SAGITTAL PLANE ANALYSIS OF GAIT BY DR TABASSUM AZMI (TABASSUM QUERESHI)

1. SHRI GURU RAM RAI University,
Dehradun

2. SAGITTAL PLANE
ANALYSIS OF GAIT

3. CONTENT
INTRODUCTION
GAIT ANALYSIS
 PROCESS AND EQUIPMENT
 FACTORS AND PARAMETERS
 TECHNIQUES
 :- TEMPORAL/ SPATIAL
 :- KINEMATICS AND KINETICS
 :- DYNAMIC ELECTROMYOGRAPHY
 APPLICATIONS
 :- MEDICAL DIAGNOSTICS
 :- PURPOSE FOR GAIT ANALYSIS
 POSTURAL BALANCE
 PRIMARY MUSCLE ACTIONS DURING GAIT

4. INTRODUCTION
SAGITTAL PLANE
 SAGITTAL plane analysis of
gait or kinematic gait analysis
in the Sagittal plane is used
for clinical and laboratory
identification of deviations of
normal gait
 The Sagittal plane divides the
body into left and right
 Extension and flexion happen
along the sagittal plane

5. SAGITTAL PLANE ANALYSIS OF GAIT
 When we move along this
plane, we are using the strength
of our muscles to move parts of
the body forward or backward
 Flexion and extension occur in
this plane
 Example:- Running, walking,
jumping , squatting, kicking a
football ,chest pass in netball,
lifting movements make use of
this plane

6. IN order to conduct a “SAGITTAL PLANE ANALYSIS OF GAIT”
we should firstly learn about the normal gait cycle
NORMAL GAIT CYCLE
(STANCE phase occupies 60% and SWING phase occupies 40%)

7. GAIT ANALYSIS

8. GAIT ANALYSIS
 GAIT :- Manner, pattern or style of walking or
way of walking
 GAIT ANALYSIS :-is the study of human motion
 :- Using the eye and the brain of observer
 :- Augmented by instrumentation
 For Measuring
 - Body movements
 - Body mechanics
 - Activity of muscles

9. The analysis of the Gait cycle is important in the
Biomechanical mobility
For analysis of gait cycle we can used
Subjective and Objective Methods
FUNCTION DIVISIONS OF THE GAIT CYCLE (GAIT
ANALYSIS)

10. Gait initiation (GI) involves the shifting of body weight
from double limb support during quiet standing (QS) to a
single limb, moving the body forward while controlling
frontal and sagittal plane forces as the body transitions to
steady-state gait whereby the center of mass (COM)
velocity is relatively constant.
 With the feet side-by-side prior to GI, the initial intended
swing limb is unable to develop ‘push-off’ energy
normally seen in steady-state gait.
 Thus, energy for the first step must come from other
sources, including passive gravitational forward lean and
active hip flexor contraction to pull the swing leg forward
 As opposed to the predominately sagittal motion of
steady-state gait, GI begins with the lateral shifting of the
COM, which cannot be too lateral or too fast as this may
result in a loss of balance, possibly leading to a fall

11. From a neuromuscular perspective, when a subject commits to
begin walking, soleus activity is inhibited followed
immediately by activation of the tibialis anterior of both legs,
which allows the center of pressure (COP) to move backward
Concurrently, hip abductors are inhibited on the initial stance
limb and activated on the ipsilateral limb, such that the COP
shifts briefly towards the stance limb
Paradoxically, this pattern results in the initial swing limb
being loaded momentarily while the contralateral limb is
unloaded, the intention of which is to allow the COP to
accelerate the COM toward the contralateral limb. This results
in unloading the initial swing limb so that the first step of GI
may take place
 Subsequently, the COP is driven medially during stance limb
loading, and forward along the stance foot as the swing limb is
lifted upward and forward
 During the first step of GI, hip abductors of the stance limb act
to prevent the pelvis from dropping on the side of the intended
swing limb

12.  The principle of the overall support moment, i.e., the
algebraic summation of sagittal plane lower extremity
joint extensor moments of force during gait (Winter,
1980).
 The principle was based on the concept that the central
nervous system (CNS) does not simply control individual
joint moments of force; rather, the entire lower extremity
acts as a single unit with respect to support against gravity,
particularly during the single support phase of gait where
the collapse of the limb would be disastrous. The support
moment allows the CNS considerable flexibility in
adapting joint motion patterns of the lower extremity hip
and knee moments, depending upon such circumstances
as pain avoidance, changes in terrain, speed, aging, and so
forth.

