Transcription
So hello everyone and welcome back to my YouTube channel physio's Healing Touch. So today in this video, I will tell you everything about phases of gate cycle. And if you will watch this video completely, it will be very, very fruitful for you because in exams, gate is a very important topic. If you will see the past year question papers, you will find at least one question from gate. I will tell you so many amazing things about phrases of eight cycle. So please continue watching and it will definitely contribute in your knowledge.
So basically, there are two phases of gate cycle. First is stance phase and second is Swing phase. So stance phase is that phase of gate cycle in which our foot, so suppose this is foot, so it touches the ground or floor. When the foot touches the floor, then that phase of gate cycle is called as stance phase. So in this diagram, you can see this is the foot and this is the floor. So one foot will touch the floor, then this face is known as stance face. And when the foot touches the floor, it actually bears the body weight. So it will carry the body weight. So whenever the foot touch the floor, it will actually carry the body weight. And that's why this phase is also known as weight bearing phase because during this phase, this lag is actually holding the weight of the body. And because of this, it is very sad because, you know, he has to carry the a lot of weight of the body. So this is also known as weight bearing phase. And it contributes nearly about 60 to 65 percent of gate cycle. So this phase contributes to around 60 to 65 percent of date cycle.
On the other hand, swing phase is that phase of gate cycle in which our foot, so this is our foot and this is floor. So when our foot does not touch the floor, so this is the food and it is not touching floor. So this phase is known as swing phase. So it does not touches the floor. So where it will be in the air? So this lag remains in the air and it does not touches the floor. And that's why it is known as swing phase because the lag is actually swinging in the air. So that's why it is known as swing phase. And because of this, because this lag does not touch the ground, so that's why it does not bear any weight of the body. So it does not bear any weight of the body because it does not touches the ground, it remain in the air. So that's why it is very happy, you know, because he does not have to bear any weight of the body. And he is also showing his teeth. And, you know, the reason why he is also showing his teeth because he has given all his weight, all the weight of the body to the contralateral lymph, to the opposite limb. Because if one limb is is in the air, then of course the opposite limb, then of course the opposite limb will be on the ground. Because a person cannot walk by both legs in the air. So if one leg is in the air, then of course the opposite leg will be on the ground. So this laugh which is in the swing phase, it actually it gives all his weight to the opposite or punctuality lag which is on the ground. So that's why he is smiling so much because he does not have to carry any weight and he has given all his weight to the contralateral limb. And this phase contribute to about 40 percent of gate cycle.
So basically, there are five sub stages of stance phase, which I will cover one by one. So first is initial contact or heel strike. In traditional classification system, we call it heel strike. So as the name itself suggests, heel strike means when the heel, so this is the heel of the foot, so one heel strikes the floor. So that this is known as heel strike. So when heel strikes the floor, so this is known as heel strike. And this is also known as weight acceptance period because from this phase, the body, our legs start accepting the body weight. So that's why it is known as weight acceptance period because you weight have a foot except, that's why it is known as weight accept, weight acceptance period. And it contributes to about 10 percent of gate cycle.
Now let me explain you the range of motion of every joint. So first is hip joint. So hip joint will be flexed. So it will be flexed to about 20 to 40 degrees. So hip joint will be flexed to about 20 to 40 degrees. As you can see in this uh diagram. And knee drawn in knee joint, it can be extended or slightly flexed. So it can be extended to about zero degrees and it can be slightly flexed to about 5 degrees. So it can vary. Now at the ankle joint, the ankle joint will be neutral position or slightly plantar flexed. Now, some people think like how it will be neutral position? It seems like it is dorsiflexed. But let me tell you the answer. The if you see the lower limb, it is not straight, it is slightly tilted. So it is not straight. And if I draw the line, so if I draw the line, so actually the foot is at 90 degrees. It is not upward, it is not downward, it is at 90 degrees. So that's why it is in neutral position. So that's why ankle remain in a neutral position or slightly plantar flexed.
If you also want me to explain all the muscles that are involved during gait, then I can make a separate video. You can leave comment in the comment section and I will make a separate video because if I will add all those things in this video, this this video will become very long. So that's why you can leave comments. So now you can see in this diagram. So this is the area where all the weight of the body is concentrated during field strike. So during heel strike, this is the area where all the body weight is concentrated.
