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Journal of Physical Therapy Science logoLink to Journal of Physical Therapy Science
. 2025 Sep 1;37(9):466–473. doi: 10.1589/jpts.37.466

Trajectory and asymmetry of lower limb joint moments during normal and blindfolded gait

Naruyoshi Komuro 1,*, Akira Hirosawa 1, Tatsuya Sano 2,3, Ayumi Mohara 1, Taito Nakamura 3,4, Minoru Fukunaga 3,5, Yuuki Homma 1, Fujiyasu Kakizaki 6
PMCID: PMC12399306  PMID: 40895759

Abstract

[Purpose] This study examined gait asymmetry through analyzing gait trajectories and asymmetry of the lower limb moment of the frontal plane in normal and blindfolded gaits. [Participants and Methods] A three-dimensional motion analyzer and force plates were used to determine the thoracic lateral deviation and asymmetrical ratios of the upper and lower thoracic shapes in the standing position of 20 healthy adult men. The progression angle pelvic and thoracic rotation angles; and asymmetry of the hip, knee, and ankle moments in the frontal plane in full- and no-vision gaits were measured. [Results] The thorax deviated to the left relative to the pelvis, and the upper and lower thoracic shapes were asymmetric. The no-vision gait trajectory exhibited a significantly deviated to the left, and the pelvis and thorax were significantly rotated to the left compared with those of the full-vision gait. Asymmetry of the knee moment at the mid-stance and the ankle moment at the loading response were significantly lower under no-vision gait than during full-vision gait. [Conclusion] The proprioceptive trunk information was unbalanced in able-bodied participants. Imbalances in proprioceptive information may cause asymmetric motion of the knee and ankle during gait.

Keywords: Gait asymmetry, Visual deprivation, Gait trajectory

INTRODUCTION

The able-bodied gait is asymmetric, and previous studies have reported asymmetries in ground reaction force1, 2), joint moments3, 4), and electromyographic data5, 6). Despite the importance of gait asymmetry for functional tasks, such as support and propulsion7, 8), it increases energy costs9) and is a risk factor for disability. Significant asymmetries exist in the ankle frontal moment, center of pressure (CoP) lateral deviation, and lateral tilt angle of the shank during gait in able-bodied participants; these asymmetries are associated with thoracic lateral deviation and asymmetry of the thoracic shape in the standing position10, 11). Although the ankle frontal moment contributes to the lateral stability of gait, it deteriorates lower limb alignment in orthopedic diseases12,13,14). Therefore, the causes of asymmetry of the ankle frontal moment must be clarified. However, the mechanism that associates trunk malalignment with the asymmetry of ankle movements during gait is unknown.

One’s position relative to the environment to gait on a straight trajectory till reaching the target while maintaining stability must be continuously and accurately perceived. Three primary types of sensory information (visual, somatosensory, and vestibular) are used for gait control15). Because these sensory details are complementary, if any type of sensory information is unavailable, the contribution of the others increases (sensory reweighting)16, 17). For example, the weighting of postural control by the somatosensory and vestibular senses is greater in a blindfolded gait18). Crisafulli et al.19) analyzed gait trajectories during visual deprivation in cervical dystonia patients with proprioceptive impairment. They reported that gait trajectories deviated significantly in more than 90% of the participants. Courtine et al.20) analyzed gait trajectories during visual deprivation by applying unilateral vibratory stimulation to each muscle of the entire body. The gait trajectory significantly deviated when vibration stimulation was applied to the trunk muscles; however, no deviation occurred in the case of the lower-limb muscles. These studies indicate that the subjective straight-ahead (SSA) perceived in the horizontal plane21) is based on proprioceptive information in the trunk. Moreover, the signals input from proprioceptive receptors in the trunk are asymmetric22).

Crisafulli et al.19) reported a deviation in the gait trajectory during visual deprivation in half of normal participants. As the ribs and spine of able-bodied participants are misaligned11, 23,24,25), able-bodied participants may also receive asymmetric signals input from proprioceptive receptors in the trunk and, consequently, cannot build accurate body schemas. We hypothesized that the asymmetry of the ankle frontal moment observed in able-bodied gait may contribute to gait on a straight trajectory to the target while having an inaccurate body schema. Although the relationship to the thorax has not been examined, asymmetries of frontal moments in the hip and knee may contribute to gait trajectory control. Thus, this study measured the progression angle, trunk rotation angle, and asymmetry of lower-limb moment of the frontal plane in normal and blindfolded gait in able-bodied participants and compared them. In addition, the thoracic lateral deviation and asymmetry of the thoracic shape in the standing position were analyzed as supplementary data. The purpose of this study was to examine the causes of gait asymmetry in able-bodied participants.

