Adequate joint range of motion in the hip, knee, and ankle is needed for standing and walking to be practical. Limitation of motion at these joints, imposed by joint restrictions or by orthoses, will interfere with the normal swing and stance and decrease walking efficiency (Murray et al. 1964).
The individual needs strength in the muscles of the ankle, knee, hip, and trunk to stand up and walk without external support. Correct timing of the contraction and relaxation in these muscle groups is required for practical balance and gait (Horak and Nashner 1986; Eberhart et al. 1954). Exercises on the mats and treatment table are used to help bring the muscles to the level of strength needed for function.
To analyze the gait pattern start with an inspection in all three planes. In stance look for the alignment of the head and neck, shoulders and upper trunk, lumbar spine and pelvis, hips, knees and feet (O Fig. 12.4). Inspection of the gait concentrates not only on the motion of the lower extremities but also on the symmetry of the leg and pelvic motion, the rotation of the upper trunk, and the arm swing. Check walking aids such as walkers, canes, orthoses or prostheses, and observe abnormal wear and tear on the shoes. Also note the velocity and endurance and whether the patient can walk independently.
Watch the patient's gait from the front and the back and from both sides. If possible have the patient walk backward and sideways as well as forward.
In the sagittal plane look for:
— Excessive or decreased flexion and extension in the trunk, the hip, the knee and the ankle.
— Whether the right and left leg steps are of equal length and time duration.
In the frontal plane look for asymmetry between the left and right sides:
— Lateral trunk movement, pelvic tilting and dropping
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