doi:10.1016/j.gaitpost.2006.04.009        

Copyright © 2006 Elsevier B.V. All rights reserved.

Compensatory strategies during normal walking in response to muscle weakness and increased hip joint stiffness

Evan J. Goldberg^a and Richard R. Neptune ^{, a,  
a}Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX 78712, United States
Received 14 July 2005;  revised 16 April 2006;  accepted 18 April 2006.  Available online 23 May 2006.

Abstract

Compared to young adults, older adults exhibit a slower walking speed, smaller step length, shorter swing phase time and decreased range of motion in their lower extremity joints. The underlying mechanisms causing these gait adaptations is not well understood, with various musculoskeletal parameters being put forth as contributing factors, including increased joint stiffness and decreased isometric muscle strength. The objective of this study was to identify the necessary compensatory mechanisms to overcome such musculoskeletal deficits and regain a normal walking pattern. Understanding these mechanisms has important implications for designing effective rehabilitation interventions for older adults that target specific muscle groups and properties (e.g., isometric strength versus joint stiffness) to improve gait performance. Muscle-actuated forward dynamics simulations of normal walking were analyzed to quantify compensatory mechanisms in the presence of muscle weakness in specific muscle groups and increased hip joint stiffness. Of particular importance were the compensatory mechanisms provided by the plantar flexors, which were shown to be able to compensate for many musculoskeletal deficits, including diminished muscle strength in the hip and knee flexors and extensors and increased hip joint stiffness. This importance was further highlighted when a normal walking pattern could not be achieved through compensatory action of other muscle groups when the uniarticular and biarticular plantar flexor strength was decreased as a group. Thus, rehabilitation or preventative exercise programs may consider focusing on increasing or maintaining plantar flexor strength, which appears critical to maintaining normal walking mechanics.

Keywords: Gait; Muscle work; Musculoskeletal model; Forward dynamics simulation

 Correspondence to: Department of Mechanical Engineering, The University of Texas at Austin, 1 University Station C2200, Austin TX 78712 USA. Tel.: +512 471 0848; fax: +512 471 8727.