13. Joint Power and Mechanical Energy in Gait
Initiation
From the perspective mechanical energy, GI has been
described as the the changing of the body’s energy
state from primarily potential energy during QS to the
states of both kinetic and potential energy during the
first three steps (Miller and Verstraete, 1999).
Previous energy analyses of GI have considered
segmental components and total body energy
throughout each step calculated from anthropometric
and kinematic data
However, for individuals with neurological conditions
such as multiple sclerosis or Parkinson’s disease,
movement transition states such as GI present unique
neuromuscular control challenges.

14.  Hypotheses
The sagittal plane support moment would be like that
previously reported and would be evident following the
first step.
There would be a differentiation in the roles of the
sagittal and frontal planes support moment,
respectively.
Sagittal powers would have little contribution during
the initial transfer of weight in the stance phase of the
first step.
The energies in the sagittal plane would be significantly
larger than those of the frontal plane particularly for the
hip in the first step forward.
By the third step of GI, all kinetic variables would be like
those seen in steady-state gait.

15. : Schematic of the gait initiation protocol - FPn = force platform n. +Y = AP
direction, +X = ML direction B: Time-normalization schema - DS = double
support, SwL = swing leg, StL = stance leg

16. SAGITTAL PLANE DATA
To facilitate understanding the natural sequence of GI, STEP1 and
STEP3 are plotted continuously (left leg) with STEP2 (right leg)
plotted underneath for each joint in each plane. Vertical dotted
lines show the

17.  Sagittal plane
The typical support moment pattern, i.e., predominately
extensors during stance and zero during swing, seen in
steady-state gait was not evident in STEP1.
 During STEP2, there was a gradual increase in
magnitude during the stance phase of the support
moment as the COM began to move away from the
starting point.
By STEP3, there was positive (extensor) activity during
stance and slightly negative or zero support moment
during swing, which was more or less typical (Winter,
1980).
 At the lower extremity joints, the magnitudes of the
moments in STEP1 were relatively small, with most of the
activity occurring in STEP2 and STEP3 at the ankle.
Typical support moment patterns at the hip and knee
were not evident until STEP3.

18.  Sagittal Plane Energy
 There were no sagittal plane energy data for the knee joint
during STEP1. Ankle energy absorption (A1) was present in all
three steps and modified as a function of the step number
(F(2,42) = 36.27, p < 0.0001): A1 progressively increased in
magnitude with each step. Ankle push-off (A2) was also present
in all three steps, and modified as a function of the step number
(F(2,42) = 68.27, p < 0.0001): A2 was lowest in STEP1, highest
in STEP2, and all steps were different from each other.
 At the knee, no knee energy bursts were apparent in STEP1, K2
and K4 appeared in STEP2, while STEP3 contained K2, K3 and
K4. Therefore, at the knee, steady state gait patterns were
achieved progressively with each step. Comparisons across the
latter two steps demonstrated that only K4 was different
(F(1,28) = 5.50, p = 0.026), with STEP3 larger than STEP2.
 At the hip, only hip pull-off (H3) was apparent at the toe-off in
STEP1. Additional energy bursts became apparent as steps
progressed: H1 was added at STEP2, and H2 was added at
STEP3. H1 was significantly greater in STEP3 compared to
STEP2 (F(1,26) = 10.44, p = 0.0033). Hip pull-off (H3) was not
different across the different steps (F(2,42) = 2.32, p = 0.11

19. PROCESS AND EQUIPMENT
 Subjective and Objective Methods can be used to assess
the Gait cycle
 SUBJECTIVE:-
 :1- Different Gait patterns-
 -Ask the patient to Walk normally
 -On inside and outside of the feet in a straight line
 -Running call the time looking to compare side
and understanding of normal
 2- Ask/observe:-
 -the type of footwear the patient uses
 -Shoes affect Velocity, Step time and Step length
in younger children’s gait

20. Objective
 1- QUANTITATIVE & PARAMETERS LIKE
 time, distance & muscle activity will be measured
 Other objective methods to assess the gait cycle
that
 USE Equipment include-

 :-Video Analysis & treadmill
 :-Electronic & Computerized apparatus
 :- Electronics pedometers
 :- Satellite positioning system

