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Aust. N.Z. J. Surg.

(1999) 69, 276288



Department of Surgery, Wellington School of Medicine, Wellington South, New Zealand
Key words: Borelli, history, human gait, kinematic.

The book on which this is based is, in fact, two books. The first was
published in 1680 and the second a year later by the man who is
considered to be the father of modern biomechanicsGiovanni
Borelli. On browsing through these books one is immediately
fascinated by the diagrams, so painstakingly drawn and reproducedand the principles demonstrated by them. Borelli wasnt
the first to experience a surge in interest in the mechanics of
human movement because the mechanisms by which man and
other animals propel themselves have fascinated observers and
experimenters since the time of the ancient Egyptians. The earliest
studies by the ancient Greeks were directed to an understanding
of body structure, with a philosophical approach to the propulsive
mechanismsbased on theory and surmise, rather than on
experimental evidence (Fig. 1).
Philosophers, they were called, but the name of natural scientists
would perhaps give us a better idea of their activities . . . They were
not doctors in our sense of the word, that is to say specialised
physicians, for the separation of Medicine from Philosophy did
not come until the time of Hippocrates. For them at that time
the study of man, the working of the human body and the way in
which our sense organs operate were as much a part of their
activities as mathematics, physics and astronomy.1,2

The Greek philosopher Pythagoras ( 580 BC) proposed the

theory that numbers possess certain virtues and from this he
developed the concept of the four body humours. This formed
the basis of Hippocrates physiology and, for that matter,
Galens and so was to influence the scientific basis of medicine for
over a thousand years.2
There followed a protracted period during the times of the
Roman empire when there was a preoccupation with anatomy
and surgery in the management of traumatic wounds. A more
scientific approach to movement studies came in the 17th
century with the beginning of the theoretical period of motion
studies. The late 19th century saw the beginning of the experimental period with the detailed measurement and analysis of
both body movement and the forces involved in this movement.
The 20th century has seen the fields of kinematics and kinetics
expand enormously with the increase in sophistication of the
equipment available to study the movement of the human body.
Correspondence: A. J. Thurston, Associate Professor of Orthopaedic
Surgery, Department of Surgery, Wellington School of Medicine, PO Box
7343, Wellington South, New Zealand.
Email: <surgat@wnmeds.ac.nz)>
Accepted for publication 17 November 1998.


The precursor of the anatomist is the Egyptian embalmer . . .
It would be erroneous, in the light of present knowledge to
regard the Egyptian embalmer as an anatomist or indeed as a scientist of any kind . . . His procedures were purely ritual in origin and
intention and his techniques were strictly utilitarian in purpose. The
anatomical knowledge that resulted therefrom was accidental.
Nevertheless, such fortuitous knowledge was of the greatest
importance, for it was unrivalled elsewhere in the world.3

It seems likely that the earliest studies of human structure by the

Greeks may have derived from Egyptian sources because public
opinion in Greece at that time condemned dissection of the
human body.4 Certainly the earliest records of the formal study of
anatomy date from the time of Hippocrates (460370 BCborn on
the island of Cos and being one of a medical family known as
Asklepiads2) who wrote extensively on medical matters. He held
very practical views on anatomy with a decidedly mechanical
approach to fracture management.5
Plato (427347 BC) was a moralist and, although possessing
one of the keenest intellects of all time, did little to advance
medical science. Many of his ideas are now considered bizarre,
inaccurate and fanciful. He elaborated the humoral pathology
of Hippocrates. The world, he thought, was composed of four
elements: fire consisting of pyramidal-shaped atoms, earth of
cubical, air of octagonal and water of 20-sided atoms. The
marrow consists of triangles and the brain is the perfection of
the marrow. The soul dominates the marrow and the separation of
the two causes death. The purpose of the bones is to protect the
marrow against changes of temperature.4
It is not surprising then that his pupil Aristotle (384322 BC, the
son of Nichomachus) studied locomotion without a knowledge of
muscular action, believing that the extremities were activated
by animal spirits.6 He did not, however, advance beyond the
concept that nerves were akin to ligaments and tendons and that the
nerves originated in the heart. In spite of the deficiencies in his
knowledge of anatomy and physiology he is still considered by
many to be the greatest scientific genius the world has ever
seen.7,8 In De Motu Animalium (334 BC), he gave a geometrical
analysis of muscular flexion as a change from a straight line, to an
angle and he recognized that without flexion there could be no
forward progression.9 In his writings On Parts of Animals and
On Progression of Animals, he described the transfer of rotary
motion of the feet to translatory motion, and he recognized that,
in moving, the animal makes its change of position by pressing
against that which is beneath it.10 He demonstrated a remarkable
knowledge of the centre of gravity, laws of motion and leverage.