PARTICIPANTS AND METHODS

Twenty healthy men without deformities of the trunk or lower extremities and without vestibular or neuromuscular disorders were recruited for this study (age: 25.5 ± 5.1 years, height: 170.9 ± 4.2 cm, body mass: 65.6 ± 7.4 kg, body mass index: 22.4 ± 1.9 kg/m2; mean ± standard deviation [SD]). Before conducting the experiments, the participants were informed of the scientific purpose and significance of the study, and their written consent was obtained. This study was approved by the Ethics Committee of Bunkyo Gakuin University (Approval Number: 2022-0015).

We measured the thoracic lateral deviation, the asymmetrical ratios of the upper and lower thoracic shapes in the standing position, gait speed, progression angle, pelvic and thoracic rotation angle, and asymmetries of the frontal moments of the hip, knee, and ankle during gait under the two conditions. A three-dimensional motion analyzer (Vicon Nexus2; Vicon Motion Systems, Ltd., Oxford, UK) with eight infrared cameras and six force plates (Advanced Mechanical Technology, Inc., Watertown, MA, USA) was used for the measurements. The sampling frequency was 100 Hz.

In this study, 21 reflective markers were placed on the sternal angle (A): three equally spaced on each side at the same height as A (right; A1–3, left; A4–6), the spinous process at the same height as A (B), the xiphoid process (C), the spinous process at the same height as C (D), three equally spaced on each side at the same height as D (right; D1–3, left; D4–6), the T8 spinous process, the anterior superior iliac spine (ASIS), and the posterior superior iliac spine (PSIS) (Figs. 1, 2a, and 2b). The distance between the markers at A1–6 and D1–6 was defined as 13% of the distance between the left and right acromions to fit within the thorax. These markers were placed horizontally and equally spaced using a line laser and tape. Measurements were performed three times for 5 s each while each participant was standing naturally in the resting expiratory position to prevent changes in the thoracic shape with breathing. Vision was not blocked during the measurements in the standing position.

Fig. 1.

Fig. 1.

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Marker placements of thoracic lateral deviation.

Midpoints of C and T8 are defined as the center of the thorax. Those of ASIS and PSIS on each side are calculated, and their respective midpoints are defined as the center of the pelvis. The lateral axial coordinates of the center of the thorax relative to the center of the pelvis are defined as thoracic lateral deviation.

Thoracic lateral deviation [mm]=Center of thorax − Center of pelvis

ASIS: anterior superior iliac spine; PSIS: posterior superior iliac spine; RPSIS: right posterior superior iliac spine; RASIS: right anterior superior iliac spine; LPSIS: left posterior superior iliac spine; LASIS: right anterior superior iliac spine.

Fig. 2.

Fig. 2.

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Marker placements of thoracic shape.

a: Asymmetrical ratio of the upper thoracic shape is defined as the right anteroposterior diameter (BA1 + BA2 + BA3) divided by the left anteroposterior diameter (BA4 + BA5 + BA6).

b: Asymmetrical ratio of the lower thoracic shape is defined as the right anteroposterior diameter (CD1 + CD2 + CD3) divided by the left anteroposterior diameter (CD4 + CD5 + CD6).

Based on previous studies11), thoracic lateral deviation was calculated from the center of the thorax and pelvis. The midpoints of C and T8 were defined as the center of the thorax, and those of ASIS and PSIS on each side were calculated, and their respective midpoints were defined as the center of the pelvis (Fig. 1). The lateral axial coordinates of the center of the thorax relative to the center of the pelvis were defined as thoracic lateral deviation. Positive values for thoracic lateral deviation indicated a right deviation of the thorax relative to the pelvis.

The asymmetrical ratios of the UTS and LTS were calculated from the anteroposterior diameters of the thorax on each side11). The distances from B to A1–6 (BA1, BA2, BA3, BA4, BA5, BA6) were calculated. The right sum (BA1 + BA2 + BA3) was defined as the anteroposterior diameter of the right upper thorax, and the left sum (BA4 + BA5 + BA6) was defined as the anteroposterior diameter of the left upper thorax (Fig. 2a). The distances from C to D1–6 (CD1, CD2, CD3, CD4, CD5, CD6) were calculated, and the anteroposterior diameters of the right lower thorax (CD1 + CD2 + CD3) and left lower thorax (CD4 + CD5 + CD6) were defined using the same method as that of the upper thorax (Fig. 2b). The right anteroposterior diameter divided by the left side was defined as the asymmetrical ratios of the UTS and LTS. An asymmetrical ratio of 1 indicates that the left and right anteroposterior diameters are symmetrical, and a value higher than 1 indicates that the right is greater than the left. A mean value of 3 s was calculated from the 5-s measurements, with the mean value of three trials defined as the representative value for each participant.