21. 2- QUALITATIVE METHODS
:- Rancho Los Amigos Hospital rating list
 :- ten meter walking test
 :-6 minute walk test
 :- 2 minute walk test
 :- Dynamic gait index
 :- Emory Functional profile
 :- Timed and go test ( falling in men but not in women)
 :- Functional Ambulation categories
 :- Tinetti test

22. Video Gait Analysis & Treadmill

23. Rancho Los Amigos Gait Cycle

24. FACTORS
EXTRINSIC
Such as terrain, footwear , clothing, cargo
 INTINSIC :-
Sex, weight, height, age etc
 PHYSICAL :-
Such as weight, height , physique
 PSYCHOLOGICAL :-
Personality type, emotions
PHYSIOLOGICAL :-
psychiatric disorders Anthropometric characterstic
smeasurements & proportions of body
PATHOLOGICAL :-
For example- Trauma, neurological diseases, musuculoskeletal
Anomalies

25. Factors Affecting joint momemts

26. PARAMETERS
 STEP LENGTH STRIDE LENGTH CADENCE
 SPEED DYNAMIC BASE PROGRESSION LINE
 FOOT ANGLE HIP ANGLE SQUAT PERFORMANCE

27. TECHNIQUES
Gait Analysis involves measurement
Where measurable parameters are
 - Introduced
 - Analyzed
 - Interpretation
Where Conclusions about the subject are drawn
 - Health
 - Age
 - Size
 - Weight
 - Speed


28. TEMPORAL/ SPATIAL
Spatio-Temporal-Gait -parameters

29. TEMPORAL/SPATIAL
 It consists of
:-The calculation of
speed
:-The length of
rhythm
:- Pitch
Measurements are carried out
through
:- Stopwatch & marks on the
ground
:-Walking on a pressure mat
:-Range laser sensors
scanning a plane a few
centimeters above the floors
:- Inertial sensors and
software to interpret 3D
gyroscope & 3D
accelerometric data

30. KINEMATICS & KINETICS
KINEMATICS
 IT is defined as study of angular
rotations of each joint during
movement
 It can be observed & measured at
foot, ankle, knee & hip during gait
cycle
 Observed in three planes
Sagittal: hip flexion, extension
Coronal: hip abduction, adduction
Transverse: hip rotation,
tibial,foot
 KINETICS:- is the study of the
forces involved in the production
of movements

31. SAGITTAL PLANE ANALYSIS OF GAIT
 The pelvis is tilted anteriorly
approx-15 degrees
 Minimal motion of anterior tilt
 When Hamstrings are tight,
pelvis assumes posterior tilt
 The hip is flexed at initial
contact & extends during stance
phase
 The hip continues to flex during
walking

32. SAGITTAL PLANE ANALYSIS
 INITIAL CONTACT
Hip 30 degree of flexion
Knee is extended
Ankle is neutral
GRF
 - Anterior to Hip, drives the hip
into flexion
 - Anterior to Knee, drives the
knee into extension
 - Ankle into planter flexion

33. HIP:- hamstrings, gluteus
maximus, and adductor magnus (i
to e)
 KNEE:- quadriceps (c to e)
TIBIOTALAR joint: tibialis
anterior (e)
SUBTALAR joint:- anterior and
lateral compartment muscles (e)

34. SAGITTAL PLANE ANALYSIS
LOADING RESPONSE
 Hip extension 25°
 Knee flexion 20°
 Ankle planter flexion to 10°
 Contra-lateral pelvis rotates anterior
 GRF
 > Anterior to hip
 > Posterior to knee
 > Posterior to ankle

35.  HIP:- Extensors (e), Abductors (e)
limit contra-lateral drop 5 degree
 KNEE:- Quadriceps fire (c)
 ANKLE:- Tibialis anterior (e)

36. SAGITTAL PLANE ANALYSIS
MID STANCE
GRF through hip, Knee, and
ankle
Muscular activity terminaters
Hip and knee stability
provided by ligamentous
restraints

37. GRF
 Posterior to hip
 Anterior to knee and ankle
 Gastroc-soleus complex fires to
initiate knee flexion
 Pelvis continues to rotate,
abductors continue to resist
pelvic drop

38. SAGITTAL PLANE ANALYSIS
TERMINAL STANCE
 Single stance : falling
forward
 Forward fall of the body
moves the vector further
anterior to the ankle, creating
a large dorsi-flexion moment
 Strong activation of gastroc-
soleus complex
 Begins as COG passes over
foot & ends when opposite
foot touches ground