Fig. 1. Running gaitathletes depicted on a Greek vase.

Archimedes (287212 BC) demonstrated a similar knowledge of the

laws of leverage and the centre of gravity.10
The expansion of anatomical knowledge during the third
century BC was largely due to the Alexandrian anatomists. That
they carried out their human dissections in Egypt is irrefutable.3
Erasistratus of Chios (310250 BC) (the grandson of Aristotle11) and
Herophilus of Chalcedon ( 300 BC), demonstrated that muscles had
contractile ability. The latter also divided nerves into motor and
sensory components, although neither was aware of the difference
between tendons and nerves.12 Hegetor of Alexandria gave the first
descriptions of the relationships of the hip joint and a description
of the ligamentum teres in 100 BC.11 Rufus of Ephesus (50 AD)
described the lens of the eye and was the author of the first scientific anatomical nomenclature. Soranus of Ephesus (100 AD)
described the pregnant uterus and Marinus of Tyre ( 100 AD)
was the author of several treatises on anatomy.3
The major advance in anatomy was effected by Galen (Fig. 2)
(131211 AD). From dissection he was able to describe the
origin, insertion and function of muscles, describing them in
systems.13 In his De Motu Animalium he regarded the body as
a unified organ of locomotion. He sought the mechanism which
activated voluntary movement during life and concluded that
it arose in the brain and travelled through the nerves as a vital
humour. He also described the phenomenon of tonic contraction
agonist and antagonist actions of muscles,11 and he distinguished between motor and sensory nerves.10 His is the first
recorded description of the relations of movements of the spine and
joint mechanics.14 Although it is acknowledged that he carried out
human dissection in Egypt3 his later work was in Rome where most
of his anatomy studies were based on apes and pigs, and the
errors which this led him into were perpetuated in part because of
his forthrightness and in part because his views on the subornation
of body to soul endeared him to the church, so that to question
his views was considered to be a mortal sin.15 Therefore, this
Galenic doctrine stood, unchallenged and uncontradicted, for
hundreds of years, until the time of the Italian anatomists.
Because of the unshakeable belief in Galenic doctrine and
medieval superstition, anatomy suffered for lack of practical
dissection and any dissections of human remains were carried
out in secret. Nicolas of Reggio translated Galens On the Use
of the (Bodily) Parts, in the early 14th century when there was
an awakening interest in human anatomy. Saliceto, a pioneer of
the late 13th century, was followed by Mundinus of Bologna
(d. 1325), both of whom carried out clandestine dissections.

Fig. 2. Galen (131201 AD). Most of his anatomy studies were based on
apes and pigs, and the errors into which this led him were perpetuated for
hundreds of years, until the time of the Italian anatomists.

The work was continued by Guy de Chauliac (d. 1368) and

Leonardo da Bertapaglia (d. 1460).16 However, during the
Renaissance, it was the artists who did much to lift anatomy
(particularly that of the locomotor system) out of the rut in
which it had lain for so long.15 Leonardo da Vinci (14521519)
based much of his anatomical knowledge on his own dissections by
way of improving his art (Fig. 3). In his treatise on the muscles of
the human body he showed a sound knowledge of mechanics
which is also manifest in his art works. He related structure to
function and he showed the relationship between the centre of
gravity and balance, and the centre of resistance.10 He was the
first to record scientific data on movement.17 The concept of
mechanical linkage and the hypothesis of synergistic action
upon which muscle balance depends, developed by da Vinci,
form the basis of kinesiology.11
Anatomical knowledge in Europe mushroomed during this
period, with greater acceptance of human dissection to the
extent that many were conducted in public. Probably the most
well-known dissector of the time was Vesalius (Fig. 4)
(15141564), although he was not the only anatomist of the day
performing public dissections. Born in Brussels, he studied in



Fig. 4. Andreas Vesalius (15141564)probably the most wellknown anatomical dissector of the time.
Fig. 3. da Vinci anatomical drawingthese showed a sound
knowledge of mechanics which is also manifest in his art works.

