The Major Determinants in Normal
and Pathological Gait
Charalambos P. Charalambous
102.1 Author
Saunders JB, Inman VT, Eberhart HD
102.2 Reference
J Bone Joint Surg Am. 1953;35(3):543558.
102.3 Institution
Department of Anatomy and orthopaedic surgery, School of
medicine and the College of Engineering, University of
California, San Francisco
102.4 Abstract
Human locomotion is such a complex process consisting of
multiple simultaneous individual three dimensional motions
that its analysis is difficult without a unifying principle. Such
a unifying principle is the concept that locomotion is essen-
tially the travel of the centre of gravity through space along
a pathway that requires the least energy expenditure. This
allows qualitative analysis of gait in terms of the essential
determinants of gait. The six major determinants are pelvic
rotation, pelvic tilt, knee and hip flexion, knee and ankle
interaction, and lateral pelvic displacement. Changes in these
determinants may help understand and assess pathologi-
cal gaits. Pathological gaits may represent a try to preserve
energy consumption by exaggerating motion at unaffected
levels. Compensation is reasonably effective, with loss of
the knee determinant being the most costly. Loss of two
C.P. Charalambous, BSc, MBChB, MSc, MD, FRCS (Tr&Orth)
Department of Trauma and Orthopaedics,
Victoria Hospital, Blackpool, UK
e-mail: bcharalambos@hotmail.com
P.A. Banaszkiewicz, D.F. Kader (eds.), Classic Papers in Orthopaedics,
DOI 10.1007/978-1-4471-5451-8_102, Springer-Verlag London 2014
102
determinants may make effective compensation impossible
with the energy cost of locomotion increasing by threefold.
102.5 Summary
In this classic article Saunders et al. describe the displace-
ment of the centre of gravity through the gait cycle, in both
the vertical and horizontal planes. They bring on the notion
than smooth and low amplitude displacement of the centre of
gravity is important in minimising energy expenditure during
locomotion. They describe six primary determinants of
human locomotion (pelvic rotation, pelvic tilt, lateral pelvic
displacement, knee flexion in the stance phase, and foot and
knee mechanics) which work together to limit excessive dis-
placement of the centre of gravity and hence conserve energy.
Saunders et al. suggest that gait disorders can be analysed in
terms of changes in these primary determinants and therapeu-
tic interventions can be applied to correct these. The authors
also examine the compensatory changes occurring in the
remaining gait determinants, when one of them fails. Such
compensatory changes ensure that the centre of gravity main-
tains its normal displacement pattern.
102.6 Citation Count
467
102.7 Related References
1. Murray MP, Drought AB, Kory RC. Walking patterns of
normal men. J Bone Joint Surg Am. 1964;46:33560.
2. Lamoreux LW. Kinematic measurements in the study
of human walking. Bull Prosthet Res. 1971;10(15):
384.
3. Cavagna GA, Margaria R. Mechanics of walking. J Appl
Physiol. 1966;21(1):2718.
403
404
102.8 Key Message
The six major determinants of gait are pelvic rotation, pelvic
tilt, stance phase knee flexion, knee and ankle mechanics,
and lateral pelvic displacement. These, work in a synergistic
way to ensure that during locomotion the centre of gravity
translates through space along a smooth pathway requiring
the least energy expenditure. Saunders et al. suggest that gait
disorders can be analysed in terms of changes in these pri-
mary determinants and in terms of centre of gravity displace-
ment patterns and therapeutic interventions can be applied to
correct these.
102.9 Why It Is Important
Saunders paper is important because it links the various
components of pelvis and limb movements as coming
together to influence energy expenditure in locomotion.
They describe not only how motion occurs but why motion
occurs in this way.
102.10 Strengths
Human locomotion is presented not only in the form of the
isolated gait components but the way that such components
combine to allow a smooth centre of gravity propagation is
analysed.
102.11 Weaknesses
The results of this paper are based on previous experimental
studies described by Saunders and detailed results of those
are not presented in this paper. Even though the methodol-
ogy used in gathering data is briefly described, the main aim
of the paper is to bring together and describe the conclusion
of the authors in gait determinants of human locomotion.
102.12 Relevance
Sixty years ago, a group of researchers at the University of
California proposed six kinematic mechanisms to explain
how movements of the lower limb joints contributed to the
centre of gravity when humans walk at their preferred speed.
These variables (described by Saunders as determinants of
gait) influence the displacement of the centre of gravity in
such a way, and hence ensure efficient energy expenditure.
