Crouched postures reduce the capacity of muscles to extend the hip and knee during the single-limb stance phase of gait

Many children with cerebral palsy walk in a crouch gait that progressively worsens over time, decreasing walking efficiency and leading to joint degeneration. This study examined the effect of crouched postures on the capacity of muscles to extend the hip and knee joints and the joint flexions induced by gravity during the single-limb stance phase of gait. We first characterized representative mild, moderate, and severe crouch gait kinematics based on a large group of subjects with cerebral palsy (N=316). We then used a three-dimensional model of the musculoskeletal system and its associated equations of motion to determine the effect of these crouched gait postures on (1) the capacity of individual muscles to extend the hip and knee joints, which we defined as the angular accelerations of the joints, towards extension, that resulted from applying a 1 N muscle force to the model, and (2) the angular acceleration of the joints induced by gravity. Our analysis showed that the capacities of almost all the major hip and knee extensors were markedly reduced in a crouched gait posture, with the exception of the hamstrings muscle group, whose extension capacity was maintained in a crouched posture. Crouch gait also increased the flexion accelerations induced by gravity at the hip and knee throughout single-limb stance. These findings help explain the increased energy requirements and progressive nature of crouch gait in patients with cerebral palsy.