevation of opposite limb until both ankles are aligned in coronal plane Concentric contraction of G. Medius & calf muscles Eccentric contraction of pelvic & hip flexors

17. Stance Phase Terminal phase begins when the supporting heel rises from the ground and continues until the opposite heel touches the ground Toe flexor & tibialis ant, eccentric hip flexor, concentric plantar flexors

18. Stance Phase Pre-swing(second double limb support) from initial contact of opposite limb to just prior to elevation of ipsilateral limb Hip flexor to propel advancing limb

19. Swing Phase Initial swing ( toe off) start of single limb support for opposite limb from elevation of limb to point of maximal knee flexion hip flexors concentrically contract to advance the swinging leg, concentric tibialis ant.

20. Swing Phase Mid-swing (foot clearance) following knee flexion to point where tibia is vertical ankle dorsiflexors contract to ensure foot clearance

21. Swing Phase Terminal swing (tibia vertical) from point where tibia is vertical to just prior to initial contact hamstring muscles decelerate forward motion of thigh

22. Gait Cycle Variables Pelvic ant/post tilt Pelvic rotation pelvis rotates 4 degrees medially on swing side lengthens the limb as it prepares to accept weight Pelvic tilt pelvis drops 4 degrees on swing side lowers COG at midstance Lateral displacement of pelvis pelvis shifts over stance limb  COG must lie over base of support (stance limb)

23. Gait Cycle Variables Knee flexion in stance Lowers COG, decreasing energy expenditure Also absorbs shock of heel strike Early knee flexion (15 degrees) at loading response   At midstance, the knee extends  as the ankle plantar flexes and foot supinates Restores leg to original length Reduces fall of pelvis at opposite heel strike

24. Gait Cycle Variables Center of gravity (COG) in standing position is 5cm anterior to S2 vertebral body vertical displacement during gait cycle COG displaces vertically in a rhythmic pattern the highest point is during midstance phase lowest point occurs at the time of double limb support horizontal displacement COG displaces 5cm horizontally during adult male step

25. Variables Ground Reaction Forces(GRF) Ankle, knee, hip ACL Acetabulum Upper limb frequency Low speed: stepping frequency (2:1 ratio of arm to leg) Higher velocity: stride frequency (1:1 ratio of arm to leg)

26. Stance Phase Initial contract( heel strike) Hip external rotation Tibia internal rotation (popliteus muscle) Ankle- foot, supination, plantar flexion

27. Stance Phase Loading response(initial double limb support) Hip internal rotation Knee flexion, 20 degrees Tibia internal rotation Ankle- foot, pronation plantarflexion

28. Stance Phase Mid stance Hip neutral Knee extend Tibia neutral Ankle- foot, almost neutral, 3 o dorsiflexion

29. Knee

30. Stance Phase Terminal phase Hip external rotation Tibia external rotation Ankle- foot, supination, 15 o plantar flexion(max)

31. Stance Phase Pre-swing(second double limb support) Hip external rotation Tibia external rotation Ankle- foot, supination, 20 o plantarflexion

32. Compensations Hip tightness To keep stride length compensate with: more anterior & posterior pelvis tilt Excessive stress of lumbar spine

33. Compensations Hi heel shoes To keep stride length compensate with: more knee flexion Excessive stress of knee joint

34. Q-Angle

35. Q- angle Normal Q-angle: 10 o -15 o >20 o is pathologic Male average: 14 o Female average: 17 o

36. Women naturally have a larger Q-angle than men In addition, women have increased hip adduction, hip internal rotation, knee valgus, and the internal rotation during functional activities such as running and walking as compared to men

37. Valgus vs Varus

38. Flat Feet Congenital Asquired, structural changes, occurred over time All babies have flat feet Arches typically form by age 6

39. Flat Feet Flexible Rigid Adult Acquired(Fallen arches) Vertical Talus

40. Flat Feet, Risk Factors Achilles tendon injuries Broken bones Cerebral Palsy(CP) Diabetes Down syndrome Hi BP Obesity Pregnancy RA Soccer, basketball

41. Flat Feet, Causes Posterior Tibial Tendon Dysfunction(PTTD)

42. Tarsal Bones Tarsals: 7 bones Calcaneus Talus Navicular Medial cuneiform Intermediate cuneiform Lateral cuneiform Cuboid Foot contains: 26 bones 33 joints 100 tendons, muscles & ligaments

43. Flat Feet, Sign & Symptoms Leg cramp Foot pain, particularly heel and arch area Muscular pain Toe drift(point outward)

44. Hip Stabilizers

45. G. Medius, dual function

46. Arthrogenic Gait Stiff hip or knee or ankle due to stiffness, laxity or deformity Joint related pathologies (examples of joint pathologies are osteoarthritis , hip joint problems such as avascular necrosis of the femoral head, rheumatoid arthritis, etc…)