39.  The body moves past the foot
 Hip is in 20 degrees extension
(apparent motion; some of these
comes from pelvic rotation)
 Knee is in 5 degrees of flexion
 Ankle is in 10 degreed of
dorsiflexion

40. SAGITTAL PLANE ANALYSIS
PRE-SWING
 Hip 20° of hyper-extension
 Knee 30° of flexion
 Ankle 20° of plantar-flexion
 Toes 50° of hyper extension

41. GRF
 Posterior to hip, knee anterior to
ankle
 Rapid flexion of knee from rapid
heel rise and unweighting of limb
 Rectus femoris initiates hip flexion
 Adductor longus
 Hip: iliopsoas, adductor magnus,
adductor longus
 Knee: Quadriceps
 Ankle: Gastrocsoleus complex
 Toes: Ab.hal. FDB, FHB, Introssei,
lumb.

42. SAGITTAL PLANE ANALYSIS
INITIAL SWING
 Hip 0- 30° of flexion
 Knee from 30- 60° of flexion and
extension from 60-30°
 Ankle 20° of plantar-flexion to neutral
 Foot clearance is passive due to rapid hip
flexion, unless gait is very slow
 In slow gait, tibialis anterior and
hamstring fire to help
 Gait cadence (speed) governed by
accelerations of hip flexion during this
phase

43.  Hip flexion
 - Rectus femoris
 - Hiacus
 - Adductor longus
 - Gracilis
 - Sartorius
 Rest of limb is passive
pendulum

44. SAGITTAL PLANE ANALYSIS
MID SWING
 Tibialis anterior fires to
maintain foot position
 Knee extension and hip
flexion continue by
inertia

45.  Leg has advanced past the
stance limb
 Hip is in 25 degrees of flexion
 Knee is in 25 degrees of flexion
(perpendicular to the ground)
 Ankle is in 0 degree dorsiflexion

46. SAGITTAL PLANE ANALYSIS
TERMINAL SWING
 Decelerate Knee extension and
hip flexion
 - Hamstrings
 - Gluteus maximus
 Quads Co-contract
 Tibialis anterior maintains
ankle position

47.  The leg extends to provide
length to the step
 The hip is in 20 degrees of
flexion
 The knee is in 5 degrees of
flexion
 The ankle is in 0 degrees of
flexion

48. KINETICS (FORCES)

49. BODY WEIGHT & GRF

50. MUSCLE FORCE

51. DYNAMIC
ELECTROMYOGRAPHY
EMG Activity during Gait

52. APPLICATIONS
MEDICAL DIAGNOSTICS
1. Pathological Gait
 Cerebral palsy
 Stroke
• Gait Analysis techniques
allow for the assessment of
gait disorders & effects of
corrective orthopedic
surgery

53. CEREBRAL PALSYEx:- options for treatment
of cerebral palsy
 Botox or the lengthening
 Re-attachment or
detachment of particular
tendons
 Osteotomy
Gait Analysis is used in
professional sports
training to optimize and
improve athletic
performance

54.  2. Chiropractic & Osteopathic uses
• Gait assessment may be indicative of a mis-aligned pelvis or sacrum
• Both doctors use Gait to discern the listing of a pelvis & can employ
various techniques to restore a full range of motion to areas involved in
ambulatory movement
 3. Comparative Biomechanics
By studying the gait of non-human animals
 4. Gait as biometrics
• Gait has been established as biometrics to recognize people by the way
they walk
• For forensics use since each person can have a gait define by unique
measurements such as the locations of ankle, knee,hip

55. PURPOSE FOR GAIT ANALYSIS
For a particular disorder
to gain an understanding of the gait
Characterstics of a particular disorder
For a diagnosis
to assist movement diagnosis
For a selective treatment
to inform treatment selective
To Evalute the effectiveness of
treatment

56.  Paediatric physiotherapist
Can use gait analysis to help
identify the issues with
developmental delay along with
more general injury

57. SPORTS PHYSIOTHERAPIST
For athletes and knee runners
Sports Physiotherapist can use
gait analysis to improve the
efficiancy of their running style

58. POSTURAL BALANCE
BALANCE AND POSTURE CONTROL DURING STANDING
AND WALKING

59. PRIMARY MUSCLES ACTION DURING GAIT

60. THANK YOU SO MUCH