走路难看,这些异常步态是怎么引起的?

2021-10-22 康复医学网 康复医学网

每天走在路上的时候,大家有没有注意到别人走路的姿态呢?

每天走在路上的时候,大家有没有注意到别人走路的姿态呢?

如果细看擦肩而过的陌生人,有些人走路摇摇晃晃,有些人走路来会突然有一个踉跄,有些走路好像在扭动屁股。

其实,每个人都有自己独特的走路方式,而这个过程中时时刻刻地在影响着生活的方方面面。也许我们注意到了身体出现不协调的问题,却不知道为什么。今天就向大家解开每种步态背后的身体秘密。

 

日常步行可以分两个阶段,分别是支撑相、摆动相,由髋、膝、踝三个关节的不同活动配合完成。

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支撑相(站立相):下肢接触地面和承受重力的时相。

摆动相(迈步相):下肢在空中向前摆动的时相。

人体在行走时需要关节和肌肉之间的密切配合,因此每一个关节如果出现关节活动度下降或者周围肌肉出现问题,都会导致步态上发生变化。

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首先是髋关节,在走路过程中需要髋关节的前屈后伸来完成步行动作。在这期间,屈髋肌和伸髋肌分别在不同阶段帮助人体完成行走。

屈髋肌:

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伸髋肌:

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在行走的过程中,主要肌肉有:髂腰肌、股四头肌、缝匠肌、耻骨肌、长收肌、短收肌等等,在这其中股四头肌跟前腰肌的力量是最强的。

这些肌肉除了完成髋关节的屈曲之外,对于维持髋关节周围肌肉力量的平衡也不可或缺,这对于人体的正常直立和行走的步态也同样重要。

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若是这些肌肉一旦失衡,就会出现各种不同的步态,导致各种问题的出现。

1、 木马步态——屈髋肌短缩

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具体表现为单侧短缩,一侧骨盆前倾明显,患侧屈膝、骨盆下垂、脊柱侧弯单侧短缩;一侧骨盆前倾明显,患侧屈膝、骨盆下垂、脊柱侧弯。

2、臀大肌无力步态——棘旁肌收缩

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具体表现为挺胸凸腹,棘旁肌发生s代偿,因为足跟落地时为防止摔倒,导致棘旁肌出现收缩失衡的情况。

3、 鸭步步态——臀中肌无力

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这是由于臀中肌无力导致控制骨盆的能力下降,呈现鸭子走路一般的步态。

4、屈髋肌无力 

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这种情况呈现的步态分为几种情况:

(1)、摆动期髋回旋画圈,走路时一只脚以髋关节向外画圈落地;

(2)、摆动初期骨盆后倾,因为需要收腹肌,身体可能出现前倾的动作,摆动中期躯干向后倾斜,脚蹬地瞬间上半身突然向后倾斜。

5、内外八字

支撑期外八字,这是由于股骨颈后倾、髋外旋肌紧张导致,同理如果出现支撑期内八字,则是相反,股骨颈前倾,髋内旋肌紧张.

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其次是膝关节,膝关节依靠不同肌肉收缩在步行过程中反复屈伸,因此我们需要注意起止点在膝关节周围的肌肉。

在行走过程中,膝关节的重要性不言而喻。如同吃饭必须要有牙齿一般,行走离不开膝关节。膝关节依靠不同肌肉收缩在步行过程中反复屈伸,因此我们需要注意起止点在膝关节周围的肌肉。

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股四头肌张力增加:膝关节过伸骨盆前移,张力增加的同时屈膝肌松弛、臀大肌紧张。表现为开始着地后,膝关节迅速伸直。

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股四头肌无力:骨盆在重心后、膝盖在中心前;骨盆在重心前,过度伸膝,走路时中心前移,代偿股四头肌。

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膝关节屈曲:摆动期间屈曲,胫骨前肌肌力不足,代偿腘绳肌,或者是支撑腿短,摆动腿需要屈膝代偿;

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支撑期间屈曲,支撑腿屈曲,为屈髋肌太紧张,在腿该伸直的时候屈曲,多数为髋的问题,非常类似下图;

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支撑和摆动末期屈曲,腘肌强直、或落地时不解锁。

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膝关节内翻(O型腿)

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最后为踝关节:

① 跨阈步态,主要是胫骨前肌无力。

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① 步幅缩短,出现该问题则是由于腓肠肌无力:蹬地爆发力不足,身体前移减少,髋关节屈髋肌无力:通过躯干在脚马上离地的时候后仰向前摆动代偿。

