The gait cycle is divided into two main phases—stance and swing, each consisting of numerous subphases.
2,3 Traditionally, the human gait cycle is considered to have six determinants that function independently, yet simultaneously, to generate the normally fluid, continuous movements of ambulation.
4 The first two determinants of the gait cycle—pelvic rotation and pelvic tilt—involve the pelvis, including the right and left innominate bones and the sacrum.
During the swing phase of the gait cycle, the pelvis rotates forward on the side of the swinging leg about a transverse plane, with the hip joint of the stance leg serving as the axis of rotation. In addition to this forward rotation, Trendelenburg tilt occurs on the side of the swinging leg, with the pelvis dropping by approximately 5 degrees.
2 The degree of tilt is limited by contraction of the hip abductor muscles of the stance limb, primarily the gluteus medius. Also during Trendelenburg tilt, there is a lateral shift of the pelvis toward the stance leg, resulting in a shift in the center of gravity.
2
In traditional gait theory, the pelvis is thought to function and move as a single unit, with the individual components immobile relative to one another.
2,4 Osteopathic theory, however, holds that individual motions occur between the right and left innominate bones and the sacrum.
5-7 These individual motions arise when torsion forces are created within the pelvis during the gait cycle, leading to variations in the timing of rotation, tilt, and lateral shift between the sacrum and innominates. Studies have documented the range of motion and the degree of rotation in these bones.
8,9 Thus, clinical gait analysis must incorporate both traditional and osteopathic gait theory to arrive at the correct diagnosis.
Physicians typically rely on visual observation alone to assess both normal and pathologic gait. Gait disturbances may arise from pathologic conditions of the spinal cord and lower body, as well as from cognitive and neurologic disorders of the brain.
10-12 Gait analysis systems, such as GaitMat II (EQ Inc, Chalfont, Pennsylvania), are now available for making reliable measurements of numerous spatial and temporal gait parameters as a patient walks across a mat, 12 feet in length, that has electronic sensors connected to a computer. These systems, which can aid physicians in diagnosing gait pathologic conditions,
13 are increasingly used in the clinical setting.
1,14-15
Although the GaitMat II system measures only foot contact patterns recorded on the mat, these patterns arise from the collective motions of the individual musculoskeletal components that contribute to bipedal locomotion.
16 Therefore, GaitMat II can be used to assess normal and abnormal gait patterns, as well as the effects of somatic dysfunction and OMT on gait. We used GaitMat II in the present case report to evaluate a patient with Trendelenburg gait before and after OMT.