Ascending Phases
Loading response Midstance elevation Preswing Early swing Late swing
Ascending
Loading Response
Ref limb initial contact -> contralat toe off
Ascending
Mid stance elevation
Contralat toe off-> contralat contact
Ascending
Preswing
Contrlat initial contact -> ref limb toe off
Ascending
Early Swing
Toe off -> point where ref limb crosses contralat limb
Ascending
Late swing
Crossing contralat limb -> referance limb contact
Ascending Loading Response
OBJECTIVES
Forward Progression
WB Stability
Ascending Loading Response
CRITICAL EVENT
Flat foot contact Hip/knee extension (50-30/60-40) Restrained DF (10-15) Pelvic stability (frontal) Forward trunk lean- FOR ALL!!!!!!
Ascending Loading Response
MUSCLE ACTION
HIP:
Sagital (con) EXT- glut max, ham, add mag
Frontal (iso) ABD- up glut max, glut med
KNEE:
Quads (con)
ANKLE:
PF (eccen)
Ascending Midstance Elevation
OBJECTIVES
WB Stability
Progress COM over/beyond BOS
Elevate COM
Ascending Midstance Elevation
CRITICAL EVENTS
Hip Extenstion (30-10) Knee Extension (40-10) Ankle PF (decreasing from 15-5)
Ascending Midstance Elevation
MUSCLE ACTION
HIP:
Sagital (con) EXT- glut max, ham, add mag
Frontal (iso) ABD- up glut max, glut med
KNEE:
Quads (con)
ANKLE:
PF (con)
Ascending Preswing
OBJECTIVES
Initiate limb advancement
Elevate COM
Ascending Preswing
CRITICAL EVENTS
Begin hip/knee flexion (10-20/10-30)
DF to PF with heal rise (5-10pf)
Ascending Preswing
MUSCLE ACTION
HIP:
Sagital (con) FLEX- rec fem
KNEE:
BFSH (con)
ANKLE:
PF (con)
Ascending Early swing
OBJECTIVES
Limb advancement
Foot clearance
Ascending Early swing
CRITICAL EVENTS
Hip FLexion (20-60) Knee Flexion (30-60) Ankle DF (10-10)
Ascending Early Swing
MUSCLE ACTION
HIP:
FLX (con)- RF, Illiacus, Psoas
KNEE:
BFSH (con)
ANKLE: Ant Tib (con)
Ascending Late Swing
OBJECTIVES
Complete limb advancement
Foot clearance
Prepare limb for stance
Ascending Late Swing
CRITICAL EVENTS
Hip Exten (60-50) Knee Exten (80-60) Ankle DF maintained (10)
Ascending Late Swing
MUSCLE ACTIVATION
HIP:
EXT (con)- glut max
KNEE:
Quads (con)
ANKLE: Ant Tib (iso)
Descending stairs Phases
Loading response Midstance Lowering Pre swing Early Swing Late swing
Descending
Loading Response
Ref limb initial contact -> contralat toe off
Descending
Mid stance Lowering
Contralat toe off-> contralat contact
Descending
Preswing
Contralat initial contact -> ref toe off
Descending
Early Swing
Toe off-> ref limb crosses contralat limb
Descending
Late Swing
Ref limb crosses contralat -> ref limb contact
Descending Loading Response
OBJECTIVES
Shock absorption
Modulated forward progression
WB stability- sag and frontal
Descending Loading Response
CRITICAL EVENTS
Sustained hip flexion (20)
Restrained Knee flexion (10-20)
Restrained DF (20-10)
Backward trunk lean–FOR ALL!!!!!
Descending Loading Response
MUSCLE ACTIVATION
HIP:
Sagital (iso) EXT- glut max, ham
Frontal (iso) ABD- up glut max, glut med
KNEE:
Quads (eccen)
ANKLE:
PF (eccen)
Descending Mid stance Lowering
OBJECTIVES
WB stability
Prog COM over/beyond BOS
Lower COM
Descending Mid stance Lowering
CRITICAL EVENTS
Hip Flexion maintained (20) Restrained Knee flexion (20-50) Restrained DF (10-20) Pelvic Stability (frontal)
Descending Mid stance Lowering
MUSCLE ACTIVATION
HIP:
Sagital (ios) EXT
Frontal (iso/ecc) ABD
KNEE:
Quads (eccen)
ANKLE:
PF (eccen)
Descending Pre Swing
OBJECTIVES
Initiate limb advancement
Preserve balance and stability
Descending Pre swing
CRITICAL EVENTS
Hip flexion (20-30) Knee Flexion (50-70) restrained Ankle PF (20d-15p)
Descending Pre Swing
MUSCLE ACTIVATION
HIP: no activity (hip flex from knee flex)
KNEE:
Quads (eccen)
ANKLE:
Elastic recoil- residual tension in pfs leads to brisk PF
Descending Early Swing
OBJECTIVES
Limb advancement
Foot Clearance
Descending Early Swing
CRITICAL EVENTS
Hip Flexion (30-40) Knee Flexion (70-80) Ankle DF (15-0)
Descending Early Swing
MUSCLE ACTIVATION
HIP:
FLX (con)- RF
KNEE:
BFSH (con)
ANKLE: Ant tib (con)
Descending Late Swing
OBJECTIVES
Lenthen limb to contact next step
prepare for stance
Descending Late Swing
CRITICAL EVENTS
Hip Extension (40-20) Knee Extension (80-10) Ankle PF (0-20)
Descending Late Swing
MUSCLE ACTIVATION
HIP:
Ext (con)- glut max
Hamstring extends hip and decelerates knee extension
KNEE:
Quads (con)
ANKLE:
PF (con)
followed by co-activation PF and DF
Patient Complaints w/ Ascending
Tripping: swing (toe clearance)
Unstable: WT bear stabil phases
Pain: depends on condition
Slow: all phases