② 髋回旋、上提

摆动期髋回旋,由于髋关节、膝关节屈曲减少,踝关节背屈减少

摆动期髋上提是因为髋关节、膝关节屈曲减少,踝关节背屈减少,功能性或结构性短腿,同时会代偿到竖脊肌、腰方肌,使得骨盆抬高。

 

跳跃步态

第一种跳跃步态是由于踝关节趾屈肌紧张,一般出现在脚快要离地时,足跟提高,可能伴有踝关节背屈肌力下降。

第二种跳跃则是出现在健侧支撑期,患侧摇摆期),具体表现为以左脚支撑为例,右下肢在抬起脚时,膝关节、髋关节屈曲,踝关节背屈减少,离地距离短,为此左侧踝关节跖屈增加离地距离。

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作为常人来说,可能不会出现如此大幅度的步态问题,但是因为肌肉力量不均衡引发的细微变化,都隐藏在走出的每一步之中。

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正确的步态

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1.单腿站立引导肢向前阶段:

下腹部收紧保持躯干稳定,髂腰肌收缩屈髋(抬大腿),腘绳肌与小腿收缩屈膝(弯小腿),胫骨前肌和腓骨肌收缩出现踝屈(勾脚动作),引导肢向前时,对侧肩关节向该侧髋关节靠拢足趾的伸肌收缩出现勾脚尖动作(趾部伸展);

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2.重心前移,单腿支撑阶段:股四头肌收紧,臀部肌肉开始收缩;

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3.重心继续前移:向前跌倒倾向臀部收缩伸髋,其他地方维持稳定,小腿及足部肌肉收缩明显(很多人是在这里控制不恰当,出现各种问题,往往都是臀部力量缺乏与腿部前后侧力量不平衡引起);

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4.推动阶段:臀部继续收紧伸髋,股四头肌继续发力伸膝盖,该侧支撑肢会完全伸展到摆动肢即将着地,摆动过程中,对侧肩会向摆动肢髋关节靠拢,这个阶段的末段是趾长屈肌发力,也就是走路的时候脚趾头也得发力,很少有人注意到这点。

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5.摆动肢接触地面时,新的周期开始

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6.走路的过程中头始终看正前方。

我们不需要像模特一样走出美感,不需要和国旗班战士一样走出飒爽英姿,但至少优雅的步态可以成为我们一道无形名片,加深别人对自己的好印象。

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    2022-03-15 cqlidoudou
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    2022-09-15 xxxx1061
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    2022-05-07 ayqdf

    感谢分享。

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1673203, encodeId=039d16e3203a8, content=<a href='/topic/show?id=8c0a926556e' target=_blank style='color:#2F92EE;'>#走路#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92655, encryptionId=8c0a926556e, topicName=走路)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=54d126929591, createdName=cqlidoudou, createdTime=Tue Mar 15 00:12:52 CST 2022, time=2022-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1741993, encodeId=9f071e4199300, content=<a href='/topic/show?id=5681632e84e' target=_blank style='color:#2F92EE;'>#步态#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63278, encryptionId=5681632e84e, topicName=步态)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=76f034999566, createdName=xxxx1061, createdTime=Thu Sep 15 19:12:52 CST 2022, time=2022-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217692, encodeId=ed47121e69236, content=感谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2f71997775, createdName=ayqdf, createdTime=Sat May 07 19:16:46 CST 2022, time=2022-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063277, encodeId=ca3f10632e704, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1e05489924, createdName=ms1000002136354097, createdTime=Sat Oct 23 22:38:03 CST 2021, time=2021-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063107, encodeId=346b106310e9e, content=睡眠障碍可能是导致这种风险的一个未确, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Sat Oct 23 08:52:29 CST 2021, time=2021-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063102, encodeId=e97f1063102c6, content=优秀, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211015/8d56d5fcf5414c569fbb9517e4db6199/10eae43200f34453a94bd30c453d4254.jpg, createdBy=e2255212929, createdName=lemo003, createdTime=Sat Oct 23 08:40:25 CST 2021, time=2021-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063092, encodeId=d077106309216, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Sat Oct 23 06:52:26 CST 2021, time=2021-10-23, status=1, ipAttribution=)]
    2021-10-23 ms1000002136354097

