Frontal and sagittal plane analyses of the stair climbing task in healthy adults aged over 40 years: what are the challenges compared to level walking?
Introduction
Stair climbing is a demanding locomotor task frequently performed in daily activities. In particular, for elderly persons and those with disabilities of the lower limbs, stair climbing, like stepping over an obstacle and rising from a chair, can be very challenging. Being able to negotiate stairs could dramatically improve the quality of life of a person with physical impairments, as well as it could facilitate the work load of the caregivers. Moreover, recovering safe locomotion is often a key factor that allows a patient to return home after a trauma or a disease attack (for review, see Startzell et al., 2000). To date, basic information on the biomechanical requirements of stair climbing as compared to level walking has been mostly restricted to young, fit adults or to elderly adults and has concentrated on sagittal plane patterns. More complete information is required for the rehabilitation of the general public.
In the past two decades, researchers have begun to study stair walking using simulated staircase set-ups in gait laboratories. Assessment of the stair climbing kinematics in healthy subjects has revealed increased lower limb joint ranges of motion in the sagittal plane for stair climbing as compared to level walking (Andriacchi et al., 1980; Livingston et al., 1991; Laubenthal et al., 1972; Hoffman et al., 1977; Rowe et al., 2000; Riener et al., 2002). At the knee, some studies have reported maximum values ranging from 80° to 100° for typical step configurations (slopes from 30° to 35°), or approximately 12° to 20° more knee flexion than seen in level walking (Andriacchi et al., 1980; Livingston et al., 1991; Riener et al., 2002). Increases in the range of 15–20° have also been reported in hip flexion during stair climbing (Andriacchi et al., 1980; Livingston et al., 1991).
Kinetic and electromyography (EMG) analyses have further specified the muscle groups recruited in stair tasks and level walking. Previous analyses measuring the kinetics of the lower limbs have shown that greater knee moments were required in the stair climbing tasks than in level walking and that the largest increase in the sagittal moment in stair climbing occurs at the knee joint (Andriacchi et al., 1980; McFadyen and Winter, 1988). In ascent, the knee extensor muscles had a dominant role in the progression from one step to the next, assisted by the ankle plantar flexors and the hip extensors (McFadyen and Winter, 1988; Moffet et al., 1993; Townsend et al., 1978; Joseph and Watson, 1967). The result is a high increase of energy generation at the knee as compared to level walking where energy generation is provided mostly by the plantar flexors and the hip flexors and extensors (Winter, 1983; Winter, 1991). Comparison of the percentage of maximal activation level of some lower limb muscles also reveals significantly higher activation of the knee extensor muscles (vastus lateralis and medialis) and medial hamstring muscles during walking up stairs than level walking (Richards et al., 1989). Sagittal plane analyses have been useful in understanding the stair climbing task. However, it gives only a partial picture of information. As in level walking, the stair climbing task also needs to be analysed in other planes of movements.
Only a few studies have provided data on lower limbs in the other planes of movement. Andriacchi et al. (1980) have reported the moments in the frontal and transverse planes in a group of ten young male adults (age range: 20–34 years). In general, moments in the transverse plane were small, under 15 N m at the hip, knee and ankle joints, when walking up from step 1 to step 3 on a staircase with a slope of 38°. The magnitude of the lower limb moments in the frontal plane was higher than in the transverse plane with the highest values observed in abduction at the hip (37 N m) and knee (33 N m) and in adduction at the ankle (43 N m). Kowalk et al. (1996) examined the magnitude of the knee abduction–adduction moments during stair climbing and descent in 10 normal subjects (age range: 22–40 years). Like Andriacchi et al. (1980), these authors found that the knee moment patterns were exclusively in abduction throughout stance (maximal value: 41.3 N m) during stair climbing. Kowalk et al. (1996) explained this finding by the location of the ground reaction vector that always passed medial to the knee joint centre during stair climbing. Kirkwood et al. (1999) investigated the hip moments during various exercises in a group of 30 healthy subjects (age range: 55–75 years). They found that among all the exercises assessed, only stair climbing generated peak moments higher than those obtained during level walking and only in medial rotation (transverse plane). The maximum hip abduction and extension moments were high (range: 0.77–1.0 N m/kg) but were similar in the two locomotion tasks (stair climbing and level walking), whereas the maximum hip adduction and flexion moments were significantly lower by 61% (0.18 vs. 0.04 N m/kg) and 59% (0.68 vs. 0.28 N m/kg), respectively in stair climbing than in level walking. Data at the knee and at the ankle joints were not presented in the study of Kirkwood et al. (1999).
In a recent review on stair negotiation, Startzell et al. (2000) mentioned that much basic research remains to be conducted to determine the key determinants of difficulty and safety on stairs. Moreover, in order to provide rehabilitation professionals with a clearer picture of the specific requirements of the stair climbing task, research must be expanded to include a wider range of age groups that represent the general public, such as including middle-aged healthy persons, a more detailed and comprehensive analysis of frontal plane dynamics, and a better understanding of the different locomotor challenges between stair climbing and level walking. Therefore, our study is a broader attempt to address the question of how stair climbing challenges the lower limbs compared to level walking in healthy adults aged over 40 years. This will be done by providing a comparison of the kinetic and kinematic patterns of stair climbing and level walking in the frontal and sagittal planes of subjects performing at the speed they feel most comfortable (natural speed).
Section snippets
Subjects
A sample of convenience of eleven healthy adults (5 females, 6 males) over 40 years old (median of 53.0 years, range 41–70 years). Eight participants were middle-aged adults (age 45 and 64 years), one was slightly younger (41 years) and two were older (68 and 70 years). Their mean (SD) stature and body mass were of 168 (8.4) cm and 68.3 (12) kg, respectively. All were living independently at home and were engaged in recreational activity. They were free of any history of injury or disorder of
Time–distance parameters
Compared to level walking, stair climbing was characterised by a lower cadence, a smaller proportion of stance phase, and a longer cycle duration (Table 1). As was expected, these differences during stair climbing were accompanied by a lower forward speed and a shorter stride length.
Joint angular displacements
Overall, the main differences in the frontal plane movement profiles were observed at the hip joint (Fig. 2). The peak hip abduction was lower than 5° in both tasks and was reached at the same point (just after
Discussion
The objective of this paper was to provide a detailed description of the patterns, particularly within the frontal plane, of healthy persons aged over 40 years for stair climbing and to compare the general patterns with those of level walking. Results of the present study revealed interesting differences between level walking and stair climbing. Although other studies have provided such information, many of the present results have not been previously highlighted and are important to know when
Conclusion
The stair climbing analyses revealed that substantial amounts of effort are required in the frontal plane mainly at the hip to control the pelvis. In comparison to level walking, walking up a set of stairs in healthy adults aged over 40 years required a reorganisation of the lower limb muscular strategies in order to respond to additional mechanical requirements such as rising the body to the next step and avoiding the intermediate step. Therefore there were major differences in patterns
Acknowledgements
This research was carried out within the laboratory of Dr. McFadyen and received financial support from Natural Sciences and Engineering Research Council of Canada. Dr. Nadeau is supported by a the Canadian Institute of Health Research (CIHR).
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