Module 5 Abnormal Gait 3 C Pathological Differences

Module 5 Abnormal Gait: 3 C: Pathological Differences: Knee Deviations

References § Perry, J and Burnfield, J. (2010). Gait Analysis: Normal and Pathological Function 2 nd edition. Ch 12. § Hsu, JD; Michael, JW and Fisk, JR. (2008) Atlas of Orthoses and Assistive Devices, 4 th edition. Ch 5, pgs 74 to 75.

Agenda - Pathological Gait: Knee Variations • 1. Sagittal Plane Deviations – – – A. Limited Knee Flexion B. Knee Hyperextension C. Extensor Thrust D. Excess Knee Flexion E. Excess Contralateral Knee Flexion – F. Wobble • 2. Coronal Plane Deviations – A. Excessive Abduction (Valgus) – B. Excessive Adduction (Varus)

Knee Variations: Sagittal Plane • A. Limited Knee Flexion – Disrupts: LR, Pre Swing and Initial Swing – During LR, reduces shock absorption and increases demand of quadriceps – During Swing, effectively lengthens limb – Pathologies leading to lack of flexion in stance or swing differ markedly – Possible Gait Deviations: – Caused by:

Knee Variations: Sagittal Plane Hyperextension • B. Knee Hyperextension – Disrupts: Stance – Reduces demand on weakened quads • It IS a position of knee stability – During WA: decreases shock absorption – During Mid Stance, Terminal Stance and Pre Swing: limits forward progression – Caused by:

B. Knee Hyperextension, continued What’s likely cause of Left? • Quad weakness (LR)? • Combined quad and PF weakness (SLS)? • Quad and PF spasticity? • Severe PF contracture? Justify.

Knee Variations: Sagittal Plane Extensor Thrust • C. Extensor Thrust – Disrupts: LR and Mid Stance – Reduces demand on weakened quads – During WA: decreases shock absorption and interferes with forward progression – Ensures knee extended at Mid Stance – Often accompanied by forward trunk lean How does this differ from hyperextension then? Explain.

Knee Variations: Sagittal Plane Excess Knee Flexion • D. Excess Knee Flexion – Disrupts: two different scenarios; each with very differing pathologies • (1) exaggeration of normal flexion arc (LR and Mid Swing) greater than 15° • (2) Loss of normal extension (Mid Stance, Terminal Stance and Terminal Swing) to fully extend knee – – During LR: places more demand on quads During Mid Stance: compromises weight bearing stability During Terminal Swing: results in shortened step length Numerous causes: • Some due to knee structures themselves; others due to adjacent joint dysfunction

D. Excess Knee Flexion, continued

D. Excess Knee Flexion, Swing Phase

D. Excess Knee Flexion - First, observe left limb… - When is excess knee flexion? - Only coronal view … - Choose a limb… - When is excess flexion?

D. Excess Knee Flexion, Pathological Mechanism • What could be a possible Pathological Mechanism? • Why?

Knee Variations: Sagittal Plane Knee Flexion • E. Excess Contralateral Knee Flexion – Disrupts: Contralateral Stance Phase – Effectively makes reference limb longer during swing • Thereby may increase likelihood of increased hip flexion or circumduction for clearance – Commonly caused by leg length discrepancy

Knee Variations: Sagittal Plane Wobble • F. Wobble – Disrupts: LR, Mid Stance and Terminal Stance – Commonly due to impairments in proprioception OR presence of clonus – Decreases forward progression, increases energy cost and decreases limb stability

Knee Variations: Coronal Plane • A. Excessive Abduction (Valgus) – Disrupts: Stance – Severe, may limit stability, necessitate proximal and/or distal compensations and contribute to pain – Pseudo-valgus = combined internal hip rotation, knee flexion and quite often severely pronated feet

Knee Variations: Coronal Plane, continued • B. Excessive Adduction (Varus) – Disrupts: Stance – Severe, may limit stability, necessitate proximal and/or distal compensations and contribute to pain

Normal Knee Joint. Sagittal Plane - Stance and Swing Phases

The End

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