Gait Analysis: Qualitative vs Quantitative What are the advantages and disadvantages of qualitative and quantitative gait analyses?

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Teresa Mosley
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1 Gait Analysis: Qualitative vs Quantitative What are the advantages and disadvantages of qualitative and quantitative gait analyses? Basics of Gait Analysis Gait cycle: heel strike to subsequent heel strike, for the same heel Phases: 1. stance (0-60%) 2. swing (60-100%) Tasks: 1. weight acceptance (0-10%) 2. single limb support (10-50%) 3. double-limb support (50-60%) 4. swing (60-100%) Strides and steps Basics of Gait Analysis Hip, knee, and ankle sagittal-plane kinematics Hip, knee, and ankle sagittal-plane kinetics Corresponding electromyography Common Gait Pathologies 1. Hip abductor weakness (Trendelenburg) 2. Lack of terminal knee extension 3. Lack of dorsiflexion 4. Hyperpronation Impairment #1: Trendelenburg Gait Trendelenburg: Related Impairments/Pathologies Hip Musculature Weakness Hip Osteoarthritis Overuse: IT Band Friction Syndrome PF Pain Bursitis Low Back Pain Knee Injury/Surgery Lateral Ankle Sprains 1

2 Trendelenburg Gait: Possible Effects Observations: Pelvic tilt, adducted femur, valgus knee Trendelenburg Trendelenburg Trendelenburg AROM Hip Abductor Exercise Functional Functional closed-chain exercises for the hip (University of Kentucky Athletic Training) 2

Functional Lateral step-ups Functional Balance Other

progression Impairment #2: A Lack of Terminal Knee

gait? Begins at ~5 flexion at initial contact, and

~5 prior to swing Begins to flex prior to swing;

Impairments/Pathologies Stiff Hamstrings or

3 Functional Lateral step-ups Functional Balance Other progressions: Flex hip Lean anteriorly Functional Cone Drills: Intermediate. Implement a ball for the advanced phase of progression Impairment #2: A Lack of Terminal Knee Extension (TKE) What is normal knee motion during gait? Begins at ~5 flexion at initial contact, and flexes to ~20 through single limb stance Returns to ~5 prior to swing Begins to flex prior to swing; maximal flexion is ~70 through swing TKE: Related Impairments/Pathologies Stiff Hamstrings or Plantarflexors Weak Quads ACL Injury Meniscal Damage Inflammation Pain Does it really matter? What are the implications? 3

1 4 7 Experimentally Induced Knee Pain Does knee pain alter joint mechanics in a way that may promote osteoarthritis?

Torque 0.06 10 0.05 0 0.04-10 0.03-20 0.02 Control -30 0.01 Isotonic -40 Hypertonic 0-50 -0.01-60 -0.02-70 -0.

37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 100 1 4 7 1 4 7 Sagittal-plane Knee Angle Control Isotonic

03 Lack of Terminal Knee Extension Frontal-plane Net Knee Torque Control Isotonic Hypertonic Hypomobile Hamstrings or

4 1 4 7 Experimentally Induced Knee Pain Does knee pain alter joint mechanics in a way that may promote osteoarthritis? Lack of Terminal Knee Extension Lack of Terminal Knee Extension Lack of Terminal Knee Extension Sagittal-plane Net Knee Torque Control Isotonic -40 Hypertonic Sagittal-plane Knee Angle Control Isotonic Hypertonic Lack of Terminal Knee Extension Frontal-plane Net Knee Torque Control Isotonic Hypertonic Hypomobile Hamstrings or Gastrocnemius What can be done? What are the stretch choices? Which is the best choice? What actually happens to a stretched muscle?

