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Therapeutic Kinesiology:Musculoskeletal Systems, Palpation, and Body Mechanics
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Description
Chapter 8 Notes
Transcript
Therapeutic Kinesiology Instructor Manual: Ch08 p.1
TK INSTRUCTOR MANUAL: CHAPTER 8
Gait
Chapter manuals include:
Objectives
Lecture Notes
Suggested Classroom and Student Development Activities
For other chapter-by-chapter resources, see:
Key Term Quizzes
Muscle Origin and Insertion Worksheets
Muscle OIAs List by Chapter
MyTest Test Bank
For additional resources see “Teaching Tips and Tools”:
7 research-based learning principles for kinesiology courses in massage
5-step self-directed learning cycle for body mechanics courses
Tools that build metacognitive skills: e.g., concept (mind) maps, grading rubrics, and self-assessments inventories
OBJECTIVES
Define gait and name another term for gait.
Name and define the two phases of gait patterns and the subphases of each.
Describe the difference between walking and running.
Define step, stride, and step width and the average length of each one.
Define cadence and describe three different levels of cadence in gait.
Describe how the pelvis moves in each plane during a normal walking gait.
Discuss the dynamics of contralateral motion in the limbs and trunk.
Discuss the role of fall and recovery in gait.
Describe the three functions of muscles in the lower limbs during gait.
Define an antalgic gait and describe how it can be treated with massage and bodywork.
List and describe five antalgic gait patterns.
List four atypical gait patterns caused by joint dysfunctions and describe each one.
Define an ataxic gait and describe two types of ataxic gait patterns.
Describe different approaches to gait assessment.
LECTURE NOTES
COMPONENTS OF GAIT
Gait (ambulation) mechanics underlie all movement patterns
Postural patterns are carried into gait
Gait influenced by psychology and emotional disposition
Gait demonstrates habitual muscle and joint patterns
Rolling through foot
Weight rolls from heel to toes
Weight follows curve pressure path
Rolling through foot important
For weight to load of arches
To create elastic energy and rebound
Stance phase occurs during 60% of walking
Heel strike: Heel contacts ground
Ankle flexes and toes hyperextend
Brief moment of double limb support (20%)
Foot flat: Whole foot contacts with ground
Midstance: Body weight shifts over stance leg
Heeloff: Heel lifts off the ground
Pushoff (toe-off): Toes push off ground
Swing phase occurs during 40% of walking
Early swing (acceleration): Lower limb swings in downward arc
Midswing: Lower limb swings under hip
Late swing (deceleration)
Lower limb swings in upward arc
Knee extends in preparation for heel strike
Step and stride length and width
Step =
Movement between right and left foot
Averages 1518 inches
Stride = Two steps
Averages 3036 inches
Stride = 1 gait cycle
Step width
Distance between right and left heel
Averages 24 inches
Foot angle
Degree of toe-out
Averages 57 degrees
Cadence is the speed of gait
Measured by number of steps per minute
Slow cadence: 7090 steps
Average walking cadence: 100120 steps
Average running cadence: 180 steps
Running gait
Has float moment: When both feet are off ground
Has three phases: stance (40%), swing (60%, float (20%)
Joint motion in lower limbs during stance
Heel strike: Hip flexes 30 degrees, ankle at 90 degrees
Heel strike to foot flat: Ankle plantarflexes 5 degrees
Foot flat to midstance: Body shifts over standing leg
Extensor support moment: Both hip and knee extend
Prevents lower limb from buckling
Heeloff : Ankle dorsiflexes 510 degrees
Pushoff: Toes extend, knee extends, hip hyperextends 1020 degrees
Joint motion in lower limbs during swing
Early swing: Hip and knee fall into flexion, knee flexes 30 degrees
Swing phase: Hip, knee, and ankle flex
Late swing: Hip flexes, knee extends, ankle dorsiflexes
Pelvic movement in each plane
Sagittal plane motion
Pelvis tilts forward and back 5 degrees
Pelvis shifts 2 inches up/over stance leg
Frontal plane motion
Pelvis makes lateral tilt about 1½ inches
Stance leg adducts, swing leg abducts
Horizontal plane motion
Pelvis rotates forward with swing leg
Rotation averages 8 degrees
Trunk rotation and contralateral limb motion
Upper body rotates opposite lower body
Opposing arms and legs swing in opposition
Rotation mediated by crossed extensor reflex
A lightning-quick response
Involves flexion of one leg /extension of other
Reflexive movement cycles of fall and recovery
Walking is a process of losing balance
Catching oneself with a reflexive step
MUSCLE ACTIVITY IN GAIT
Function of each type of contraction
Isometric contractions: Stabilize and support stance phase
Concentric contractions: Accelerates lower limb motion
Eccentric contractions: Decelerates lower limb motion
In lower limb during stance phase
Heel strike
Concentric in hip flexors, knee extensors, dorsiflexors
Eccentric in hip extensors, knee flexors, plantarflexors
Foot flat
Eccentric in dorsiflexors
Concentric in knee flexors
Midstance
Isometric in hip abductors
Isometric in knee extensors, plantarflexors
Heeloff
Concentric in plantarflexors
Eccentric in hip, knee extensors
Pushoff
Concentric in hip extensors, plantarflexors, dorsiflexors
Eccentric in hip flexors, ankle dorsiflexors
In lower limb during swing phase
Early swing
Concentric in hip extensors, knee flexors, dorsiflexors
Eccentric in hip flexors
Midswing
Concentric in knee flexors, dorsiflexors
Eccentric in hip extensors
Late swing
Concentric in hip flexors, knee extensors
In trunk and shoulders
Postural muscles work isometrically to stabilize trunk.
