How to Simplify Gait

Introduction:

Understanding the gait cycle is a critical component of being a movement expert —It's the one "sport" in which almost every human participates. Additionally, the information can pile up when there are several phases, multiple muscle groups, and various compensations in just one gait cycle. For these reasons, it's one of the most challenging topics for PT students and physical therapists to comprehend. However, I've found that if you remain in detail, then the topic remains challenging. Instead, it would help if you had a gait paradigm shift. Learning categories can accomplish this to comprehend the gait cycle and beneficially utilize it during your treatments.In this article, I'll discuss the following topics:

• Movement Clusters
• Three Simple Phases 

If you're a visual learner, watch the video to learn the same concepts

Movement Clusters:

Before diving straight into gait, it will be helpful to learn synonymous movement terms. In other words, when one of these motions occurs, they're all simultaneously transpiring through the entire kinetic chain. The two movements that we all move through are external or internal rotation. See below for the additional combinations. 

• External Rotation
• Flexion
• Abduction
• Plantarflexion
• Supination

• Internal Rotation
• Extension
• Adduction
• Dorsiflexion
• Pronation

This means, when you see a supinating foot, we can label it as external rotation. Likewise, a collapsed pronated foot can be labeled as internal rotation. 

 Simplification Strategy: Condense the number of terms that you're using to describe a particular motion

Three Simple Phases:

No matter who's literature you're looking at, you'll find more than three phases and different language to describe the stance phase of gait. So, we will continue to simplify our thought process by condensing it to only three main phases. These phases consist of early, mid, and late. Continue reading to learn more details about each specific phase.

 Phase 1: Early - External Rotation

This phase consists of external rotation movements throughout the entire body. We can understand how to bias and assess limitations with two simple strategies. 

 Simple Strategy #1:  The angle the tibia makes cues us to the phase of gait we're in. For example, a negative shin angle represents the early stance phase. Visually, the tibia will be more posterior relative to the ankle while placing more weight through the heel of the foot. So, if there are limitations in the early stance phase of gait, we can program the exercise to bias a negative shin angle. For example, a front foot elevated split squat will work to improve early external rotation deficits.

Simple Strategy #2: Our range of motion assessments will demonstrate early stance phase deficits. Specifically, 0-60° of hip flexion represents the external rotation necessary for optimal mechanics. So, if your patient has a hip flexion measurement < 60°, they most likely struggle to acquire early external rotation. Let this be your cue to prescribe an exercise that biases a negative shin angle.

Phase 2: Mid - Internal Rotation

ˆThis phase consists of internal rotation throughout the entire body. Similarly, we can understand how to bias and assess limitations with two simple strategies.

 Simple Strategy #1  The angle the tibia makes continues to cue us what phase of gait we're in. For example, a neutral shin angle represents the mid-stance phase. This creates an almost straight line from the knee, tibia, and ankle while placing more weight through the mid-foot. So, if there are limitations in the mid-stance phase of gait, we can prescribe exercises that bias a neutral shin angle. For example, a split stance lunge will work to improve internal rotation deficits. To further promote this, a contralateral load will increase the amount of internal rotation by turning the body towards the stance leg.

Simple Strategy #2:  Our range of motion assessments will demonstrate mid-stance phase deficits. Specifically, 60-90° of hip flexion will represent the internal rotation necessary for proper mechanics. So, if your patient can achieve early hip flexion but shows limitations from 60-90°, they most likely struggle to acquire internal rotation mechanics. When this is the case, prescribe exercises that require a neutral shin angle to address the problem.

Phase 3: Late - External Rotation

This phase consist of an external rotation throughout the entire body. Lastly, we can understand how to bias and assess limitations with two simple strategies.

Simple Strategy #1: As we know by now, the angle that the tibia makes cues us to the phase of gait we're in. For example, a positive shin angle represents that late stance phase. Visually, the tibia is in front of the ankle while most of the weight is placed through the front foot. So, if there are limitations at this phase of gait/movement, we can prescribe exercises that bias a positive shin angle. For example, a heels elevated split stance lunge with a slant board will work to improve external rotation deficits. To promote this further, an ipsilateral load will increase external rotation by delaying or yielding the body towards the stance leg.

Simple Strategy #2: Our range of motion assessments will demonstrate late stance phase deficits. Specifically,  90-120° of hip flexion will represent the external rotation necessary for proper mechanics. So, if your patient struggles to achieve > 90° of hip flexion, they most likely struggle to re-capture external rotation for their full range of motion. When this is the case, prescribe exercises emphasizing a positive shin angle to address the limitation. 

Conclusion:

The intent of this article is to provide you with a more simplistic categorical approach to gait. When you understand these principles, you can make the necessary modifications specific to your patients. Let me know if you have any questions!