Padua, Pisa and Bologna and published his magnum opus De

Humani Corporis Fabrica in 1543.16 Vesalius studied muscular
function in detail and identified that the contractile elements
were the fibres of muscle, rather than the tendinous or ligamentous
elements: Muscle gathers itself together and becomes thicker
and shortens, and moves the part to which it is attached.18 He stated
that neither Plato nor Aristotle understood the nature of muscles.
His other studies were concerned with neuromuscular function,
anatomy of the intervertebral disc12 and the appearance of degenerate articular cartilage in senile cadaversthe first description of
the pathology of osteoarthrosis.11 The combination of mechanical
knowledge and anatomy is evident in the efforts of Ambroise
Par (15101590) in designing various splints and prostheses
including a splint for hip disease.11,19 Girolamo Fabrizio
(15371619) described many splints and braces based on the
style of the 16th century armourers.11 The termination of this
anatomical period came late in the 17th century. A major figure
during this latter part of the period was Heronymus Fabricius
(ab Aquapendente) (Fig. 5) (15371619). Although much of his
time was given to the study of embryology, he gave exhaustive
treatment to muscles and bones and lectured publicly on them
between 1590 and 1598.20 In De Motu Locali Animalium,18,21,22
he devoted much time to the structure, action and uses of

muscle, recognizing that although the nerve initiates the contraction

of the muscle, it does not itself contract.18 With the development of
the microscope, muscle structure was studied in greater detail.
Using a microscope, Malpighi (16281694) was able to give a
description of the elementary fine structure of muscle, which he
described in De Muscularis Observationum Specimen. This study
was considerably expanded in 1667 to Elementorum Myologie
Specimen by Stensen (16481686). He described the motor fibres
(fibra motrix) arranged longitudinally and attached, at the end, to the
non-contractile tendons. Baglivi (16681707), in De Motu Muscularum and De Fibra Motrice Morbosa differentiated between
smooth and striped muscle and Leeuwenhoek (16321723) described longitudinally striped muscle and sarcolemma.11
A cycle of lectures on muscle contraction was given by
Croone (16331684) in the Surgeons Theatre, London, in 1674
and 1675. In giving these lectures he established the Croonian
lectures which are devoted to muscle physiology. John Hunter
(17281793) delivered six Croonian lectures between 1776 and
1782 and dealt with origins and insertions, fibre arrangement
and contraction and relaxation. He also discussed the two-joint
problem (where a muscle passes over two joints and can move
both of them either singly or simultaneously) and muscular



Fig. 5. Fabricius (ab Aquapedente) (15371619) devoted much

time to the structure, action and uses of muscle, recognizing that
although the nerve initiates the contraction of the muscle, it does
not itself contract.

Bichat (17711802) gained considerable anatomical knowledge in performing more than 600 postmortem examinations per
annum in his position as physician to the Htel Dieu. Through his
pioneering work in histology he contributed to the transformation
of anatomical knowledge from a collection of dogmatic statements, handed down through the ages, to a science.10


The physiological aspects of muscle function began now to
interest anatomists, and many theories were formulated as to the
mode of action of muscle tissue. Glisson (15971677) contended that muscle fibres acted by contracting rather than by
expanding, as an inflated bladder. In De Ventriculo he demonstrated, by an early method of plethysmography, that muscles
do not increase in size when they contract.10 Borelli (vide infra)
similarly noted that muscles do not exercise vital movement
otherwise than by contracting. He refuted the idea that nerves carry
attenuated corporeal animal spirits by demonstrating that cut
living muscle did not release bubbles when submerged in water.
(He assumed that animal spirits were gaseous.) He concluded
that some commotion must be communicated along some substance in the nerves in such a way that a very powerful inflation