Obliques work concentrically and eccentrically
Stabilize trunk during hip flexion
Rotate trunk
Transfer motion between upper and lower body
Hip and shoulder flexors/extensors coordinate limb swing
ATYPICAL GAIT PATTERNS
Common atypical patterns
Swinging arms sideways, holding shoulders still
Taking extra wide or extra narrow steps
Walking with pigeon-toed stride
Walking with legs toed-out like ballerina
Popping up on toes on each step
Walking with exaggerated lateral hip swing
Genu recurvatum gait: Stance knee locks in hyperextension
Antalgic gait: Self-protective gait pattern to avoid painful range of motion
For example: Occurs with plantar fasciitis or heel spurs
From paresis: Partial muscle dysfunction or paralysis
From plegia: Total muscle paralysis
Muscle dysfunctions in gait
Trendelenburg gait: gluteus medius lurch
Gluteus maximus lurch
Steppage gait (drop-foot gait) from dorsiflexor dysfunction
Psoastic gait
Limitations to joint range of motion
Knee fusion results in:
Circumducted gait or "paddling"
Vaulting gait or "peg-legged"
Neurological effects from damage to cerebellum causes ataxic gait
Main characteristics of ataxic gaits
Hypotonia (low muscle tone)
Hypertonic muscles and spasticity
Types of ataxic gaits
Crouched gait
Scissors gait
Parkinsonian gait
GAIT ASSESSMENT
Benefits of gait assessment
Effective way to study movement patterns
Information from gait can guide bodywork applications
Develops innate pattern-recognition skills
Can be practiced in public
Guideline for gait assessment
Be discrete and respectful
Self-study is recommended
General gait assessment
Observe overall quality of gait
Notice where attention is drawn
Notice underlying posture
Notice energetic or emotional pattern
Notice what moves and what holds
Notice rhythm and cadence
Notice symmetry or asymmetry
Notice dimension and planes of gait aberrations
Specific gait assessment
Observe specific phases of gait
Observe specific parts of body in gait
Assess joint motion
Assess muscle patterns
Therapeutic applications for gait assessments
To assess and improve overall body mechanics
To assess and improve muscle and joint function
SUGGESTED CLASSROOM AND STUDENT DEVELOPMENT ACTIVITIES
PROVIDE AN OVERVIEW OF THE CLASS
Before class, write a short schematic overview of the class on the board, then go over it at the beginning of class. For example:
Today's class covers:
Components of gait
Muscle activity in gait
Atypical gait patterns
Gait assessment
Activities: Review, lecture, gait lab, recap, and homework
GOING OVER GUIDELINES EXERCISES
Working with clients who have balance issues (p. 193)
Intake of clients with antalgic gait patterns (p. 198)
General gait assessments (p. 202)
Specific gait assessments (p. 203)
SELF-CARE EXERCISES
Using a rocker base in massage (p. 186)
Exercises for lower limb alignment (p. 190)
Improving sagittal tracking of the lower limb (p. 197)
GROUP DISCUSSION: About gait pattern recognition
Lead a group discussion about how we sometimes recognize a friend at a distance by the way he or she walks. What is it about gait patterns that make a person recognizable? What does gait reflect? How does a person's emotional state affect gait? Ask for examples. How does posture carry into gait? Ask for demonstrations, perhaps of what they have noticed when watching people, in their practice clients, or in themselves.
GAIT LAB
Have students get into triads to practice gait assessments: one student walks, the second student observes the gait of the walker, and the third student fills out the gait assessment forms provided below. Have students complete three rounds so that each student has an opportunity to fill each of the three roles.
Set ground rules for students to use when giving each other feedback about gait. Emphasis how everyone has something unique and personal about their gait pattern, how gait patterns are somatic (they reflect a person feelings, beliefs, and emotional states), and how important it is to respect the patterns and learn from them, rather than seeing them as a pathology or something to fix.
