Document Type : Original Articles

Authors

1 Student Research Committee, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Department of Physiotherapy, School of Rehabilitation Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: This study aimed to investigate kinematic parameters of lower limb joints during gait on inclined surfaces compared to level ground.
Methods: In this cross-sectional study, 15 healthy individuals walked at their self-selected speed on level ground with a zero slope and on two inclined surfaces. These surfaces were constructed to mimic real environments with slopes of +8 (uphill) and -8 (downhill) along an eight-meter distance. The measured variables included the angles of the ankle, knee, and hip joints sagittal plane during different phases of gait, captured through a three-dimensional motion capture system.
Results: Significant differences were observed in uphill walking compared to level-ground walking, including an increase in ankle, hip, and knee angles at initial contact, maximum ankle dorsiflexion and plantarflexion, maximum knee flexion in the stance phase, and maximum knee extension in the swing phase. There was also a reduction in the maximum extension of the hip joint (P<0.05). In downhill walking compared to level ground, significant differences were observed in the increase of ankle and knee angles at initial contact, maximum ankle dorsiflexion, maximum knee flexion in both stance and swing phases, and a decrease in the maximum angle of hip extension. However, no significant difference was observed in the hip joint angle at initial contact maximum ankle plantarflexion, maximum knee extension in swing phase between level and downhill surfaces and at maximum knee flexion in swing phase between uphill and level surfaces (P>0.05).
Conclusion: Walking on inclined surfaces influences the flexion and extension angles of lower limb joints during different phases of gait, necessitating increased joint movement. These alterations are more pronounced during uphill walking than downhill, especially at the initial contact point.
 

