Gait Analysis

 

Based on the previous client's postural assessment, in which issues related to muscles imbalances, ROM, flexibility and a possible scoliosis were found, it has been decided to perform a gait analysis. Gait analysis allows to study the human walking and helps to detect abnormalities in the locomotor (Akhtaruzzaman et al., 2016) and provide information for diagnosis, assessment, monitoring and predicting injuries (Mirelman et al., 2018). It is also another option to identify lower back pain (LBP), as individuals suffering LBP will experience difficulties in walking/ running, walk slower, and will experience fatigue in earlier stages and will walk with excessive APT compared to healthy individuals (Arjunan et al., 2010; Vismara et al., 2009).

The advantage of using observational gait analysis is its simplicity. Its reliability and validity depend on the examiner experience and proficiency (Gor-García-Foged, 2016). Krogt et al (2019) reported high inter-rater reliability (ICC>0.9) for gait parameters measured using 2D video compared to walkaway system. Furthermore, Matsuzaki et al., (2022) found intra-rater ICC=0.574-0.999 for experienced practitioner versus 0.367-0.973 for non-experinced practitioner. Contrary, a systematic review by Hensley et al., (2022) based on 11 studies (n=251 runners) reported an inter-reliability (ICC=0.31-1.00), inter-reliability (ICC=0.31–1.00); poor to excellent validity (0.06–0.89). Therefore. cautions should be taken when using this method and appropriate consideration should be made to ensure optimal data quality.

Figure 1. Visual illustration of posterior view of client gait analysis assessment (Leg and right length stride)

                                        Video 1. Postural view of client's gait analysis.

                                Video 1. Frontal view of client's gait analysis.

Observation of the gait analysis reveals that the client feet are slightly external rotated. Evidence suggests that is common to see people with reduced ankle-drosiflexion to out-toeing, early heal heal-off and shorter step length while walking (Aquino et al., 2022. Furthermore, it  is observed that R-ankle slightly pronates in the initial contact of the stance phase, to compensate reduced ankle-dorsiflexion (Pohl and David, 2009). Evidence has suggested that hyper-pronation can influence abnormal anterior or lateral pelvic deviations (Pinto, 2008) which can result hyper-lordosis or scoliosis, resulting in LBP (Yasdani et al., 2019). Possible muscle tightness in the calf muscles (gastrocnemius and soleus) can limit ankle dorsiflexion and contribute ankle pronation (Cote et al., 2005) and weaknesses in the tibialis anterior (responsible of controlling pronation during gait) (Bramah et al., 2019) and peroneus longus (responsible for eversion) (Moseley et al., 2006).

Furthermore, the pelvis seems to be laterally tilted to the right thought locomotion, continued by the shifted weight-bearing to the right, with trunk rotation. Shoulders also seems to be elevated on the contralateral side of the pelvic that is lateral tilted. This could be result of a possible mild scoliosis, which could be inhibiting the correct posture therefore causing an area of concern or caused by sacroiliac dysfunction known as Trendelenburg gait dysfunction (pelvis drops towards the affected side during the swinging phase of walking, caused by defective hip abductor mechanisms) (Gandbhiret al., 2022). Further Adam’s Scoliosis Test or Trendelenburg test would be necessary to evaluate further.

On the lateral view (see image 2), it can be observed APT, resulting in tightness of hip flexors and weakness of the gluteus maximus, hamstrings and abdominal muscles, which may result in compensatory hyper-lordosis in the lumbar region. This will result in a posterior shift in the trunk position and centre of mass (Power, 2010). Poor trunk stability is associated with poor pelvis control, thus core and pelvis stability training program should be considered. Furthermore, evidence has suggested that Anterior pelvic tilt contributes Trendelenburg gait because the pubofemoral ligament of the ipsilateral leg is tight during the standing phase of Trendelenburg gait, it resists hip abduction, which also makes Trendelenburg gait worse (Paul et al., 2018).

                                      Figure 2. Visual illustration of side view gait analysis.

 

Table 1.  Movement compensation summary in the gait analysis (Clark et al., 2016; Paul et al., 2018).

Compensation	Tight/ Overactive     Muscles	Inhibited/Weak      Muscles
Foot external rotation Ankle pronation	Gastrocnemius  Soleus	Anterior Tiblialis
Lateral pelvic tilt	Hip abductors	Gluteus medius Gluteus minimus
Anterior pelvic tilt	Erector spinae (spinalis, longissimus, iliocostalis lumborum) Quadratus lumborum	Rectus abdominus Internal/ External obliques Gluteus maximus

 

Figure 3. Muscles activation during gait cycle (Akhtaruzzama, 2016).

 

References: 

Akhtaruzzaman, M. d., Shafie, A.. and Raisudding, K. (2016) ‘Gait analysis: Systems, technologies, and importance.’ Journal of Mechanics in Medicine and Biology, 16(07), p. 1630003.

