Gait analysis in water

Johan Lambeck PT
EWAC allied health consultant
International Aquatic Therapy Foundation
www.halliwick.eu
 Contents

!! Kinetics
! Fluidmechanics
! Ground Reaction Forces (GRF)
!! Kinematics
! Temporal and spatial parameters
! Joint movements
! Muscle moments
!! EMG studies
 Why biomechanics

!! To understand:
! the mechanical loads on the body
! Human adaptation to changes of mechanical constraints
!! To contribute to:
! A more appropriate prescription of walking in water as
part of rehabilitation programmes
 Land vs water

!! Kinetics are quite different

! Buoyancy forces
! Drag forces
!! Kinematics are robust
! Dynamic similarity

!! Dynamic Systems Model

! The body chooses for effectiveness and efficiency: adaptation
to mechanical constraints within the biomechanical possibilities.
 Conflicts

!! Kato et al 2001:
! In water, the strategy of locomotion is quite different from
that on land

!! Degani & Danna-dos-Santos 2006:

! Older adults . using a similar pattern in water than used
on land
Mitarai et al
1972
Effects of buoyancy
 Flow impedance / drag force

!! Fd= .5 * d * Ap * v2 * c

!! Fd = drag force, d = density, Ap = frontal

plane, v = velocity, c = constant factor
 Kinematic viscosity (v)

!! v = dyn. visc / density

!! Water: dyn visc = 1, density = 1
!! Air: dyn visc = 0.018, density = 0.0013
!! v air = 14
!! v water = 1
!! 14 : 1 = differences in resistance (range is about 0
42)
 Robust kinematics (Miyoshi 05)

!! Dynamic similarity
! At different speeds and in different environments we try to
preserve energy as best as possible. For this,
biomechanically, we need to walk with similar Froude
numbers
o! Froude number: ratio of inertia forces over gravity forces
! Ref: Exploring biomechanics, animals in locomotion. R. McNeill Alexander (1992).
Scientific American Library, New York. ISBN 0 7167 5035 X
 Elastic similarity

!! To have dynamic similarity, there must be elastic

similarity. In water elasticity is different. Walking can
never be exactly the same the same on land and in
water
o! Donelan et al 00
 Kinetics

!! Ground reaction force components

! Vertical
o! Magnitude of 2 peaks and the valley
o! % body weight reduction
o! Initial slope of the GRF curve (impact force)
! Anterior posterior
o! Magnitude
o! Impulse (energy through the foot: area of curve)
! Medio-lateral
 Ground reaction forces during walking on dry
land and in water

Cole & Becker: Comprehensive Aquatic Therapy 2002

 Ground Reaction Force

Harrison 92: measuring platform with pair of

scales, fairly accurate
Velocities are not mentioned
Harrison et al, 1992
 Harrison confirmed by Roesler 06

!! Gait conditions
! ISG: slow gait, arms next to the body (0.41 m/s)
! IQG: quick gait, arms next to the body (0.55 m/s)
! OSG: slow gait, arms out of water (0.43 m/s)
! OQG: quick gait, arms out of water (0.66 m/s)
!! Cohorts
! 1: manubrium sterni at 1.34
! 2: manubrium sterni at 1.40
! 3: manubrium sterni at 1.47
!! Water depth 1.40, young adults n = 70
Roesler 2006
 Water walking velocity
!! Comfortable = 0.55 m/s
!! Fast = 0.93 m/s
! Miyoshi 05
!! Self selected = 0.5 m/s (1.8 km/h)
! Barela 06a and 06b
!! Slow = 0.41 0.43 m/s
!! Fast = 0.55 0.66 m/s
Roesler 06
!! Slow = 0.5 m/s
!! Fast = 0.8 m/s
! Masumoto 04 Treadmill
!! Slow / normal = 0.51 m/s
!! Fast = 0.61 m/s
! Fowler-Horne 00
!! Comfortable = 0.75 m/s
! Chevutschi 07
Barela 2006b
 Barela et al 2006a: young adults Barela & Duarte 2006b: elderly

Always a positive av GRF in water: always propulsion needed against impedance.

Confirmed by Roesler 2006 and
 Comparison elderly / adults

!! Elderly showed significantly:

! Lower first peak of heel strike
! Lower impact (less steep rise of 1st peak)
! Lower impulse
Nakazawa 1994,
same results as
before
Nalasco, R. 2003: magnitude differs with depth
Nakazawa 94a
Slow = slower than
comfortable
Fast = faster than comfortable

Nakazawa 94b
Differences in depth
 Kinematics

!! Stride temporal and spatial parameters

! Length
! Duration
! Speed
! Support phase
!! Joint ROM
Temporal and spatial gait parameters
Stride cycle water Duration Length Speed Stance Support
vs land (s) (m) (m/s) time phase %
Barela a adults 150% Same 60% same
Longer Slower
Barela b elderly 100% same 60% same
Longer* Slower*
Nakaza- adults Longer
wa ! depth
Shono Adults Slower Lower
treadmill
Chevutsc Adults 25% 60%
hi less slower
Fowler- Adults reduce slower
Horne d
* Elderly had ss longer duration and slower speed than adults
 Water

!! Duration % of stance and swing did not alter despite

slower speed, contrary to land.
! > effect of unloading counterbalances the effect of slow
walking (Barela)
!! Stride frequency and double support phase are
reduced
! Shono 04
Nakazawa 94b
1.! Stance time increases with
depth

2.! Body weight decreases with

depth (see also e.g Roesler)