Now let me tell you some important things that you'll have to see in patient during heel strike. So if a person suffering from plantar fasciitis, plantar fasciitis is basically a condition in which the plantar fascia of the foot at its insertion point on the calcaneum become inflamed. That means there will be inflammation. So there will be inflammation at the insertion of plantar fascia on calcaneum. And during the heel strike, during the heel strike, it will cause pain. It will cause heel pain because during heel strike, it actually puts pressure on that inflamed area. And that's why it triggers pain on the patient. That's why doing heel strike, if if a person has plantar fasciitis, it will trigger pain.
So the two pathological gate seen during heel strike is first is quadriceps gate. So quadriceps gate is basically when the quadricep muscle is weak, patient feel unable to Do complete knee extension during heel strike. And because of that, patient by his own hands extend the knee because quadriceps is weak and he cannot able to extend the knee fully during heel strength. So this is the pathological gait seen during the heel strike. And another one is foot drop gate. In foot drop gate, what actually happens is dorsiflexase of the foot is weak. And because of that, it cannot able to, it cannot able to maintain the foot in neutral position. And because of that, plantar flexions overact. And at the heel strike, it will cause slapping of the foot on the floor because dorsiflexes are weak and it cannot maintain the foot in neutral position. And because of that, foot will remain in plantar Flex. So that's why there will be no heel strike seen on those patient who has foot drop.
Now the next phase of stance phase is load response, also known as foot flat. Now, as the name itself suggests, foot flat. So in this phase, the foot will remain flat on the surface. So this is the surface and you can see the foot is completely flat, placed flat on the surface. And that's why it is known as foot flat. And these are the areas where weight bearing will take place during foot flat phase. So I hope you can actually imagine what I am trying to say. So this is the heel, metacarpal, metatarsal heads and phalanges. So these are the areas where weight bearing will be seen during foot flat fees. So the range of motion will be. So first is hip joint. So hip joint will remain in flexed position. So it will be 25 degree flexed. But now after this stage, it will go into extension. So after foot flat face, the hip joint will go into extension. In knee joint, it will also remain in flexed position. 15 degree knee flexion will be seen in foot flat. And ankle will remain in 10 degree plantar flexed position. So here it is in plantar flexed.
Now the third phase of stance phase is met stance. And you can remember this by mid. So you can see here mid word. So mid refers to middle. So the lab remains in the middle. It does not, it is not in completely Flex position or extended position. It is in the middle. Hip remain in zero degree extended position. Knee remain in zero degree extended position. And ankle is in 5 degree dorsiflex position. So it is 5 degree dorsiflex. So Labs remain straight in the midline. And that's why it is known as mid stance. You can remember in this way. During this phase, as our whole body weight is concentrated on that one foot. So the weight will be evenly distributed on the entire foot. And because of this, there is an important thing to note. Whenever a patient has any painful condition in hip joint, or he has arthritis in knee joint, or he has planted fasciitis an ankle joint and a painful condition in any of these joint. And enduring this phase, the whole weight bearing is concentrated on one single lag. And the other leg and the other lab is actually in swing phase. So the contralateral lag is actually in swing phase. So this slide is actually in swing phase. And the whole body weight is concentrated on one single leg. And suppose a person has arthritis, arthritis of knee joint, then during this phase, it will actually create a lot of pain on the patient. It will create a lot of pain of knee joint. And that's why patient will hurry. He will hurry. So the duration of this phase decreases in those patients who have unpainful conditioning and hip, knee or ankle joint. So if any of the painful condition present in any of these joint, the patient will hurry during this phase because this face will create pain. That's why the duration of this phase will decrease in those patient who has any of these conditions present in any of these joints.
One more pathological gauge seen during this gate is trundle and work gate. Because in this phase, one leg is in swing phase and another lag in his stance phase. And suppose The Stance face gluteus medius is weak. So this gluteus medius of stance phase is weak. And because of that, it cannot hold that palette this into a neutral position. Because of that, it will drop the contralateral pelvis will drop. And because of that, the Triangular gate was seen during this phase.
