GAIT ANALYSIS & GAIT TRAINING
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Identify phases of the gait cycle
Differentiate between stride and step length
Introduce common pathological gait patterns
Define terms used to describe normal gait
Identify joint specific gait abnormalities in lower
extremities
 Gait is one of the most basic components of
independent function
 A common goal of rehabilitation is to restore or
improve the ambulatory status of a patient
 Purpose of Gait Analysis:
 Assist with understanding the gait characteristics
of a particular disorder
 Assist with movement diagnosis
 Determine proper interventions
 Evaluate the effectiveness of treatment
 The gait cycle begins when the heel of the
reference extremity contacts the supporting
surface and ends when the heel of the same
extremity contacts the ground again
 The gait cycle is divided into two phases:
 Stance –
 The interval in which the foot is on the ground
(60% of the gait cycle)
 Swing –
 The interval in which the foot is not in contact with
the ground (40% of the gait cycle)
 Refers to the interval in a gait cycle in which
body weight is transferred from one foot to the
other and both right and left feet are in contact
with the ground at the same time
 Two periods of double support occur within a
single gait cycle
Traditional Terminology
Rancho Terminology
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Heel strike
Footflat
Midstance
Heel-off
Toe-off
Initial contact
Loading response
Midstance
Terminal stance
Preswing
Traditional Terminology
Rancho Terminology
 Acceleration
 Midswing
 Deceleration
 Initial swing
 Midswing
 Terminal swing
 Refer to O’Sullivan (pg.
255) for differences
between the two
terminologies
 Heel strike to foot flat
 Foot flat through midstance
 Midstance to heel off
 Heel off to toe off
 Normal Motion:
 0 -15 degrees PF
 Normal Muscle
Activity:
 Eccentric contraction
of tibialis anterior
 Result of Weakness:
 Lack of PF causes the
foot to slap the floor
 Normal Motion:
 15 degrees PF to 10
degrees DF
 Normal Muscle Activity:
 Gastroc and soleus
muscles act eccentrically
 Result of Weakness:
 Excessive DF and
uncontrolled tibial
advance
 Normal Motion:
 10-15 degrees of
dorsiflexion
 Normal Muscle
Activity:
 Gastroc and soleus
contract eccentrically
 Result of Weakness:
 Excessive DF and
uncontrolled forward
motion of tibia
 Normal Motion:
 15 degrees DF to 20
degrees PF
 Normal Muscle Activity:
 Gastroc, soleus,
peroneals, and flexor
hallicus longus contract
to PF the foot
 Result of Weakness:
 No roll off. Decreased
contralateral step
 Acceleration to midswing
 Midswing to deceleration
 Normal Motion:
 Dorsiflexion to neutral
 Normal Muscle Action:
 Dorsiflexors are contracting to bring the ankle
into neutral
 Result of Weakness:
 Foot drop and/or toe dragging
 Normal Motion:
 Neutral
 Normal Muscle Action:
 Dorsiflexion
 Result of Weakness:
 Foot drop and/or toe dragging
 What happens at the knee during the stance
phase and swing phase of gait?
 Tables 10.4 and 10.5
 Page 323 in O’Sullivan
 What happens at the hip during the stance
phase and swing phase of gait?
 Tables 10.6 and 10.7
 Page 324 in O’Sullivan
 Stride Length
 The distance between corresponding contact
points of the same foot (e.g., distance from heel
strike to heel strike of the same foot)
 Step Length
 The distance between corresponding contact
points of opposite feet (e.g., distance from heel
strike of one foot to heel strike of the opposite
foot)
 Stride Width
 The lateral distance between the feet
(continued)
 COG located at S1 - S2
 During preferred rate walking the COG
approximates a sinusoidal curve from the:
 Sagittal perspective - no greater than a 2” peakto-valley excursion
 Frontal perspective - no greater than a 2” medialto-lateral excursion
 If the COG deviates too far from the norm
increased energy is required
 Example: Walking with a stiff-knee (“stiff-knee
gait”) while in a brace/cast
 During stance phase the patient will vault over
the fixed foot (especially during mid-stance)
 COG will be deflected higher than the usual 2”
upward vertical displacement with increased
energy cost
 Requirements for normal gait:
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Normal range of motion
Normal and balanced muscle strength
Normal balance
Stabile structures for weight acceptance
Normal control of reciprocal gait pattern both in
symmetry and muscle activation sequence
 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
 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)
 Will vary from individual-to-individual
 Results when a segment is not able to move as
it should
 Common Causes:
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Injury
Weakness, loss of flexibility
Pain
Bad habits
 As a result, compensations occur elsewhere in