can be brought about in the twinkling of an eye. This commotion

effected a reaction of substances within the muscle as when
spirits of vitriol are poured on oil of tartar.18 Stensen also
rejected the notion of animal spirits and he showed that isolated
muscle contracted only when the nerve was stimulated or when the
muscle itself was irritated.
A major advance came in 1740 with the discovery, by von
Haller (17081777) and Whytt (17141766), of the association
of muscular contraction with electricity. Galvani (17371798)
studied the effects of electricity on frog muscle preparations.
His Effects of Electricity on Muscular Motion is the earliest
explicit statement of electrical potential.10 The foundations of
modern electrophysiology were laid down by M. Emile du BoisReymond (18181896). His kymograph and induction coil were
still found in many physiology laboratories in the early 1900s.23
Duchenne (18061875) determined the action of practically all
important muscles by electrical stimulationPhysiologie de
Mouvement. The higher control of muscle movement was investigated by C. S. Sherrington in his work on decerebrate rigidity,
reciprocal innervation and reciprocal inhibition. He found that
when agonists are under reflex stimulation, the excitation of one
centre of control is simultaneous with the inhibition of the other.
This, together with the all-or-none reaction, is fundamental to
the understanding of the kinetic events of the human body.9
The invention of the electromyograph by Wedenski in 1880
allowed him to demonstrate the existence of action currents in
human muscles. Then, in 1906, Einthoven developed the string galvanometer for the study and recording of action currents and in
1910 Piper produced a paper on the physiological aspects of
muscle electricity.9,10 Knowledge of this work did not spread to the
English-speaking world until Adrians paper, Interpretation of
the electromyogram was published in 1925.24 Richard Scherb
carried out detailed investigation into the sequence of muscle
actions during walking (on a treadmill), first by laborious palpation
and later by electromyographical studies.25,26
The thermodynamics of muscular work were first studied by
August Chauveau (18271917), while Fenn, Benedict and Cathcart
studied energy expenditure during gait.9 As the study of muscle
physiology progressed, other workers were investigating the
more mechanical aspects of animal motion.


The concepts of voluntary and involuntary muscle action and
tonic contraction interested William Harvey (15781644) and
he began looking into the reasons for movement. In De Motu
Locali Animalium (1627) he considered the implications of
Aristotles statement that men run faster if they swing their arms
and they jump further with weights in their hands.27 This interest
in the mechanics of motion flourished. Descartes (15691650), a
philosopher, drew on a knowledge of both anatomy and physiology
in considering man as an early machine: Machine de Terre.9
For him the body was a machine made by the hand of God:
incomparably better than any machine of human invention.8
Advances in mechanical knowledge came through the work
of both Galileo Galilei (15601642) with his advances in
mechanics in mathematical terms and of Isaac Newton
(16421727): Principia Mathematica Philosophiae Naturalis.
In this, Newton laid the foundations of modern dynamics with
his three laws of movementthe laws of inertia, momentum
and interaction.10 It is, however, Borelli (Fig. 6) (16081679)
who is credited as being the father of modern biomechanics.



Fig. 6. Giovanni Borelli (16081679)credited as being the father of

modern biomechanics.

Borelli was an Italian physiologist and physicist with a strong

mathematical leaning.26 Born in Naples in January 1608, he was a
pupil of Galileo and his association with Malpighi gave him an interest in anatomy.18 His two major works, De Motu Animalium I
(1680) and De Motu Animalium II (1681), in which he sought to
equate animals with machines, contain detailed studies of the
fundamental actions of muscles in both internal and external
movements. In his analyses of the movements of lever arms and the
relationship of the muscle forced to the angle of application, he considered the bones as levers, and that muscles worked on mathematical and geometrical principles (Fig. 7).28 After determining
the centre of gravity of the human body, he formulated the
theory that forward progression involved the displacement of the
centre of gravity beyond the area of support and that the swinging
of the limbs saved the body from losing balance.9 His other considerations were of the motor force involved, the resistance to be
overcome, and the point of body support during walking.6
Other workers made equally painstaking calculations of
various aspects of locomotion. Keill (16741719) calculated the
number of fibres per muscle belly and determined, thereby, the
amount of tension developed in each muscle during lifting.
However, he drew the erroneous conclusion that muscles do not
contract to less than two-thirds of their resting length. In France,
Roulin published his Recherches Theoretiques et Experimentales sur
la Mchanism des Attitudes et des Mouvements de Lhommes
in 1821; Chabrier published his Memoire sur les Mouvements
Progressifs de Lhomme et des Animaux; Gerdy (b. 1797) published

Fig. 7. Borellis diagram demonstrating his analyses of the movements

of lever arms and that muscles worked on mathematical and geometrical principles. From De Motu Animalium I (1680).

his Physiologie Mdicale Didactique et Critique, in which he

examined the phenomena occurring in the trunk during walking, and
Poussin wrote on the quality of movement produced in walking
Traite Mchanique.29 Thus began the experimental period.