3.! Impulse highest in 40 and 70 cm

and only in 1.20 lower than on
land
 Flex

stance swing

Barela etal, 2006a: young adults Barela & Duarte 2006b: elderly
 Conclusions young adults

!! Quantitatively all joint show roughly the same

patterns, however in water:
! More plantar flexion of the ankle (body leans slightly
backward)
! Reduced flexion of the knee first 15 stance (less weight
acceptance needed)
! Increased flexion of the hip in swing (buoyancy effect)
o! Shared by Miyoshi 00 and others
Miyoshi T, 2003

swing
Barela 06
Comparison stance phases adults
 Conclusions elderly

!! Quantitatively all joints show roughly the same

patterns, however in water:
! More plantar flexion of the ankle (body leans slightly backward)
! No clear heel strike but foot strike
! Increased knee flexion at begin and end
! Increased hip flexion in the whole cycle
!! Degani 06/07 did not find differences between young
adults and the elderly
 Comparison elderly / adults

!! Elderly significantly:
! Smaller overall ankle ROM
! More knee flexion at initial contact
! Less dorsiflexion ankle at initial swing
! Less knee flexion at initial swing
! More hip flexion at initial swing
o! > less movements in ankle and knee, compensated by the hip +
less weight catching
Shono et al 2005: walking faster changes knee ext / or knee flexion
Pyhnen 02
 Hoffman- reflex (H-reflex)

Pyhnen 02
EMG comfortable walking young adults

!! In water (Barela 06):

! Flatter patterns, less peaks: less phasic and more tonic activity
(synergistic to maintain balance, to keep propelling against
drag)
! Gastrocnemius same pattern as on land
!! In water (Chevutschi 07)
! Patterns in terms of peak amplitude and shape the same as on
land
! Erector spinae more and soleus less active in water, rectus
femoris variable between subjects
 Barela & Duarte 2006b:
Barela et al 2006a: adults
elderly
Nakazawa 1994a
Healthy adults
1.30 depth
Speed not quantified

Biceps femoris
Vastus medialis
Tibialis Anterior
Gastrocnemius
Soleus
Nakazawa 1994b
 Nakazawa 94

!! Inter-muscular coordination patterns change when

walking in water or walking with different speeds
!! No difference between non-loaded and loaded
walking (10% added weight)
!! BF is more active in water (propulsion)
!! BF and Gas reacted more to velocity, Sol and VM
less
EMG activity during walking on dry land and
in water 2 (Chevutschi et al. 2007)
EMG activity patterns during walking on dry land and
in water (pilot study, Kotka, Finland, unpublished. Courtesy T. Pyhnen)
Muscle activity during walking on dry land and in water
(Masumoto et al 2004)
 Moderate: 0.65 m/s
Slow speed: 0.5 m/s
Fast speed: 0.8 m/s
Depth: Xypoid
Flowmill / treadmill

Masumoto et al 2004
 Conclusions Masumoto

!! Walking in water with current

! Abd, PA, GM, RF, VM, GA " 40-60% land
! BF, TA " 70% land
!! Walking in water without current
! Abd, PA, GM, , VM, GA, BF " 30-50% land
! TA " 60% land

! > Shono 2001: walking on the flowmill is very similar to walking

through the pool
 Petrofsky 2002

Quadri Tib ant Glut m. Gastroc

amplitude EMG EMG EMG EMG
L,1.6 km/h 7.8 17.3 18.6 46.8
L,1.2 km/h 5.4 11.1 13.5 38.1
W122, 1.6 4.8 10.8 2.6 5.6
W122, 1.2 2.1 5.9 1.8 3.6
W91, 1.6 2.9 3.1 5.5 8.2
W91, 1.2 1.8 2.3 2.5 3.5
1.6 km/h = 0.44 m/s
Water vs Gastrocn Tib ant Biceps fem Vastus m/l Rectus
land St sw St sw St sw St sw fem
St sw
Barela adult = = = + + - - =
35% weight start
Barela elder = = + + + +

Nakazawa = + - =

Nakazawa = = + = =
50% weight
Chevutschi +
averaged
Kottka + - = + = +
start
Petrowski - = =
122 cm
Masumoto - - - - - - - - - -
 Erector L1 Rectus abd Glut max Tensor fl Soleus
St sw St sw St sw St sw St sw
Barela adult - + - +
end
Barela elder + +
end
Nakazawa -

Nakazawa +

Chevutschi + -

Kottka

Petrowski -

Masumoto - -
 Conclusions GRF

!! In water
! A decrease of magnitude and impact of the vertical GRF
o! Depends on depth and velocity
! The a-p GRF is always positive / propulsive
 Conclusions Kinematics
!! Stride time increases in water
! % same increase of both stance and swing
!! The comfortable velocity in water is about 50% of land velocity
!! Stride length does not alter
!! Joint angles are roughly identical in water and on land with small
changes because of buoyancy and drag effects
!! Increase of speed: knee angles more in the flexion range
 Conclusions EMG

!! Muscles show les peaks, signals are flattened in water

!! Poly-articular muscles increase activity more than
mono-articular when walking faster (BF and Gas as
opposed to VM and Tib ant)
!! Till 50% immersion: hardly a change in muscle activity
!! In general no consistent oucomes in EMG research
Shono wt al 2005
Myoshi, 2003
Miyoshi 05: moments during stance
Dahsed line = land
All thick lines: additional 8 kg load
 Conclusions Miyoshi

!! Moments
! Of plantar flexion significantly decreased
! Of knee extension shows 1 peak at late stance, on land 2
peaks
! Constant hip extension during stance
! Of hip extension increase with velocity