    谢谢分享

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1673203, encodeId=039d16e3203a8, content=<a href='/topic/show?id=8c0a926556e' target=_blank style='color:#2F92EE;'>#走路#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92655, encryptionId=8c0a926556e, topicName=走路)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=54d126929591, createdName=cqlidoudou, createdTime=Tue Mar 15 00:12:52 CST 2022, time=2022-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1741993, encodeId=9f071e4199300, content=<a href='/topic/show?id=5681632e84e' target=_blank style='color:#2F92EE;'>#步态#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63278, encryptionId=5681632e84e, topicName=步态)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=76f034999566, createdName=xxxx1061, createdTime=Thu Sep 15 19:12:52 CST 2022, time=2022-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217692, encodeId=ed47121e69236, content=感谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2f71997775, createdName=ayqdf, createdTime=Sat May 07 19:16:46 CST 2022, time=2022-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063277, encodeId=ca3f10632e704, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1e05489924, createdName=ms1000002136354097, createdTime=Sat Oct 23 22:38:03 CST 2021, time=2021-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063107, encodeId=346b106310e9e, content=睡眠障碍可能是导致这种风险的一个未确, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Sat Oct 23 08:52:29 CST 2021, time=2021-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063102, encodeId=e97f1063102c6, content=优秀, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211015/8d56d5fcf5414c569fbb9517e4db6199/10eae43200f34453a94bd30c453d4254.jpg, createdBy=e2255212929, createdName=lemo003, createdTime=Sat Oct 23 08:40:25 CST 2021, time=2021-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063092, encodeId=d077106309216, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Sat Oct 23 06:52:26 CST 2021, time=2021-10-23, status=1, ipAttribution=)]
    2021-10-23 查查佳佳

    睡眠障碍可能是导致这种风险的一个未确

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1673203, encodeId=039d16e3203a8, content=<a href='/topic/show?id=8c0a926556e' target=_blank style='color:#2F92EE;'>#走路#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92655, encryptionId=8c0a926556e, topicName=走路)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=54d126929591, createdName=cqlidoudou, createdTime=Tue Mar 15 00:12:52 CST 2022, time=2022-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1741993, encodeId=9f071e4199300, content=<a href='/topic/show?id=5681632e84e' target=_blank style='color:#2F92EE;'>#步态#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63278, encryptionId=5681632e84e, topicName=步态)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=76f034999566, createdName=xxxx1061, createdTime=Thu Sep 15 19:12:52 CST 2022, time=2022-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217692, encodeId=ed47121e69236, content=感谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2f71997775, createdName=ayqdf, createdTime=Sat May 07 19:16:46 CST 2022, time=2022-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063277, encodeId=ca3f10632e704, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1e05489924, createdName=ms1000002136354097, createdTime=Sat Oct 23 22:38:03 CST 2021, time=2021-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063107, encodeId=346b106310e9e, content=睡眠障碍可能是导致这种风险的一个未确, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Sat Oct 23 08:52:29 CST 2021, time=2021-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063102, encodeId=e97f1063102c6, content=优秀, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211015/8d56d5fcf5414c569fbb9517e4db6199/10eae43200f34453a94bd30c453d4254.jpg, createdBy=e2255212929, createdName=lemo003, createdTime=Sat Oct 23 08:40:25 CST 2021, time=2021-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063092, encodeId=d077106309216, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Sat Oct 23 06:52:26 CST 2021, time=2021-10-23, status=1, ipAttribution=)]
    2021-10-23 lemo003

    优秀

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1673203, encodeId=039d16e3203a8, content=<a href='/topic/show?id=8c0a926556e' target=_blank style='color:#2F92EE;'>#走路#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92655, encryptionId=8c0a926556e, topicName=走路)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=54d126929591, createdName=cqlidoudou, createdTime=Tue Mar 15 00:12:52 CST 2022, time=2022-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1741993, encodeId=9f071e4199300, content=<a href='/topic/show?id=5681632e84e' target=_blank style='color:#2F92EE;'>#步态#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63278, encryptionId=5681632e84e, topicName=步态)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=76f034999566, createdName=xxxx1061, createdTime=Thu Sep 15 19:12:52 CST 2022, time=2022-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217692, encodeId=ed47121e69236, content=感谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2f71997775, createdName=ayqdf, createdTime=Sat May 07 19:16:46 CST 2022, time=2022-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063277, encodeId=ca3f10632e704, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1e05489924, createdName=ms1000002136354097, createdTime=Sat Oct 23 22:38:03 CST 2021, time=2021-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063107, encodeId=346b106310e9e, content=睡眠障碍可能是导致这种风险的一个未确, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Sat Oct 23 08:52:29 CST 2021, time=2021-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063102, encodeId=e97f1063102c6, content=优秀, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211015/8d56d5fcf5414c569fbb9517e4db6199/10eae43200f34453a94bd30c453d4254.jpg, createdBy=e2255212929, createdName=lemo003, createdTime=Sat Oct 23 08:40:25 CST 2021, time=2021-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063092, encodeId=d077106309216, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Sat Oct 23 06:52:26 CST 2021, time=2021-10-23, status=1, ipAttribution=)]
    2021-10-23 学医无涯

    学习一下

    0