Saunders et al. began by assuming that gait was most effi-
cient when vertical and horizontal (lateral) excursions of the
bodys center of gravity were minimized. They suggested
C.P. Charalambous
that pathological gait could be identified when these six
determinants of gait were compromised. Any pathology that
increases the vertical distance between the high and low
points increases the energy cost of ambulation
1. Pelvic rotation (in the horizontal plane)
This allows the swinging hip to move forwards faster than
the stance hip. Pelvic rotation occurs anteriorly on the swing-
ing limb and posteriorly during mid-stance. It is maximal
just before heel strike with a total motion of pelvic rotation
of 5 to each side. Pelvic rotation also produces a longer
stride length for the same amount of hip flexion of the
advancing leg and hip extension of the retreating leg. Thus,
it allows for longer steps without changing the COM dis-
placement significantly.
2. Pelvic tilt (in the frontal plane)
As the pelvis on the swing leg is lowered, the hip abduc-
tors of the stance hip control pelvic tilt. During normal gait
the pelvis drops 5 on the side of the swinging leg. This pel-
vic dip decreases horizontal displacement of the COM dur-
ing single limb support
3. Knee flexion
This decreases the vertical displacement of the COM.
This occurs during mid-stance, as knee flexes to approxi-
mately 15 occurs under the control of eccentric quadriceps
contraction and remains flexed until the foot is flat on the
ground.
4,5. Knee and ankle motion
This involves control of the knee-ankle-foot motion. This
synchronized movement results in eccentric control of plan-
tar flexion of the ankle and knee flexion, which occurs during
the first portion of the stance phase. These factors help to
avoid abrupt changes of the lowest portion of COM arc, pro-
ducing a smooth sinusoidal curve instead of an arched
pattern.
6. Lateral pelvic displacement
This is the lateral sway or side to side oscillation that
occurs with each step. This defines the motion of the COM in
the horizontal plane.
Pelvic rotation and tilt, knee flexion at mid-stance, foot
and ankle motion, and lateral pelvic displacement all affect
the displacement of the centre of gravity and hence the
energy efficiency of walking. Lateral pelvic displacement
reduces displacement of the centre of gravity in the horizon-
tal plane whereas the rest reduce displacement in the vertical
plane.
Saunders et al. defined walking as the displacement of the
centre of gravity through space in a way that requires the
least energy expenditure. During each walking cycle, the
centre of gravity moves upwards and downwards twice, seen
as moving up and down of the head. It also displaces in a side
to side direction. Both the vertical and horizontal displace-
ments follow a smooth sinusoidal pathway and are just less
than 2 in. in magnitude. Any displacement of the centre of
102 The Major Determinants in Normal and Pathological Gait
Table 102.1 Determinants of gait
Determinant
First Pelvic rotation
About the vertical axis, alternating to
the right and to the left relative to line
of progression
Second Pelvic tilt
At horizontal axis at midstance
Third Knee flexion in stance
Fourth and Fifth Foot and ankle mechanism
Sixth Lateral displacement of pelvis
COM Centre of mass
gravity beyond its normal maximum limits or any abrupt
irregular movement wastes energy.
Saunders article is of vital importance as the gait deter-
minants described form the basis of much of our understand-
ing of the kinematics of normal walking. Saunders provided
a different way of looking at gait analysis where the various
components of gait come together to ensure a smooth and
limited displacement of the centre of gravity and hence a
more efficient way of conserving energy.
Monitoring the displacement of the centre of gravity and
analysis of the gait determinants have been used in patho-
logical gait analysis in both neurological and orthopaedic
disorders. Interventions in such pathological gaits have been
assessed based on their corrective effects on the centre of
gravity and the resultant energy conservation they achieve
[19]. The principles of avoiding excessive centre of gravity
displacement, has also been used in athletic training to pro-
vide energy efficient training (Table 102.1).
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405
COM displacement Effect
Decreased 4 from each side from a Energy conservation saves the COM
total of 8 drop at its lowest point 6/16 in.
Reduces the drop in COM during (elevates end or arc)
double limb support
Reduces the peak of COM during Energy conservation by shortening the
single limb support pendulum of the leg(3/16 in.) at the
high part of arc(depresses summit arc)
High point of COM further reduced by Energy conservation by decreasing
knee flexion in midstance rise of arc(7/16 in.) by walking over a
bent knee (depresses summit arc)
Combination of foot and ankle motion Flattens and slightly reverses arc of
with knee motion smoothes the COM translation(decreased 3/16 in.)
change in direction
Must bring COM above support point Lateral displacement of the pelvis is
to balance on one leg largely abolished by the presence of
the tibial-femoral angle. There is a
side-to-side sway of 1.7 in. radius
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