The second last stage of stance phase is terminal stance or heel off. Both heel of face and toe of face, which is the next phase after he off, they both combinedly contribute to 10 percent of gate cycle. Now during this phase, what actually happen is, as the name itself suggests, if you will concentrate on the names, then automatically you will come to know about what does it mean. So first you have to understand the name and you will automatically come to know what does what does exactly that mean. So heal off. So during this phase, the heel of the patients lift from the floor. As you can see in this diagram, the weight bearing diagram, the there's no weight bearing in the heel area. So there is no weight bearing on the heel. So through this diagram, you can comprehend better that during heal off phase, all the weight gets concentrated on the metatars of pharyngeal joints and phalanges. So all the weights get distributed over that area. And here is lifted off during this phase.
Now again, the range of motion is at hip joint, it is 20 degree hyper extended. So the hip is hyper extended 20 degrees. Knee is in extension, zero degree extension. And here the ankle is in dorsiflexed 10 degree dorsiflex. Now again, you will think like it seems like it is in plantar Flex position. But again, let me tell you like the way I told you in the previous time. So this is the straight line and this is the line created by the foot. Now this time, the 90 degree is decreasing. There is a angle formed in between both these lines. And the 90 degree angle has decreased. And because of this, this angle formed in between both of these lines and which is a which has slightly decreased. And because of this, we can see the foot is in dorsiflex position and not in plantar Flex position. But in the next stage, which will be two off stage, in that phase, you will see that here the foot will be in plantar Flex position. But right now, it will, it is in dorsiflexed position. So if you are someone who also want to write the range of motion of amtp joints, then it is 30 degree extended. So MTP joints are 30 degree extended. And the previous phases, it was in neutral position. It was zero degree. It was in neutral position. And in this phase, the antimage joints are 30 degree extended.
Now the last phase of stance phase is pre-swing Phase or toe off. Now in this phase, it is called pre-swing phase because after this phase, this lab will go into swing phase. That's why it is known as pre-string phase because now the lab prepares for swing phase. So the range of motions are at hip joint at the zero degree. And it at knee joint, it is 40 degree flexed. At ankle joint, it is 20 degree plantar flex. And an MTP joint, it is MTP joints are extended 60 degree extended.
Now one important thing during this phase to understand is, as you can see, the weight bearing is more concentrated towards the toes, towards the pharyngeal joints. And because of that, if patient has any painful condition at an MTP joint of thumb or any other MTP joint, then during weight bearing, because during this phase, the weight, all the weight is concentrated on this area, so patient will have pain. It will trigger pain during this phase. So suppose a person has metacarsalgia, then during this phase, it can trigger pain. I hope you are able to understand what I am trying to say because I am not teaching you physically. So comments are the only way to make sure that I you are able to understand. So you can leave the comments so that I can able to make sure that I can able to teach you and you all are understanding.
So now the next piece is Swing face. So basically there are three phases. First is initial phase, also known as acceleration phase. Second is mid swing. And third is terminal swing, which is also known as deceleration please. But when I will increase my budget, I will also bring a bigger board. So during the initial swing, the hip will be in Flex position, 15 degree Flex. Knee will be in 60 degree flexed position, which is the maximum flexion during all these phases. So during initial phase, the knee will be in maximum flexion, which is 60 degree. And the ankle will be in 10 degree plantar Flex position. Now here is one important thing. Person who has foot drop, that means they cannot able to dorsiflex their foot. So in those patients, they cannot clear the ground and put their foot forward. So in order to clear the ground, they have to lift their knee above than the normal. So they have to lift the knee, they have to lift the knee above then the normal in order to clear the ground and lift the foot forward. So in in those patients, the knee range of motion will be higher. The flexion range of motion will be higher because they have to lift the knee higher than the novel in order to clear the ground and lift it forward in those patients who has foot drop. And in all these phases, the MTP joint will remain in neutral position, that means zero degree. In mixed swing, the hip was 25 degree flexed, uh 25 degree. Knee was flexed. And ankle is zero degree in neutral position. In terminal swing, the hip is 25 degree Flex. Knee is extended, zero degree. And the ankle is in neutral position. Now please don't ask me why it is a neutral position because it seems like it is dorsiflex because I have already explained you in previous phases. So yeah, that's it for today's video. And I'll try to cover many important points. And I hope I helped you in understanding the phases of gate cycle. And meet you in my next video.