Foremost in the early part of this period were the brothers
Weber.30 Eduard (18061871) and Heinrich (17951878) studied
the dynamic action of muscles while Eduard and Wilhelm
(18041891) studied the mechanics of locomotion. Their methods
were largely observational, with some basic measurements
being made of the alternation of the stance and swing phases
(Fig. 8), the inclination of the trunk during these phases, the
relationship between step length and step duration, and the
rhythm of alternation in walking and running.26,3133 They concluded, erroneously, that the leg action in walking was pendular and
that the swing time for a cadaver leg was 0.355 s.34 They suggested
that posture was maintained by ligaments and not by muscles,
and also that walking was a process of falling forwards, which was
arrested by the weight of the body being thrown on to the next supporting limb. Their major problem was the lack of a suitable
method for the chronological study of gait.


The transit of Venus in 1878 was studied by Janssen, an

astronomer, by taking serial photographic representations. The
application of this method to the study of movement was quickly
realised and kinematography was born. The first major works utilizing serial photography were by E. Muybridge (18301904)The
Horse in Motion (1882) and Animal Locomotion (1887).
Muybridge was born at Kingston-upon-Thames on 9 April
1830, the son of John and Suzannah Muggeridge and baptised plain
Edward James. He was later to change the spelling to Eadweard
and his surname to Muybridge. In 1852 he sailed for America and
settled in San Francisco. Here he worked as the agent for a book
firm, The London Printing and Publishing Company. Out of this
pursuit he came into contact with the studios and galleries then
making photography such a lively art in San Francisco. In the
late 1860s he established a reputation as a landscape photographer

Fig. 8. Diagram by Wilhelm Weber

(18041891) illustrating the alternation of the stance and swing
phases of gait.

Fig. 9. Studies of human locomotion by E. Muybridge (18301904)

using a battery of 12 fixed cameras
along the length of a walkway with
six portable cameras arranged in
a vertical bank at each end. These
were triggered sequentially to produce a series of photographs taken
at various stages of the gait cycle.


and he became the official photographer of the United States

government. In 1872 he was commissioned by Leyland Stanford, a former governor of California, to photograph his famous
veteran trotting horse, Occident. The problem of photographing at
speed fascinated Muybridge and it was from this work that he
developed the technique of cinmatography. The books that he published on animal locomotion were instant best-sellers. He photographed athletes in every conceivable physical activity, women at
the washtub or spanking a child or climbing into bed, birds in flight,
ostriches walking and even camels at the gallop. For his studies of
human locomotion he used a battery of 12 fixed cameras along the
length of his walkway with six portable cameras arranged in a
vertical bank at each end. These were triggered sequentially to
produce a series of photographs taken at various stages of the
gait cycle (Fig. 9).35


This work was followed by many photographic studies of

movement. Anschutz and Londe made similar photographic
recordings in 189134 and . J. Marey (18301904), Professor at
the College of France, carried out extensive photographic
studies using both still and moving photographic plates.36 Marey
dressed his subject in a black costume bearing white, luminous
markers (Fig. 10(a)). The subject then walked, in sunlight, in
front of a black screen while the photographic plate was
exposed intermittently. To overcome the problems of parallax
error, Marey mounted his camera on wheels and this tracked
alongside the subject as he walked (Fig. 10(b)). From his photographs (Fig. 10(c)) he was able to calculate the temporal
factors of gait and the displacements of the joints, and to
produce graphs of the angular and linear displacements of the
limb segments of the joints. Knowing the centre of gravity, he was
able to draw the displacement of the centre of gravity with time and
relate this to the events of the gait cycle.37 Before carrying out his
photographic studies, Marey had developed a shoe with a pneumatic chamber in the sole (Fig. 11) from which data concerning the
temporal factors of gait could be recorded. With another pneumatic chamber attached either to the head or to the pubis, further
information regarding vertical displacement could be gathered.38,39 Carlet, who worked in Mareys laboratory, used his
equipment, extended this work and, using a shoe with two pneumatic chambers in the sole (Fig. 12), one under the heel and the
other under the metatarsal region, he was able to calculate the
length and duration of the step, the stance and swing duration
and the inclination of the trunk.29


