During the normal gait cycle, the hip goes through a ROM of 40° of flexion and extension (10° extension at terminal stance to 30° flexion at midswing and initial contact). There is also some lateral pelvic tilt and hip abduction/adduction of 15° (10° adduction at initial contact, 5° abduction at initial swing); and hip internal/external rotation along with pelvic rotation totaling 15° transverse plane motion (peak internal rotation at the end of loading, peak external rotation at the end of pre-swing). Loss of any of these motions affects the smoothness of the gait pattern.

Hip Muscle Function During Gait

Hip Flexors
The hip flexors control hip extension at the end of stance, then contract concentrically to initiate swing. With loss of flexor function, a posterior lurch of the trunk to initiate swing is seen. Contractures in the hip flexors prevent complete extension during the second half of stance; the stride is shortened. To compensate, a person increases the lumbar lordosis or walks with the trunk bent forward.

Hip Extensors
The hip extensors control the flexor moment at initial foot contact, and the gluteus maximus initiates hip extension. With loss of extensor function, a posterior lurch of the trunk occurs at foot contact to shift the center of gravity of the trunk posterior to the hip. With contractures in the gluteus maximus, some decreased range occurs in the terminal swing as the femur comes forward, or the person may compensate by rotating the pelvis more forward. The lower extremity may rotate outward because of the external rotation component of the muscle, or the gluteus maximus may place greater tension on the iliotibial band through its attachment, leading to irritation along the lateral aspect of the knee with excessive activity.

Hip Abductors
The hip abductors control the lateral pelvic tilt during swinging of the opposite leg. With loss of function of the gluteus medius, lateral shifting of the trunk occurs over the weak side during stance when the opposite leg swings. This lateral shifting also occurs with a painful hip because it minimizes the torque at the hip joint during weight bearing. The tensor fasciae latae also functions as an abductor and may become tight and affect gait with faulty use.

Effect of Musculoskeletal Impairments on Gait
Bony and joint deformities change alignment of the lower extremity and therefore the mechanics of gait. Painful conditions cause antalgic gait patterns, which are characterized by minimum stance on the painful side to avoid the stress of weight bearing.

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