Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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24.3, Biomechanics of Gait
Table of Contents

THE HIP

Abstract:

CONTENT: The latest research on gait is readily applied to the evaluation and treatment of patients with hip pathology. Examination of the hip joint during gait is the entire focus of this monograph. The authors first review common terms used in gait analysis and then discuss spatiotemporal factors that lead into planar kinematics and kinetics of the hip during the gait cycle. Graphs and figures assist in clarifying important concepts. A major section focuses on application of normal gait to clinical pathomechanics. Acute, chronic, and pathological adaptations that accompany select pathologies are included. Discussion focuses specifically on adaptations following total hip replacement, iliotibial band syndrome, and hip flexion contracture. Gait deviations commonly observed for each orthopaedic condition are described and evidence for interventions suggested to improve aberrant gait for orthopaedic injuries is also presented. CASE ANALYSES: Two cases studies are presented. The first case describes a 25-year-old female triathlete referred to physical therapy with a diagnosis of Iliotibial Band Syndrome. The second case involves a 74-year-old male, 11 months status post left total hip replacement with continued complaints of pain and stiffness in the left hip.

Keywords:​

walking, hip injuries, kinetics, kinematics

References:

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THE KNEE

Abstract:

CONTENT: This monograph applies the latest research and evidence-based practice in assessment of knee biomechanics during the gait cycle. The authors first review knee biomechanics during the normal gait cycle. This includes temporospatial, kinematic, and kinetic factors. Clinical pathomechanics are then identified for acute, chronic, and postsurgical adaptations. Examples are provided for various pathologies such as knee osteoarthritis, anterior cruciate ligament injury, and patellofemoral pain syndrome. Treatments are presented to remedy gait aberrations brought on by knee pathology. Tissue healing factors and activity modifications address impairments of pain, knee effusion, and quadriceps weakness. Neuromuscular gait training following anterior cruciate ligament injury is also specifically presented. The long-term consequences of functional decline and reinjury for persistent aberrant gait patterns are also given consideration. CASE ANALYSES: Three cases studies are included. The first case is a 26-year-old female who complains of right knee pain in the lateral and distal quadrant of the patella during stair descent. The second case is a 20-year-old male recreational soccer player who is 9 weeks status post anterior cruciate ligament reconstruction. The third case is a 47-year-old female who complains of knee instability and an antalgic gait pattern when she exercises with her walking group.

Keywords:​

walking, knee injuries, kinetics, kinematics

References:

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THE FOOT AND ANKLE

Abstract:

CONTENT: The authors have provided the reader with an overall understanding and appreciation of the complex interrelated motions of the foot and ankle complex and its relevance to gait. They have also applied pathomechanics to injury management. The authors introduce similarities and differences between walking and running gait characteristics and highlight the 3 “rocker mechanisms” that facilitate forward progression of body mass. The specific action of the talocrural, subtalar, and transverse tarsal joints, and the collective actions of the metatarsophalangeal joints during the gait cycle are highlighted. The concept of joint coupling torque transfer throughout the kinetic chain and the sequential concentric and eccentric muscle actions that occur during stance is reviewed. Common pathologic conditions of the foot and ankle that affect gait mechanics are then covered. Posterior tibialis tendon dysfunction is highlighted and a separate section is dedicated to the management of conditions related to abnormal pronation. A separate section specifically addresses running shoes and footstrike pattern. The monograph concludes with the management of ankle inversion injury and the effects of lower extremity kinetic chain misalignment on injury and performance. CASE ANALYSES: Three cases studies are then presented. The first case describes an 11-year-old female who presented with bilateral ankle pain and how it affects gait. The two remaining cases are case control studies. Case 2 studies a NCAA Division I college football players who had sustained multiple foot or ankle injuries and who were compared to matched control players who played the same positions and who were similar in the physical characteristics of age, height, and weight. A comparison was made to identify patterns of dysfunction in the foot and ankle. Case 3 involved a group of 7 NCAA Division I female athletes with a history of multiple lateral ankle sprains who were compared to 7 matched control athletes who played the same sport. The presentation identifies screening factors that differentiate chronic ankle instability in female athletes.

Keywords:​

walking, ankle injuries, foot injuries, kinetics, kinematics

References:

Click here.

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