Aquino, M. R. C., Resende, R. A., Kirkwood, R. N., Souza, T. R., Fonseca, S. T. and Ocarino, J. M. (2022) ‘Spatial-temporal parameters, pelvic and lower limb movements during gait in individuals with reduced passive ankle dorsiflexion.’ Gait and Posture, 93, pp. 32–38.

Boden BP, Sheehan FT, Torg JS, Hewett TE. Noncontact anterior cruciate ligament injuries: mechanisms and risk factors. J. Am. Acad. Orthop. Surg. 2010;18(9):520-7.

Bramah, C., Preece, S., Gilliver, S.F., and Herrington, L . (2019) ‘Tibialis posterior dysfunction: A review. Foot Ankle Surgery.’, 25(6), pp. 811-819.

Clark, M A, Lucett, S C, and Sutton, B G. NASM Essentials of Personal Fitness Training. Lippincott Williams & Wilkins, Fourth Edition, 2012. 

Cote, K.P., Brunet, M.E., Gansneder, B.M., and Shultz, S.J. (2005) ‘Effects of Pronated and Supinated Foot Postures on Static and Dynamic Postural Stability.’ Journal of Athletic Training, 20,40(1):41-46.

Gandbhir, V.N., Lam, J.C., and Rayi, A. (2023) Trendelenburg Gait. [Updated 2022 Oct 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.[Online][ Accessed on May 1, 2023] https://www.ncbi.nlm.nih.gov/books/NBK541094/

Gor-García-Fogeda, M. D., Cano de la Cuerda, R., Carratalá Tejada, M., Alguacil-Diego, I. M., and Molina-Rueda, F. (2016) ‘Observational Gait Assessments in People With Neurological Disorders: A Systematic Review.’ Archives of Physical Medicine and Rehabilitation, 97(1), pp. 131–140.

Hensley, C. P., Kontos, D., Feldman, C., Wafford, Q. E., Wright, A. and Chang, A. H. (2022) ‘Reliability and validity of 2-dimensional video analysis for a running task: A systematic review.’ Physical Therapy in Sport, 58, pp. 16–33.

Matsuzaki, Y., Heath, M. R., Khan, J. M., Mackie, A. T., Spitzer, E. and Fabricant, P. D. (2022) ‘Reliability of 2-dimensional video analysis in adolescent runners.’ HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery, 18(4), pp. 512–518.

Mirelman, A., Shema, S., Maidan, I., and Hausdorff, J. M. (2018) ‘Gait.’ Handbook of Clinical Neurology, pp. 119–134.

Moseley, L., Jeong, S., Kim, S., and Lee, D. (2006) ‘Effects of Peroneus Longus Muscle Fatigue on Tibiocalcaneal Kinematics and Plantar Pressure Distribution During Running.’ Journal Orthopaedics Sports Physical Therapy.

Paul, Y., Swanepoel, M., Ellapen, T., Barnard, M., Hammill, H., Müller, R. and Williams, J. (2018) 'What Is the Association between an Anteriorly Tilted Pelvis and Trendelenburg Gait?'. Open Journal of Orthopedics, 08(12), pp.464-475. 

Pinto, R. Z. A., Souza, T. R., Trede, R. G., Kirkwood, R. N., Figueiredo, E. M. and Fonseca, S. T. (2008) ‘Bilateral and unilateral increases in calcaneal eversion affect pelvic alignment in standing position.’ Manual Therapy, 13(6), pp. 513–519.

Pohl, M. B., Hamill, J., and Davis, I. S. (2009) ‘Biomechanical and Anatomic Factors Associated with a History of Plantar Fasciitis in Female Runners.’ Clinical Journal of Sport Medicine, 19(5), pp. 372–376.

Poosapadi, Arjunan., S., Kumar, D., Poon, W. M., Rudolph, H., and Hu, Y. (2010). ‘Variability in surface electromyogram during gait analysis of low back pain patients.’ Journal of Medical and Biological Engineering, 30(3), pp. 133–138.

Powers, C. M. (2010) “The influence of abnormal hip mechanics on knee injury: A biomechanical perspective.” Journal of Orthopaedic & Sports Physical Therapy, 40(2) pp. 42–51.

Van der Krogt, M.M., Doorenbosch, C.A., and  Harlaar, J. (2019) ‘Validation of 2D video measurements of gait using an instrumented walkway.’ Journal of Biomechanics, 88, pp. 120-124.

 Vismara, V. Cimolin, M. Galli, et al., Quantitative analysis of the effects of obesity and low back pain on gait, Gait Posture 30 (2009) S34.

Yazdani, F., Razeghi, M., Karimi, M. T., Salimi Bani, M., and Bahreinizad, H. (2019) ‘Foot hyperpronation alters lumbopelvic muscle function during the stance phase of gait.’ Gait and Posture, 74, pp.102–107.