GAIT OBSERVATION EXERCISE
In class, ask several volunteers to write a paragraph describing the gait pattern they saw, then pick three random papers and have these students present their cases in class. Discuss how pain patterns affect gait (how people usually walk around a painful area rather than moving through it), causing people to limp, walk asymmetrically, and freeze painful area into holding pattern.
Pick several key patterns to discuss:
Whiplash creates rigidity in neck, shoulders, and spine.
Sacroiliac pain causes the pelvis to move like a block.
Restricted sacral movement (nutation and counternutation) results in increased rotation in waist, which can underlie lumbar spine instability and pain.
Pain from plantarfasciitis will prevent rolling through foot.
GENERAL GAIT ASSESSMENT
NAME: _______________________________ PARTNER: _____________________________________
As you answer these assessment questions, be aware of when your answers are objective or subjective. An objective finding is some aspect of gait that two or more people could observe and agree on. A subjective answer is an intuitive impression or opinion.
What is the overall quality of the gait (e.g., is it bouncy, fast, measured, confident, awkward, or tipsy)? _________________________________________________________________________________
What part of the body is your attention drawn to and why? _________________________________________________________________________________
What is the underlying posture of the gait? _________________________________________________________________________________
What is the energetic pattern of the gait (e.g., the energy could be heavy, light, bent, cautious, jumpy, guarded, internally focused, externally focused, sympathetic dominance, or parasympathetic dominance)? _________________________________________________________________________________
What moves and what holds as your partner walks? Does he or she tend to walk around a certain part of the body? __________________________________________________________________________________
What is the rhythm and cadence of the gait? __________________________________________________________________________________
Is the gait symmetrical? __________________________________________________________________________________
Does your partner lean back or does any part of the body move sideways?
__________________________________________________________________________________
Does one part of the body arrive before another (e.g., in the head-forward posture, the face arrives first; in the posterior pelvic tilt, the hips tend to arrive first)?
__________________________________________________________________________________
SPECIFIC GAIT ASSESSMENT
NAME: _______________________________ PARTNER: _____________________________________
Feet
Are your partner’s feet pigeon-toed or toed-out?
Do your partner’s feet chronically supinate (which leads to high arches) or pronate (which leads to flat feet)?
What is the foot angle? What degree do the toes point to the side?
If your partner’s feet are misaligned, to what degree? Also, which muscles are adaptively shortened and stretch-weakened by the pattern?
Does your partner roll through the entire foot into pushoff? Do your partner’s toes bend to 90 degrees on pushoff?
What is your partner’s step width?
Does the foot on the swing leg extend into heel strike?
Is the heel strike on the front leg simultaneous with the pushoff on the back leg?
Knee and Limb Alignment
Are your partner’s feet, ankles, knees, and hips facing forward and moving along a sagittal track? If not, what direction does each joint move?
Does your partner have a pattern of genu valgum (knock-kneed) or genu varum (bow-legged)? To what degree?
Do your partner’s thighs swing under the pelvis in the sagittal plane? If not, in what direction do they move? Do your partner’s hip joints swing freely?
What are the step and stride lengths? Are the steps symmetrical? If not, how are they asymmetrical and to what degree?
Right after midstance, is there an extensor support moment where the knee, hip, and spine extend together?
Pelvis
Does your partner’s pelvis rock forward and backward in an anterior and posterior tilt? Is the tilt limited or exaggerated? If so, by how much?
Does your partner’s pelvis rotate horizontally, moving forward with the swing leg? Is the rotation limited or exaggerated? If so, by how much?
Does your partner’s pelvis make a lateral shift, swinging side to side? Is the shift limited or exaggerated? If so, by how much?
Arms and Trunk
Do your partner’s arms move in sagittal plane? If not, in what direction do they move?
Do your partner’s arms swing freely at the shoulders? If not, how do they move?
Do your partner’s arms swing in opposition to the legs?
Do your partner’s pelvis and thorax counterrotate?
Is there an ease of rotation in your partner’s thorax? Are your partner’s spine and ribs supple and responsive to the movement of the lower limbs? If not, are they held and rigid?
Head and Neck
Does your partner’s head ride over the thorax?
Does your partner’s head move freely, subtly bobbing on top of the neck?
Are your partner’s eyes looking out on the horizon? If not, where does he or she look while walking?
Developing a Treatment Plan Based on Gait Assessment
1. What areas of the body have muscles appear adaptively shortened and need stretching?
2. What areas of the body have muscles appear stretch-weakened and need facilitation and strengthening?
3. Which joints appear hypermobile and need stabilization?
4. Which joints appear hypomobile and need an increased range of motion?
5. If this person were your client, how would you work with him or her in a bodywork session to improve overall gait?
© 2013 by Education, Inc. Foster, Instructor Resources for Therapeutic Kinesiology
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