In Germany, Braune (18311892), an anatomist, and Fischer

(18611916), a mathematician, perfected Mareys chronophotographic technique. Using Geisler tubes, attached to the subject,
giving intermittent illumination at 26 Hz, and four synchronous
cameras to give three-dimensional pictures, they were able to
produce much information concerning human movement.40 By
dividing the body into 12 theoretical segments, they were able to
calculate the pathways of each of the segments during the gait
cycle. They also used frozen, dismembered cadavers to determine the centre of gravity, by a double suspension method, of each
of the 12 segments. However, neither the ages nor the physiques
of the four male bodies that were used were recorded and the
values resulting from this study could be used only as a guide.
Their major interest was in the forces acting on, and acceleration
of, the component parts of the body during walking. Their work
was so meticulous and detailed that no subsequent publication
has superseded it.26
At the same time, much work was being carried out on the
mechanical properties of tissues. Roux, von Meyer, and Culman
studied the mechanical properties of bone. Roux worked also
with Julius Wolff (b. 1836) on the functional adaptation of bone,
from which Wolffs law of bone remodelling emerged,41 while
Volkman and Heuter formulated the law of bone reaction to
Mareys pneumatic apparatus stimulated the inventive minds
of many investigators to develop instruments for recording the
various parameters of gait. Generally, these instruments incorporated a means, either electrical, pneumatic or mechanical, of

Fig. 10. (a) Subject in a black

costume bearing white, luminous
markers. J. Marey (18301904).
(b) Mareys camera mounted on
wheels. This tracked alongside the
subject as he walked to overcome
the problems of parallax error. (c)
Stick diagram produced by Mareys


Fig. 11. Subject wearing a shoe with a pneumatic chamber in the

sole from which data concerning the temporal factors of gait could
be recorded. With another pneumatic chamber attached to the head
information regarding vertical displacement could be gathered. J.
Marey (18301904).

Fig. 12. Carlets subject using a

shoe with two pneumatic chambers
in the soleone under the heel
and the other under the metatarsal


registering foot contact with the ground combined with a

method of recording time impulses and with or without photographic recording of movement. Marey used a vibrating tuning fork
to draw timed impulses on his recordings. Meyer used an experimental shoe to record foot pressures in combination with sphygmographic and cardiographic recordings. 9 Plato Schwartz
invented several instruments for the study of gait. His basograph
recorded the swing of a pendulum with pelvic movement. 43 His
pneumograph used pneumatic shoes, similar to Mareys, recording
on a kymograph,6 and an electrobasograph relied on electrical
contact between three electrodes on the sole of a shoe and an
aluminium walkway.44 Mosso (1884) developed an ergograph to
measure muscle force and Regnier and Walter studied muscle
strength and muscular effort, respectively, with a dynamograph.
The ground reaction force was an unmeasured quantity until
1916 when Amar invented the forceplate (Trottoir dynamographique). This was a mechanical device which relied on the
deflection of indicators, linked through springs to the force
Many photographic methods of recording movement began to
evolve. Bernstein, a Russian professor of physiology, used
chronophotography at a rate of 60190 exposures per second,
with light bulbs for targets. He studied 152 subjects of both
sexes, and ages ranging from 10 years to 75 years. Stick diagrams were drawn to connect the exposures of the light bulbs.
Bernstein recognized deficiencies in this system and developed the
kymocyclograph with intermittent exposure of a slowly moving
photographic film. He even tried stereophotography but found
that more accurate data were obtained by having only one
camera, with a mirror in its field of view to provide the second
image.46 This avoided the problems with synchronizing cameras
and the differences between cameras. Bernstein wrote several
treatises on biomechanics, including General Biomechanics
(1926), Studies on the Biodynamics of Locomotion: Normal
Gait, Load and Fatigue (1935) and The Construction of Movements (1947). In these he questioned Fischers data on the
masses and the radii of gyration of the body segments and the
application of the results to the living, pointing out that the age and


