Kinematics can help to discriminate the implication of iliopsoas, hamstring and gastrocnemius contractures to a knee flexion gait pattern

Abstract

Background: Excessive Knee Flexion Gait Pattern (KFGP) is a common gait deviation in many pathological conditions. The contractures of the muscles that have been identified as being responsible of KFGP are: iliopsoas, hamstring and gastrocnemius. Research question:How do isolated contractures of the iliopsoas, hamstrings and gastrocnemius impact knee flexion during gait?Methods: Three levels of contracture (mild, moderate and severe) were simulated bilaterally using an exoskeleton on 10 healthy participants for iliopsoas, hamstring and gastrocnemius muscles. A gait analysis session was performed to evaluate the joint kinematics according to the different simulated contractures. Thirty one parameters were chosen to analyze the kinematics of the thorax, pelvis, hip, knee and ankle. A principal component analysis (PCA) was used to determine the kinematic parameters influenced by contractures. Results:In addition to a permanent knee flexion observed for the three muscles with contracture: the contracture of the iliopsoas induces a large hip flexion with pronounced anterior pelvis tilt; the contracture of the hamstrings induces an ankle dorsiflexion during the support phase with a posterior pelvis tilt; the contracture of the gastrocnemius induces an absence of first and second rocker of the ankle with a slight flexion of hip and a slight anterior pelvis tilt.Significance: These results support the identification of the muscles responsible for a KFGP.A better knowledge of the interactions between contractures and associated joint kinematics of the same and adjacent joints will support the interpretation of gait analyses by more precisely and faster targeting the concerned muscle.

Modular reorganization of gait in chronic but not in artificial knee joint constraint

“…In humans, the short-term effects (immediate to a few minutes following application) of artificial joint constraints have been studied using external devices. For example, to mimic the knee flexion contracture gait pattern typical for people with cerebral palsy and people with knee arthropathy and to mimic full knee extension following knee arthrodesis surgery (44)(45)(46)(47)(48)(49)(50)(51)(52). A simulated knee flexion contracture results in an increased forefoot weight bearing and flexion posture during stance, increasing the knee extensor torque (46,48,51).…”

“…A simulated knee flexion contracture results in an increased forefoot weight bearing and flexion posture during stance, increasing the knee extensor torque (46,48,51). Both simulated knee flexion contracture and knee arthrodesis change ankle and hip kinematics to facilitate foot clearance of the braced limb (44)(45)(46)(48)(49)(50). Only one previous study reported short-term changes in EMG in response to an artificial knee flexion contracture and found an increase in the amplitude and duration of the gluteus maximus, vastus lateralis, and soleus muscles during the stance (46).…”