Thirty-nine reflective markers were placed on anatomical landmarks following the Vicon Plug-in-Gait marker placement protocol. The tasks were defined as full-vision and no-vision gaits. An eye mask was worn to block vision during the no-vision gait. The body orientation on the horizontal plane in the starting position was defined by marking a line on the floor parallel to the X-axis (transverse direction) in the measurement space; consequently, the toe tips were aligned. Under both conditions, the participants were instructed to gait straight ahead relative to the measurement space. In the no-vision gait, the measurement assistant signaled the end of the gait and guided the participant to the starting position. Only the starting position markings were visible, and visual feedback of the gait trajectory between each session was avoided. The two-condition gait was standardized to the cadence of the full-vision gait using a metronome. The gait speed of the full-vision gait was the comfortable speed of each participant. To reduce fear and instability owing to visual deprivation, the no-vision gait was measured after sufficient practice26). Trials for which ground reaction force on the bilateral sides could be recorded were performed, and three measurements were conducted.

The gait speed and progression angle were calculated from one gait cycle on the right. The progression angle is the angle between the horizontal line connecting the center of mass (CoM) at the right initial contact and the CoM at the next right initial contact and the Y-axis in the measurement space (Fig. 3). Positive values indicate that the gait trajectory is rightward, and vice-versa. The mean value of three trials was adopted as the representative value for each participant.

Fig. 3.

Fig. 3.

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Method for calculating the progression angle.

Progression angle is defined as the angle between the horizontal line connecting the CoM at the right IC and the CoM at the next right IC and the Y-axis in the measurement space.

CoM: center of mass; IC: initial contact.

The pelvic and thoracic rotation angles, and lower-limb joint moments were calculated for the stance phase. These gait parameters were normalized to 100% during the stance phase and averaged over the three trials. The pelvic and thoracic rotation angles are the absolute angles determined using the Plug-in Gait Model. In normal gait, the trunk is in a neutral position in the horizontal plane at mid-stance (MS)27). Therefore, the pelvic and thoracic rotation angles were calculated at the right MS (50% of the stance phase). Positive values indicate rightward rotation, and vice-versa. Joint moments were normalized by body weight. The hip, knee, and ankle frontal moments were calculated at the left- and right-loading response (20% of the stance: LR), MS, and terminal stance (80% of the stance: TS); positive values indicate that internal moments are exerted in the hip abduction, knee abduction, and ankle valgus directions, respectively. Furthermore, the asymmetry of the moment was calculated as absolute values (|R-L|). Higher values indicate more asymmetry.

The mean and standard deviation of each parameter were calculated for all participants. A 95% confidence interval was calculated from the thoracic lateral deviation and asymmetrical ratios of the upper and lower thoracic shapes. Gait parameters were compared between full-vision and no-vision gait (paired t-test or Wilcoxon signed-rank test) after testing for normality using the Shapiro–Wilk test. The effect size (r) values were also calculated. All data were analyzed and evaluated using SPSS Statistics (version 28.0, Windows, IBM Corp., Armonk, NY, USA). The significance level was 0.05.

RESULTS

The average thoracic lateral deviation was −8.7 ± 1.3 (95% CI: −11.3, −6), with the thorax deviating to the left relative to the pelvis. The asymmetrical ratio of the upper thoracic shape was 0.98 ± 0 (95% CI: 0.98, 0.99), with the anteroposterior diameter of the upper thorax on the left exceeding that on the right. The asymmetrical ratio of the lower thoracic shape was 1.03 ± 0.01 (95% CI: 1.01, 1.04), with the anteroposterior diameter of the lower thorax larger on the right than on the left.

The comparison results between full-vision and no-vision gait are presented in Table 1. The measured values of the left and right moments are presented in Table 2. No significant difference was observed in gait speed. The progression angle was significantly smaller in the no-vision gait than in the full-vision gait (p<0.01, r=0.68). Thus, the gait trajectory deviated to the left in the no-vision gait. The pelvic and thoracic rotation angles were significantly smaller in the no-vision gait than in the full-vision gait (p<0.05, r=0.5 and p<0.05, r=0.48, respectively). Thus, the pelvis and thorax were left rotated in the no-vision gait. There was no significant difference in the asymmetry of hip moment. Although the asymmetry of knee moment at the MS was significantly smaller in the no-vision gait than in the full-vision gait (p<0.05, r=−0.51), no significant difference was observed at the LR and TS. Although the asymmetry of ankle moment at the LR was significantly smaller in the no-vision gait than in the full-vision gait (p<0.05, r=0.84), no significant difference was observed at the MS and TS. Post-hoc power analyses were performed for parameters that showed significant differences to assess the adequacy of the sample size, and all of them exhibited high levels of statistical power (power=1).