the body with resultant effects (stress,
weakness, and further injury)
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Propulsive
Scissors
Spastic
Steppage
Waddling
Trendelenberg
Antalgic
 Leg length
discrepancy
 Circumduction
 Vaulting
 Hip Hiking
 Quadriceps Gait
 Stiff Knee Gait
 Propulsive Gait A stooped, rigid posture, with the head and neck bent
forward; Balance deficit
 Scissors Gait Characterized by legs flexed slightly at the hips and
knees, giving the appearance of crouching, with the
knees and thighs hitting or crossing in a scissor-like
movement
 Spastic Gait A stiff, foot-dragging walk caused by one-sided, longterm, muscle contraction
 Steppage Gait Foot drop where the foot hangs in plantarflexion, toes
can scrape the ground during swing phase;
Exaggerated hip and knee flexion used to clear toes
 Waddling Gait –
 A distinctive duck-like walk; trunk sways side to side;
wide base of support
 Trendelenburg Gait Weakness of the hip abductor muscles; pelvis drops
on the contralateral side with compensatory lateral
trunk lean over that side
 Antalgic Gait Pattern- A protective gait pattern
 Stance time is usually limited on the painful limb
resulting in uneven timing and/or uneven step
lengths
 The uninvolved limb will demonstrate a shortened
step length since it must bear weight sooner than
normal
 Pain promotes a modification of the gait pattern to
avoid joint motions, muscle contraction and
weight bearing that sustains or may increase the
pain
 Functional Leg length discrepancy –
 The pelvis dips downwards on the side of the
shortened limb with compensatory lateral trunk bend
 Circumduction Secondary to hip flexor weakness; adductor muscles
act as hip flexors while the hip joint is extended
 Hip hiking Pelvis lifts on the side of the swinging limb by
contraction of spinal muscles and lateral abdominal
wall; may also see posterior trunk lean
 Vaulting Used to increase ground clearance in swing
phase by going up on the toes of the stance
phase leg
 Stiff knee Gait –
 During stance the patient will vault over the fixed
foot (especially during mid-stance) & COG will be
deflected higher than the usual 2” upward vertical
displacement
 Gluteus Medius Gait – (Trendelenburg Gait)
 Pelvis drops on contra-lateral non-weight bearing side
 Compensation – patient moves trunk laterally over the
weak hip
 Quadriceps Gait – (weakened Quads)
 An immediate lurch occurs at heel strike forcing the
femur backward & the trunk forward to passively lock
the knee
 Compensation – COG moves anterior to the knee
with increased forces at the knee joint & hip extensors
 The knee often buckles during this gait pattern
 Normal Strength Prevent contra-lateral hip from dipping greater
than 5-8 degrees
 Stance-side abductor muscle group is active
 Loss of abductors:
 Positive Trendelenburg sign
 Weakness of abductors manifests as ‘lurching
gait’ (toward stance side)
 Early stance (Heel
strike – Foot flat)
 Guides knee into 20
degrees of flexion
eccentrically (controls
unlocking of the knee)
 Late stance (Heel off –
Toe off)
 Controls for knee flexion
(~40 degrees at TO)
 Early stance
weakness/absence
 Inability to absorb
energy
 Buckling
 Late stance
weakness/absence
 Knee collapse into
flexion -premature
flexion into early swing
 Early stance (HS FF) & late stance (HO
- TO)
 Prevent forward
flexion of trunk acting
on pelvis
 Early & late stance
weakness/absence
 Trunk falls forward
 Loss of head and neck
control
 Early stance (HS)
 Prevent hip flexion
(jack-knifing)
 Early stance (HS FF)
 Guide hip into flexion
eccentrically
 Early stance (HS)
weakness/absence
 Hip/trunk collapses
into flexion
 Early stance (HS FF)
 Trunk falls forward
 Early stance (HS FF)
 Lowers forefoot to
floor eccentrically
 After forefoot contacts
floor- pull tibia forward
over foot
 Early stance
weakness/absence
 Forefoot slaps to the
floor - ‘drop-foot’ gait
 Loss of forward pull of
tibia
 Late mid-stance
 Concentrically pulls
tibia forward
 Late stance (HO - TO)
 Provides propulsive
thrust during push off
 Early stance
weakness/absence
 Loss of forward pull of
tibia
 Loss of forward thrust
- poor transition to
early swing
 Late mid-stance
 Concentrically pulls
tibia forward
 Late stance (HO - TO)
 Provides propulsive
thrust during push off
 Early stance
weakness/absence
 Loss of forward pull of
tibia
 Loss of forward thrust
- poor transition to
early swing
 Late stance (HO - TO)  Late stance
weakness/absence
 Dynamically provide
collateral stability to
ankle when plantar
flexed
 Secondary plantar
flexor for forward
thrust
 Ankle instability
causing medial-lateral
movement
 Potential for ankle
injury - sprains
 Poor transition from
late stance to early
swing
 Late stance (HO - TO)  Late stance
weakness/absence
 Provide medial lateral stability to MTP
joints (especially nos.
