The 4 shock absorbers in gait and running:

1. Ankle Plantar Flexion (after heel strike) The tibialis anterior is the primary muscle
to ECCENTRICALLY control the ankle during this relative plantar motion. It is also a muscle
which can invert the foot, and so it will play a role in the eccentric eversion or eccentric
pronation (next).
The long toe extensors also have an assisting role in this eccentric plantar motion.
2. Subtalar pronation Friction between the calcaneus/heel and the ground increases,
with this, the talus slides anterior and medially while the tibia internally rotates (the same
motion we saw in the previous MWM video!). The end result is that the foot rolls inward and
the arch flattens during the gait cycle. Foot pronation (eversion, abduction, dorsiflexion) is
one shock absorbing mechanism which allows our foot to adapt to the floor.
3. Knee Flexion This is INITIATED by the 1st shock absorber mechanismcan you think
why? Think of the muscles eccentrically active the Tibialis Anterior and Ext. Digitorum
Longus.
Heres a break down:
1. When a muscle contracts it pulls on both the origin and insertion
2. With both insertion points on the foot being pulled into plantar flexion.
3. This has a relative pull on the origins (think where these are)
4. Creating a forward motion of the tibia!
This is of course then, slowed by ECCENTRIC contraction of the quadriceps.
Interesting application: Many stroke patients have poor muscle strength and control during
gait rehabilitation. Hyperextension during stance phase could be due to weak/inactive ankle
dorsi flexors, not initiating knee flexion.
4. Contralateral pelvic drop Downward impact forces are absorbed by eccentric
ipsilateral hip adduction (primarily the gluteus medius). This occurs as the body weight is
suddenly dropped on the limb.
Application: Too much of this ipsilateral hip adduction in stance phase is considered as
Trendelenburg Gait (as seen in the picture b). This can be caused by weakness of the
gluteus medius and minimusor a lesion of the Superior Gluteal Nerve.

Gait cycle
Walking is the most convenient way to travel short distances. Free joint mobility and appropriate muscle force
increases walking efficiency. As the body moves forward, one limb typically provides support while the other
limb is advanced in preparation for its role as the support limb. The gait cycle (GC) in its simplest form is
comprised of stance and swing phases. The stance phase further is subdivided into 3 segments, including (1)
initial double stance, (2) single limb stance, and (3) terminal double limb stance.
Each double stance period accounts for 10% of the GC, while single stance typically represents 40% (60%
total). The 2 limbs typically do not share the load equally during double stance periods. The swing phase for
this same limb is the remaining 40% of the GC. Ipsilateral swing temporally corresponds to single stance by the
contralateral limb. Slight variations occur in the percentage of stance and swing related to gait velocity.
Duration of each aspect of stance decreases as walking velocity increases. The transition from walking to
running is marked by elimination of double support period(s).
A stride is the equivalent of a GC. The duration of a stride is the interval between sequential initial floor contacts
by the same limb. A step is recognized as the interval between sequential floor contacts by ipsilateral and
contralateral limbs. Two steps make up each GC, which is roughly symmetric in normal individuals.

GC phasing
A consistent sequence of motions is performed at each of the lower extremity joints during locomotion. Each
stride contains 8 relevant phases. Stance is comprised of 5 gait phases (ie, initial contact, loading response,
mid stance, terminal stance, preswing), with the remaining 3 phases occurring during swing.
The first 2 gait phases (0-10% GC) occur during initial double support. These phases include initial contact and
the loading response. Initial contact often is referred to as heel strike. While this term is appropriate in normal
gait, many patients achieve heel contact later in the GC, if at all. The joint motion during this phase allows the
transfer of weight onto the new stance phase leg while attenuating shock, preserving gait velocity, and
maintaining stability.
Swing phase by the contralateral limb corresponds with single support by the ipsilateral limb to support body
weight in the sagittal and coronal planes. The first half of single support is termed mid stance (10-30% GC) and
is involved with progression of the body center of mass over the support foot. This trend continues through
terminal stance (30-50% GC). This phase includes heel rise of the support foot and terminates with
contralateral foot contact.[1]
The final stance element, preswing (50-60% GC), is related functionally more to the swing phase that follows
than to the preceding stance phase events. Preswing begins with terminal double support and ends with toe-off
of the ipsilateral limb.
Three unique phases characterize swing, including initial swing (60-73% GC), mid swing (73-87% GC), and
terminal swing (87-100% GC). The swing phase achieves foot clearance and advancing of the trailing limb.

Shock absorption
Shock absorption and energy conservation are important aspects of efficient gait. Altered joint motion or absent
muscle forces may increase joint reaction (contact) forces and lead subsequently to additional pathology. In

early stance, nearly 60% of one's body weight is loaded abruptly (less than 20 milliseconds) onto the ipsilateral
limb. This abrupt impact is attenuated at each of the lower extremity joints. Loading response plantar flexion is
passive, substantially restrained by eccentric work of pretibial muscles. The absorptive work by pretibial
muscles delays forefoot contact until late in the initial double support period (7-8% GC).
At initial contact, external (ground reaction) forces applied to the contact foot produce a tendency toward knee
flexion. Repositioning the knee (recurvatum) increases knee mechanical stability, but at the cost of increased
contact forces and shock generation. A balance between knee stability and shock absorption is achieved by
eccentric quadriceps contractions during loading response. The impact of loading is minimized at the hip during
single support through hip abductor muscle contraction. [1]

Energy conservation
Ambulation always is associated with metabolic costs. These costs are relatively minor in normal adults
performing free speed level walking. The self-selected walking speed in normal adults closely matches the
velocity that minimizes metabolic work. This association does not apply with gait pathology. Walking velocity,
energy cost per time, and energy cost per distance are considerations when the patient is making choices
about walking versus wheelchair mobility. Gait velocity typically decreases with all neuromuscular pathology,
and the reduction is related to the magnitude of the pathology. Energy cost per unit of time may not change
substantially, even with severe involvement. Energy cost per unit of time is maintained by decreasing walking
velocity considerably. Energy cost per unit of time does not change markedly following stroke, as compared to
changes associated with aging; however, the energy requirement per distance traveled is more than 3 times
normal.
In this same population, wheelchair use cuts energy cost per distance in half and decreases cost per minute
slightly, while preserving ambulation velocity. Similar trends are observed when examining various energy cost
parameters in individuals with spinal cord injury, myelomeningocele, and increasing levels of amputation.
Energy cost to travel a prescribed distance increases (greater than 500% increase in myelomeningocele with
bilateral knee-ankle-foot orthoses), while oxygen cost per minute is maintained by decreasing walking velocity
substantially. Often the critical factor in selecting a wheelchair for mobility is the energy requirement to traverse
a given distance. Most individuals self-select wheelchair mobility when cost per distance exceeds 300% of
normal values.