build was not allowed for, and that the material used in the
studies was cadaveric.26
Cinphotography gave experimenters rather greater scope,
and the invention of the electronic stroboscope by H. Eggerton provided the facility of instant photography with an increased sampling
rate. Charles Ducroquet carried out one of the earliest studies of gait
using cinphotography. The combination of his work and that
carried out subsequently by his family is a detailed record of
the various characteristics of gait in selected pathological states,
compared with normal gait.47 The studies are rather more qualitative than quantitative. Herbert Elftman used high-speed cinphotography and a forceplate, consisting of an embossed rubber
mat mounted on a glass sheet which was photographed from
below, for his work.48 Eberhart and Inman used two synchronized cincameras in their studies of the principal elements in
human locomotion.49,50
The goniometer, a protractor-like instrument for measuring
angular displacements at joints, was automated by Karpovich.51
His electrogoniometer was a device which incorporated an electrical transducer which, when attached to a limb above a joint,
gave a direct electrical readout of the angular displacements of
that joint. Many electrogoniometers have been developed since.
These range from simple devices to measure the movements at only
one joint to the complicated exoskeletal goniometer developed by
Lamoreaux (Fig. 13) which measured the movements of all of
the joints of the lower limbs.52
Modern studies of gait have become too numerous to be
covered by this survey. The major studies of recent years have been
carried out both in the laboratory by Murray et al.,5358 Gore et al.,59

Fig. 13. Exoskeletal goniometer developed by Lamoreaux which

measured the movements of all of the joints of the lower limbs.


and Thurston et al.,6067 and out on the street using observational

methods, with subjects who were unaware that they were being
observed, by Drillis,68 du Chatinier et al.69 and by Molen,70
while other workers have investigated the kinetics of gait.7173
The study of spinal and pelvic kinematics is rather more difficult
because of the relative inaccessibility of these parts of the body.
Eduard Weber is reported as being the first to study cadaveric
spines with the specific intention of determining mechanical
properties. His work was carried out on three cadaveric spines
(two male and one female). Using rather crude observational
methods, he assessed the range of movement in various regions.
He correlated the results with his observations of spinal movement
in vivo. He stated that the lumbar spine could flex only in the sagittal and coronal planes, it being devoid of any axial rotation.32,33
More recently this latter statement has been challenged by Fisk74
and actual recordings of transverse plane movements in the
lumbar spine have been recorded by Murray55 and Thurston.60,65,75
Volkmann was unaware of Webers work and he carried out
similar experiments on spinal movement, concentrating more
on axial rotation and producing results wildly different from
Webers33,42 The intervertebral disc interested Bishop76 and in
1859 he demonstrated the flexibility of the intervertebral cartilages
to the Medical Society of London.
These were the first of many studies of cadaver spines. Von
Meyer,14,77 determined the axis of movement in lateral flexion
and rotation and Gurin described centres of lateral inclination and
their relationship to articular and muscular systems.78 Morris in
studying facet joint movements, claimed that the superior and
inferior facets in the lumbar spine did not contact and that the intervening space provided for rotation.33,79 In 1872, Hughes sought
to reconcile discrepancies between the rotations measured by
E. Weber and Volkmann. His results relate the rotations of one
vertebra to those of the adjacent vertebrae.33,80 Various other
studies of the movements of cadaver spines include those of
Reiner and Werndorf,14,81 Guibal and Mnard14,82 who measured
movements in all planes and in compression loading using a
diopeter,14 and Lovett who compared cadaver data with data
from a live model and two scoliotic children.14,83,84 Lovett also
described the coupling of rotation with lateral flexion.
To avoid the changes in the properties of the spine consequent
on stripping of the soft tissues, Fick used unprepared cadaver
spines to measure all of the movements. He came to the conclusion
that spinal movements are extremely complex and not merely
simple rotations about set axes, as was previously thought.85
Strasser, Krammer and Novogrodsky were the first to study the
effects of external forces on two adjacent vertebrae14,86 and
they attempted to systematise and classify spinal movements
by defining frames of reference so that each movement could
be expressed in terms of three angular values.14,87 Later Mller
attempted to reproduce spinal movement in fresh cadavers faithfully
by injecting formalin solution into the appropriate paraspinal
muscles, thus causing them to contract.14,88 Virchow undertook
painstaking preparation of cadaver spines to determine sagittal
plane movement. The results from this he compared with in vivo
spine movement in contortionists (this being of questionable
Since this time, a multitude of studies of the mechanical
properties of the spine has been reported. Almost all have been
carried out on prepared spines with poor control and little or no
standardization. Evans and Lissner compared the properties of
embalmed spines (with the ligaments intact) with thawed-fromfrozen spines and he reached the conclusion that embalming