AROM for Knee Flexors and Extensors AROM

exercises can be performed using similar

isotonic knee extensions focusing on the

5 AROM for Knee Flexors and Extensors AROM for Knee Flexors and Extensors PROM exercises can be performed using similar motion; patient can use a towel or theraband to move the joint through the complete ROM. PROM exercises can be performed using similar motion; patient can use a towel of theraband to move the joint through the complete ROM. Quad Weakness: Strengthening Open-chain, isotonic knee extensions focusing on the end of the ROM Quad Weakness: Strengthening Open-chain, isotonic knee extensions focusing on the full ROM Quad Weakness: Strengthening Open-chain, isokinetic knee extensions are helpful; exercises can be practiced at angular velocities and ROMs representative of gait More Strengthening A closed-chain strength exercise for terminal extension (University of Kentucky Athletic Training) 5

6 Quad Weakness: Functional Standing Mini Squats Quad Weakness: Functional Step up progression (University of Kentucky Athletic Training) Quad Weakness: Functional Resistive reverse walking Functional Balance Forward and rearward treadmill walking, progress by increasing speed and decreasing upperextremity support Quad Weakness: Functional Reverse stair climbing Quad Weakness: Functional Star exercise is an activity that allows the patient to objectively observe improvements (University of Kentucky Athletic Training) 6

Ankle Sprain Achilles Tendinitis Various Fractures of the shank Shortened Achilles/Gastroc Complex Plantar Fasciitis can be related Neutral position, throughout swing What might it

7 Quad Weakness: Functional Lunges Impairment #3: A Lack of Dorsi or Plantarflexion (DPF) What is normal? 5-10 plantarflexion, immediately following initial contact 10 dorsiflexion, at weightbearing 20 plantarflexion, at pushoff DPF: Why does it occur? Ankle Sprain Achilles Tendinitis Various Fractures of the shank Shortened Achilles/Gastroc Complex Plantar Fasciitis can be related Neutral position, throughout swing What might it cause? Compensation at the hip and knee can leads to additional chronic injuries DPF: AROM for the Gastroc and Soleus A lack of toe clearance may cause additional ankle injuries PROM exercises can be performed using similar motion; patient can use a towel or theraband to move the joint through complete ROM. 7

no upper-extremity support and perturbation

motion; patient can use a towel of theraband

DPF: Functional Balance Exercise Toe walking

DPF: Functional Balance Walk a narrow line,

Balance Controlled sway forward and backward,

8 DPF: AROM for the Dorsi Flexors DPF: Functional Balance Exercise Heel raises, progress from no perturbation and upper-extremity support on a rail or table to no upper-extremity support and perturbation PROM exercises can be performed using similar motion; patient can use a towel of theraband to move the joint through the complete ROM. DPF: Functional Balance Exercise Toe walking (University of Kentucky Athletic Training) DPF: Functional Balance Walk a narrow line, slowly placing one foot in front of the other; focus upon a proper heel strike, stance phase, and toe-off DPF: Functional Balance Controlled sway forward and backward, progress with perturbations and implementing heel raises Impairment #4: Hyperpronation 8

9 What is normal, and why does it occur? ~ 5-10 of pronation at weightbearing; for shock absorbtion purposes Video ~ 10 of supination at pushoff; for torque production purposes Why does the impairment occur? Flat feet Overly compliant feet Weak supinators: soleus, plantaris, gastroc, tibialis posterior Lower-limb malalignment What might it cause? Various pathologies including, Chronic, varied tendinitis Abnormal wear at the ankle and knee Stress fractures at the shank Muscle Strengthening for Hyperpronation Strengthen the supinators and tibialis anterior: ankle inversion (theraband) side-lying inversion, using ankle weight single-leg stance, balance progressions Mechanical Means Orthotics are also effective Shoe characteristics for overpronators: Straight-shaped outer sole Board construction of the inner sole Firm Heel Firm Midsole toe raises 9

Jozef Murar, M.D. TCO Edina Crosstown 4010 W 65 th St, Edina, MN Tel: Fax:

Jozef Murar, M.D. TCO Edina Crosstown 4010 W 65 th St, Edina, MN 55435 Tel: 952-456-7000 Fax: 952-832-0477 www.tcomn.com ACHILLES TENDON REHABILITATION PROTOCOL Pre-op: Gait training Post-op: Week 2 Post-op