1 & 2)
 Improves forward
propulsion and
transition to early
swing
 Excessive medial lateral ‘shimmy’ of
hindfoot during HO
 Inefficient forward
thrust
 Late stance - early
swing (acceleration)
 Forward flexion of
femur working with
plantar flexors to
accelerate LE in early
swing
 Functionally shortens
LE (with eccentric
action of quadriceps
and dorsiflexors) to
prevent ‘toe-drag’
 Late stance - early
swing
weakness/absence of
forward acceleration
after TO
 Toe may not clear the
floor during swing
through
 Compensate with
circumduction at hip
 Mid-to-late swing
(deceleration)
 Affects ‘toe-up’
concentrically
 Functionally shortens
LE during swing
through
 Mid-to-late swing
weakness/absence
 Loss of ‘toe-up’
 Compensation
 Increased hip flexion ‘steppage gait’
 Circumduction at hip
 Late swing
(deceleration)
 Decelerates tibial
shank
 Provides for smooth
transition between late
stance and early swing
 Late swing
weakness/absence
 ‘Impact on terminal
extension’ - knee
slapped into extension
or hyperextension
 ROM – for any joint motion restriction
 Stretching – for soft tissue restriction or shortened
muscle groups
 Strengthening for weakened musculature
 Gait training to address specific deviations
 May need temporary or permanent AD if deviations
are significant
 Balance training
 HEP Instruction / Patient Education
 Modalities – as needed
 Orthotics
 Heel lift, or shoe build up for leg length
discrepancies or foot drop
 Appropriate assistive device
 Functional activity training
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Gait belt
Proper guarding techniques
Proper lighting
Clear unobstructed path
Proper shoe wear
Adherence to weight bearing status
Use of appropriate device that has been
fitted/measured for the patient
 Patient’s cognitive status
 Why could this statement be detrimental to your
83 y.o. patient?
 Mrs. Jones, while you’re walking, I want to go…”
“...very slow!”
 Mr. Jones will be safe - probably won’t fall and
break her hip
 The path of the COG may be distorted
 Energy cost
 Suppose Mrs. Jones has a cardiac condition?
 Mr. Jones’ gait may never return to ‘normal’
 …going very slow might actually cause Mrs.
Jones to lose her balance and fall?
 How?
 Mrs. Jones may never reach her preinjury/disease preferred rate of ambulation and
therefore never trigger a CPG that automates gait
 What is a CPG?
 A group of synaptic connections at the spinal
cord level which are triggered by an event or
condition (perturbation)
 When a threshold is met via a triggering
mechanism the CPG appears to be activated
and takes over automatic control of gait metrics
(the individual does not have to think about it)
 Are all patients’ objectives/goals the same?
 Are your objectives for Ms. Walksalot, a 39 year
old healthy female who broke her ankle two
weeks ago in an intensive tennis match, the
same as…
 Mr. Livesinathirdstorywalkup, a frail 87 year old
male, with emphysema and a fractured hip?
 It is important to keep the objectives/goals in
mind during gait training
 Various assistive devices are available for use
during gait/ambulation activities
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Parallel bars
Walkers
Bilateral & unilateral crutches
Canes (single point, quad)
 Remember it is very important to properly guard
your patient during gait training while using an
assistive device in the clinic
 Progression from assistive device to normal gait
 Progress from assistive device with large base of
support to small base of support
 2 Axillary crutches or 2 Lofstrand crutches  1
Axillary crutch or 1 Lofstrand or 1 Straight cane
 Hemi-walker  Straight cane
 Walker  Quad Cane
 Document any deviations noted during gait
training
 Did gait appear vigorous or labored?
 Was gait guarded or restrained – was the patient
attempting to gain stability and security?
 Was the toe/floor clearance distance slightly
decreased?
 Was there decreased reciprocal arm swing?
 Was there decreased step and/or stride length?
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Narrow or wider dynamic base of support?
Increased lateral head movement?
Increased or decreased rotation of pelvis?
Any abnormal or pathological gait patterns noted?
Gait distance / endurance
Any shortness of breath or other physiological
reactions
 Any episodes of loss of balance?