increases both the load that a specimen can support and the
amount of energy that it can absorb!90 Recently, more rigorous
control of the condition of the specimen has been exercised
when determining the mechanical properties, with specimens
being enclosed in environmental chambers during testing. With this
care and attention to hydration state, temperature and so on,
rather more credible results are being reported.
Attempts to measure spinal movement in vivo have been, at
best, approximate. Lhrs method involved the measurement of
spine movement from shadows thrown on to a screen. He measured
sagittal plane movement of the thoracic and lumbar spines in
47 subjects.33,91 Blumenthal also measured sagittal plane movement
but with a system of strings and small weights attached, with
adhesive tape, over the spines of his subjects.33,92 McKendrick, in
1916, measured the interspinous distances in flexion and extension.93 This marked the beginning of the appearance of many
ingenious devices to record the range of movement of the spine
in vivo. Cyriax produced a spinal torsionometer,94 Dunham produced a spondylometer95 and Asmussen used an inclinometer
to assess spinal movement in the sagittal plane in a group of
boys.96 Israel and Goff both introduced special instruments for
measuring spinal mobility.97,98 One recent introduction is the
vector stereograph which is capable of measuring spinal mobility
in three dimensions (Fig. 14).62,99 Schber devised a technique

for assessing spinal flexion by measuring the distances between the

sacrum and a point 10 cm up the lumbar spine, in the neutral
position and again in flexion.100,101 This has been modified for
increased accuracy by Macrae.101 Sagittal plane movements are
easiest to measure by simple means, but Moll has suggested
clinical techniques for measuring the other movements of the
spine.102105 Photographic methods have been used by Flint,106
Davis et al.,107 Loeel,108 and Troup et al.93 Flint and Davis compared
photographic studies with X-ray studies to determine the differences between the two methods, since many X-ray studies were
being carried out. The difficulty in studying the in vivo movements
of the spine during walking has meant that little work has been
done on dynamic studies of spinal movement. Axial rotation
during walking, at the level of the mid-thorax, was measured by
Murray.55 Gregersen and Lucas,109 and Lumsden and Morris110
measured the axial rotation of all of the thoracic and lumbar vertebrae by inserting Steinman pins into the spinous processes of volunteers (Fig. 15). The angular displacements in the transverse
plane of adjacent pins during treadmill walking was measured
with an electromechanical recording device fixed to the pins.
More recently a system utilizing television cameras interfaced to a
computer has been used to give rapid, three-dimensional analysis
of spinal and pelvic movement.6366,75 This type of sophisticated
equipment has rapidly become standard in gait laboratories

Fig. 14. Vector stereograph recordings of lumbar spinal mobility in

three dimensions superimposed photographically on a subject.

Fig. 15. Steinman pins inserted into the spinous processes of volunteers to measure the axial rotation of the thoracic and lumbar vertebrae.



throughout the world and is being used now as a clinical tool

in aiding diagnosis and assessment of movement disorders.111116
The study of human movement and gait has progressed from
simple observation and an academic discipline to a science with
increasing application in the clinical setting. The major application
at present is in gait analysis but as the horizons of movement
study widen the application of the techniques of the modern gait
laboratory will spread to other activities. Throughout the centuries the study of human movement has been advanced by many
chance findings and great minds as well as having been pursued
down many false trails. A number of these great minds are preeminent and that of Giovanni Borelli is among those whose contributions will always be regarded as a giant step for mankind.

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