Table 1. Mean values of gait parameters in full-vision and no-vision gait and comparison results.

Parameter Full-vision No-vision p-value Effect size (r)
Gait speed [m/s] 1.33 ± 0.03 1.33 ± 0.03 0.11
Progression angle [ °] 0.1 ± 0.1 −2.8 ± 0.6 <0.01 0.68
Pelvic rotation angle [ °] −0.8 ± 0.5 −2.6 ± 0.8 <0.05 0.5
Thoracic rotation angle [ °] −3.2 ± 0.5 −4.8 ± 0.9 <0.05 0.48
Asymmetries of joint moments [|R-L|]
Hip LR 246.2 ± 30.4 234.2 ± 35.5 0.14
MS 108.2 ± 21.9 109.3 ± 22.5 −0.09
TS 148.3 ± 40.4 139.7 ± 46.8 −0.18
Knee LR 108.3 ± 21.7 94.9 ± 17.4 −0.18
MS 104.0 ± 15.0 73.5 ± 12.7 <0.05 −0.51
TS 118.2 ± 17.8 112.9 ± 17.1 0.09
Ankle LR 101.1 ± 7.0 56.1 ± 7.3 <0.01 0.84
MS 78.6 ± 12.5 65.2 ± 11.1 −0.17
TS 106.7 ± 25.6 113.7 ± 27.7 0.12
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Values are mean ± SD (n=20).

LR: loading response; MS: mid stance; TS: terminal stance.

Table 2. Mean values of left and right lower limb moments in the full-vision and no-vision gait.

Parameter Full-vision No-vision
Hip moment [Nmm/kg]
(+: abduction, −: adduction)
LR L 682.7 ± 31.9 743.5 ± 38.9
R 901.8 ± 23.9 865.5 ± 50.0
MS L 495.3 ± 26.2 525.0 ± 28.6
R 537.9 ± 15.2 489.7 ± 24.4
TS L 580.0 ± 38.9 622.1 ± 40.8
R 533.7 ± 30.1 553.8 ± 29.5
Knee moment [Nmm/kg]
(+: abduction, −: adduction)
LR L 607.4 ± 31.1 649.3 ± 41.6
R 702.0 ± 30.0 685.8 ± 30.2
MS L 267.5 ± 17.8 285.6 ± 19.8
R 368.3 ± 17.8 325.9 ± 21.5
TS L 418.9 ± 27.1 425.3 ± 29.1
R 530.1 ± 23.3 516.2 ± 21.1
Ankle moment [Nmm/kg]
(+: valgus, −: varus)
LR L −12.6 ± 11.3 −24.9 ± 13.1
R 88.5 ± 10.4 25.0 ± 12.1
MS L −23.1 ± 10.7 −44.1 ± 14.7
R 51.2 ± 14.8 0.9 ± 13.4
TS L 51.5 ± 14.6 17.5 ± 20.6
R 154.5 ± 27.3 116.6 ± 28.6
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Listed as internal moments. Values are mean ± SD (n=20).

LR: loading response; MS: mid stance; TS: terminal stance.

DISCUSSION

This study aimed to investigate the factors that cause gait asymmetry in able-bodied participants. The thoracic lateral deviation and thoracic shape in the standing position, gait speed, progression angle, pelvic and thoracic rotation angle, and asymmetries of the lower-limb joint moments of the frontal plane were measured during gait, and gait parameters were compared between full-vision and no-vision gait.

In previous studies, blindfolded gait was observed to decrease gait speed and stride length, increase bipedal support time, decrease hip adduction during stance, and decrease heel rocker and forefoot rocker compared to the normal rocker28, 29). Because gait speed influences kinematic and kinetic parameters, it was standardized for the two conditions in this study. No significant difference was observed in the gait speeds between full-vision and no-vision walking, suggesting that participants walked at approximately the same speed under the two conditions. Moe-Nilssen et al.26) observed a near-normal gait for walking in the dark when participants were sufficiently habituated. Similarly, in this study, measurements were conducted after sufficient practice; thus, the fear and instability caused by visual deprivation was minimized.