Keywords

  1. Moreno CC, Mendes LA, Lindquist AR. Effects of treadmill inclination on the gait of individuals with chronic hemiparesis. Archives of physical medicine and rehabilitation. 2011;92(10):1675-80.
  2. McIntosh AS, Beatty KT, Dwan LN, Vickers DR. Gait dynamics on an inclined walkway. Journal of biomechanics. 2006;39(13):2491-502.
  3. Masayuki K, Hata K, Kiyama R, Maeda T, Yone K. Biomechanical characterization of slope walking using musculoskeletal model simulation. Acta of Bioengineering and Biomechanics. 2018;20(1).
  4. Sedaghatnezhad P, Shams M, Karimi N, Rahnama L. Uphill treadmill walking plus physical therapy versus physical therapy alone in the management of individuals with knee osteoarthritis: a randomized clinical trial. Disability and Rehabilitation. 2021;43(18):2541-9.
  5. Alexander N, Schwameder H. Lower limb joint forces during walking on the level and slopes at different inclinations. Gait & posture. 2016;45:137-42.
  6. Leroux A, Fung J, Barbeau H. Postural adaptation to walking on inclined surfaces: I. Normal strategies. Gait & posture. 2002;15(1):64-74.
  7. Kimel-Naor S, Gottlieb A, Plotnik M. The effect of uphill and downhill walking on gait parameters: A self-paced treadmill study. Journal of biomechanics. 2017;60:142-9.
  8. Gottschall JS, Nichols TR. Neuromuscular strategies for the transitions between level and hill surfaces during walking. Philosophical Transactions of the Royal Society B: Biological Sciences. 2011;366(1570):1565-79.
  9. Zeng X, Xie Z, Zhong G, Chen Y, Wen B, Li Y, et al. The 6DOF knee kinematics of healthy subjects during sloped walking compared to level walking. Gait & Posture. 2022;95:198-203.
  10. Pickle NT, Grabowski AM, Auyang AG, Silverman AK. The functional roles of muscles during sloped walking. Journal of biomechanics. 2016;49(14):3244-51.
  11. Rojhani Shirazi Z, Saadat M. Comparison of the Effects of Two Fatigue Protocols on Triceps Surae Musculotendinoes Stiffness in Healthy Students. Journal of Rehabilitation Sciences & Research. 2014;1(2):25-9.
  12. Smith JL, Carlson-Kuhta P, Trank TV. Forms of forward quadrupedal locomotion. III. A comparison of posture, hindlimb kinematics, and motor patterns for downslope and level walking. Journal of Neurophysiology. 1998;79(4):1702-16.
  13. Schwameder H, Lindenhofer E, Müller E. Walking: effect of walking speed on lower extremity joint loading in graded ramp walking. Sports biomechanics. 2005;4(2):227-43.
  14. Sun J, Walters M, Svensson N, Lloyd D. The influence of surface slope on human gait characteristics: a study of urban pedestrians walking on an inclined surface. Ergonomics. 1996;39(4):677-92.
  15. Redfern MS, DiPasquale J. Biomechanics of descending ramps. Gait & posture. 1997;6(2):119-25.
  16. Alexander N, Schwameder H. Effect of sloped walking on lower limb muscle forces. Gait & posture. 2016;47:62-7.
  17. Strutzenberger G, Alexander N, Bamboschek D, Claas E, Langhof H, Schwameder H. Uphill walking: Biomechanical demand on the lower extremities of obese adolescents. Gait & posture. 2017;54:20-6.
  18. Alexander N, Strutzenberger G, Ameshofer LM, Schwameder H. Lower limb joint work and joint work contribution during downhill and uphill walking at different inclinations. Journal of biomechanics. 2017;61:75-80.
  19. Yang F, King GA. Dynamic gait stability of treadmill versus overground walking in young adults. Journal of Electromyography and Kinesiology. 2016;31:81-7.
  20. Rahimi A, Majidirad F, Movahed M, Vali F. P007 A comparative study on electromyographic and kinematic parameters of the knee joint during walking on level ground and level treadmill. Gait & Posture. 2008(28):S53.
  21. RAHIMI A, MAJIDIRAD F, MOVAHED M, VALI F, editors. A comparative study on electromyographic and kinematic parameters of the knee joint during walking on level ground and level treadmill. 17th Annual Meeting of ESMAC, Gait & Posture; 2008.
  22. Khademi-Kalantari K, Rahimi F, Hosseini SM, Baghban AA, Jaberzadeh S. Lower limb muscular activity during walking at different speeds: Over-ground versus treadmill walking: A voluntary response evaluation. Journal of bodywork and movement therapies. 2017;21(3):605-11.
  23. Radmehr G, Mazaheri R, Sanjari MA, Halabchi F, Mansournia MA. Comparison of activation pattern of selected trunk muscles during over ground and treadmill walking. Modern Rehabilitation. 2013;6(4).
  24. Strutzenberger G, Leutgeb L, Claußen L, Schwameder H. Gait on slopes: Differences in temporo-spatial, kinematic and kinetic gait parameters between walking on a ramp and on a treadmill. Gait & Posture. 2022;91:73-8.
  25. Dingwell J, Cusumano JP, Cavanagh P, Sternad D. Local dynamic stability versus kinematic variability of continuous overground and treadmill walking. J Biomech Eng. 2001;123(1):27-32.
  26. Tulchin K, Orendurff M, Karol L. The effects of surface slope on multi-segment foot kinematics in healthy adults. Gait & posture. 2010;32(4):446-50.
  27. Park S-K, Jeon H-M, Lam W-K, Stefanyshyn D, Ryu J. The effects of downhill slope on kinematics and kinetics of the lower extremity joints during running. Gait & posture. 2019;68:181-6.
  28. Franz JR, Kram R. Advanced age and the mechanics of uphill walking: a joint-level, inverse dynamic analysis. Gait & posture. 2014;39(1):135-40.
  29. Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian journal of internal medicine. 2011;2(2):205.
  30. Lay AN, Hass CJ, Gregor RJ. The effects of sloped surfaces on locomotion: a kinematic and kinetic analysis. Journal of biomechanics. 2006;39(9):1621-8.
  31. Schmitz A, Silder A, Heiderscheit B, Mahoney J, Thelen DG. Differences in lower-extremity muscular activation during walking between healthy older and young adults. Journal of electromyography and kinesiology. 2009;19(6):1085-91.