47. Crossed Syndrome Dr. Vladamir Janda (1928-2002), a Czech physician, developed the “crossed syndrome” theory in 1979

48. Crossed Syndromes The postural distortion pattern known as upper crossed syndrome It involves: Thoracic hyperkyphosis Hypolordosis of the Cervical Spine  Hyperextension of the head upon the atlas at the atlanto-occipital joint Forward head carriage Protraction of the shoulder girdles Internal rotation of the arms at the GH joint

49. Common causes of Upper Crossed Syndrome (history of injury) Weakness in the neck flexors Weakness in the serratus anterior Weakness in the lower trapezius Tightness in the upper trapezius Tightness in the levator scapulae Tightness in the pectoralis major Tightness in the sternocleidomastoid

50. Common situations with Upper Crossed Syndrome Discomfort is increased the longer the body maintains a fixed posture, but it is relieved when the body is moved Only specific movements or angles generate pain, whereas other movements do not

51. Muscle symptoms of Upper Crossed Syndrome Upper Crossed Syndrome typically involve the following symptoms and a two-aspects evolution stage of strength impact: First aspect : symptoms perceived from mild to severe Tightness → soreness → soreness and pain → dull pain → stabbing pain → tearing pain → loss of sensation Second aspect : muscle strength impact from mild to severe, represented by a scale of 5 to 0, as follows: 5 points: can resist gravity, complete all joint range of motion, and resist maximum resistance 4 points: can resist gravity, complete all joint range of motion, and resist partial resistance 3 points: can resist gravity and complete all joint range of motion 2 points: complete all joint range of motion on a flat plane without gravity 1 point: no movement, but muscle contraction can be palpated 0 points: no movement and no muscle contraction

52. Risk factors for Upper Crossed Syndrome Poor posture; long periods of sitting, bending and hunching over, habitual side sleeping, inadequate muscle flexibility, over-exercising, etc Structural abnormalities; leg length discrepancies, flat feet, pelvic misalignment, scoliosis, fractures, trauma, post-surgery, etc Other factors; poor circulation, irregular exercise, tissue adhesion, scars, etc. Technologies!

53. In adaptive shortening of cervical spinal musculature as part of upper crossed syndrome, SCM is particularly relevant SCM crosses middle and lower cervical spinal joints anteriorly so it flexes middle and lower cervical spine But it crosses the upper cervical spinal joints, especially the atlanto-occipital joint, posteriorly, so it extends the head at the AOJ For this reason, the SCM is adaptively shortened and tightened with both the hypolordosis of the (lower and middle) cervical spine and with the hyperextension of the head at the AOJ

54. Ligament Creep

55. Common causes of Lower Crossed Syndrome (previous injury) Weakness in the rectus abdominis muscle Weakness in the transverse abdominis muscle Weakness in the oblique muscles Weakness in the gluteus maximus muscle Weakness in the posterior fibers of the gluteus medius muscle Tightness in the anterior fibers of the gluteus medius muscle Weakness in the muscles surrounding the tibialis anterior Tightness in the erector spinae muscles (including the iliocostalis lumborum, longissimus thoracis, and spinalis thoracis) Tightness in the quadratus lumborum muscle Tightness in the psoas muscle Tightness in the rectus femoris muscle

56. Tight hip flexor musculature excessive anterior tilt of the pelvis hyperlordosis of the lumbar spine hyperkyphosis of the thoracic spine hypolordosis of the lower neck with hyperextension of the head at the atlanto-occipital joint forward head carriage tight posterior neck muscles Headache

57. Common situations with Lower Crossed Syndrome Discomfort increases the longer the fixed posture is maintained, but is relieved to some extent when the body moves Pain is only felt when specific movements or angles are used, and not with other movements

58. Muscle symptoms of Lower Crossed Syndrome The muscle symptoms of Lower Crossed Syndrome usually have the following symptoms and two-dimensional evolutionary stages of strength impact: First aspect : Symptoms go from light to severe Tightness → Soreness → Soreness and pain → Dull pain → Stabbing pain → Tearing pain → Numbness Second aspect : The impact of muscle strength goes from light to severe, expressed in 5-0 points: 5 points: Can resist gravity, complete all joint movements, and resist the greatest resistance 4 points: Can resist gravity, complete all joint movements, and resist partial resistance 3 points: Can resist gravity, complete all joint movements 2 points: Complete all joint movements on a gravity-free plane 1 point: No movement on a gravity-free plane, but muscle contraction can be palpated 0 points: No movement, and no muscle contraction

59. Risk factors for Lower Crossed Syndrome Poor posture, prolonged sitting, bending over, hunchback, habitual side-sleeping, insufficient muscle flexibility, and overcompensation due to excessive exercise, etc Structural abnormalities, leg length discrepancy, flat feet, pelvic misalignment, scoliosis, fractures, post-surgery, etc. Others, poor circulation, irregular exercise, tissue adhesion, scarring, etc. Lower Crossed Syndrome is located in the lower torso, and those who lack training, overuse their iliopsoas muscles (from sitting for long periods), poor posture