No-vision gait exhibited a significantly deviated gait trajectory to the left compared to full-vision gait, and the pelvis and thorax were significantly left-rotated. Tarnutzer et al.30), Weick et al.31), and Bestaven et al.32) reported that the gait trajectory deviated to the left, and Jahn et al.33) observed deviation to the right in the blindfolded gait of able-bodied participants. Despite the differences in the measurement methods used in these studies, many studies reported deviations to the left, and their results were similar to the results obtained in this study. Studies on cervical dystonia patients with proprioceptive disorders19) and unilateral vibratory stimulation to muscles of the entire body20) have suggested that the gait trajectory during visual deprivation is based on proprioceptive information of the trunk. Therefore, it is suggested that signals input from proprioceptors, such as trunk muscles, tendons, and joints, are asymmetric in the participants in this study. A factor that may contribute to this is the influence of trunk alignment.

The thorax of the participants in this study deviated to the left relative to the pelvis in the standing position. In addition, the upper and lower thoracic shapes were asymmetrical. Healthy participants with such trunk alignment have asymmetric cross-sectional areas of some trunk muscles34, 35). The asymmetry in muscle and tendon length and joint alignment caused by the trunk malalignment contribute to the imbalance in proprioceptive information. However, this study did not examine the relationship between thoracic lateral deviation or thoracic shape and progression angle, and this inference is only a speculation. Deviations in SSA have been observed in patients with unilateral vestibular impairment36, 37), and the vestibular function has been found to be asymmetric in able-bodied participants30). Therefore, proprioceptive as well as vestibular effects are included in the findings of this study. Although the effects of both were not investigated in this study, we consider that asymmetry of sensory information is inherent in able-bodied participants.

The asymmetry of knee frontal moment at the MS and the asymmetry of ankle frontal moment at the LR were significantly smaller in no-vision gait than in full-vision gait. The effect size of the difference was largest for the asymmetry of ankle frontal moment at the LR (r=0.84). The ankle frontal moment controls the CoP and contributes to the lateral stability of the CoM38, 39). A previous study11) found that the asymmetry of ankle frontal moment existed throughout the gait cycle in the open-eye gait in able-bodied participants (that is, the internal ankle valgus moment on the right exceeded that on the left). When the deviation of the gait trajectory to the left is corrected by the ankle motion, the internal varus and valgus moments should be increased during the left and right stance phases, respectively. Although the asymmetric ankle motion is used to move straight toward the target in full-vision gait, the asymmetric ankle motion is reduced in the no-vision gait because it allows for deviation of the gait trajectory to the left. The left and right values of ankle moments at the LR listed in Table 2 show a marked decrease in the right internal valgus moment. The right ankle motion may be more involved in the increase or decrease of asymmetry than the left ankle motion.

The smaller asymmetry of the knee frontal moment at the MS may be attributed to the smaller asymmetry of the ankle frontal moment. In contrast to the ankle and hip joints, the knee joint does not perform a range of motion for adduction/abduction; thus, it is unlikely that the knee frontal moment actively controls the gait trajectory. In addition, no significant difference was observed in the asymmetry of the hip frontal moment. Therefore, the asymmetry of knee frontal moment decreased with changes in the ankle joint rather than the hip joint.

A limitation of this study is that the negative effects of visual deprivation on gait and standing could not be completely eliminated. In previous studies, blindfolded gait decreased gait speed and stride length, increased bipedal support time, decreased hip adduction during the stance, and decreased heel rocker and forefoot rocker compared to the normal rocker28, 29). Because no significant difference was observed in gait speed between the two conditions, we considered that any negative effects on movement in the sagittal plane could be reasonably excluded. However, the step distance and foot progression angle, which are involved in frontal plane movements, were not included in the analysis of this study. The possibility that these factors might have influenced the results cannot be ruled out. In addition, vision was not blocked during the measurement of the thorax in the standing position. Therefore, the trunk alignment in the starting posture may not be perfectly matched between full- and no-vision gait. The effect of trunk alignment on the progression angle during blindfolded gait is open to further research. Finally, although the sample size of this study was small, post-hoc power analysis confirmed high statistical power.

In conclusion, the gait trajectory deviated to the left, and the pelvis and thorax were rotated to the left in the blindfolded gait in the able-bodied participants. In addition, no-vision gait reduces the asymmetry of knee frontal moment at the MS and the asymmetry of ankle frontal moment at the LR compared to full-vision gait. This study showed that the proprioceptive information of the trunk is unbalanced even in able-bodied participants. It is suggested that imbalances in proprioceptive information may cause asymmetric motion of the knee and ankle in gait. We believe that this study is of clinical significance because it provides insights into a cause of gait asymmetry in able-bodied participants.

Conflict of interest

The authors declare that there is no conflict of interests regarding the publication of this article.

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