Suter E, McMorland G, Herzog W, Bray R
The University of Calgary, Canada.
J Manipulative Physiol Ther. 2000 Feb;23(2):76-80.
Knee-joint pathologies, such as anterior knee pain (AKP), are associated with strength deficits and reduced activation of the knee extensors, which is referred to as muscle inhibition (MI). MI is thought to prevent full functional recovery, and treatment modalities that help to reduce or eliminate MI appear necessary for successful rehabilitation. Clinical observations suggest that AKP is typically associated with sacroiliac (SI) joint dysfunction. It is unknown whether SI-joint dysfunction contributes to knee-extensor deficits and whether correction of SI-joint dysfunction alleviates MI.
The objective of this study was to assess whether conservative low back treatment reduces lower limb MI.
In a randomized, controlled, double-blind study the effects of conservative lower back treatment on knee-extensor strength and MI were evaluated in patients with AKP.
Twenty-eight patients with AKP were randomly assigned to either a treatment or a control group. After a lower back functional assessment, the treatment group received a conservative treatment in the form of a chiropractic spinal manipulation aimed at correcting SI-joint dysfunction. The control group underwent a lower back functional assessment but received no joint manipulation. Before and after the manipulation or the lower back functional assessment, knee-extensor moments, MI, and muscle activation during full effort, isometric knee extensions were measured.
Patients showed substantial MI in both legs. Functional assessment revealed SI-joint dysfunction in all subjects (23 symptomatic and 5 asymptomatic). After the SI-joint manipulation, a significant decrease in MI of 7.5% was observed in the involved legs of the treatment group. MI did not change in the contralateral legs of the treatment group or the involved and contralateral legs of the control group. There were no statistically significant changes in knee-extensor moments and muscle activation in either group.
The results of this study suggest that SI-joint manipulation reduces knee-extensor MI. Spinal manipulation may possibly be an effective treatment of MI in the lower limb musculature.
膝关节病变，如膝前痛（AKP），与力量不足及膝关节伸肌激活减少有关，这被称为肌肉抑制（MI）。肌肉抑制被认为会阻碍功能的完全恢复，因此有助于减少或消除肌肉抑制的治疗方式对于成功康复似乎是必要的。临床观察表明，AKP通常与骶髂（SI）关节功能障碍有关。目前尚不清楚SI关节功能障碍是否会导致膝关节伸肌功能缺陷，以及纠正SI关节功能障碍是否能减轻肌肉抑制。
本研究的目的是评估保守性下背部治疗是否能减少下肢肌肉抑制。
在一项随机、对照、双盲研究中，对AKP患者进行保守性下背部治疗对膝关节伸肌力量和肌肉抑制的影响评估。
28例AKP患者被随机分为治疗组和对照组。在进行下背部功能评估后，治疗组接受以整脊脊柱手法治疗形式的保守治疗，旨在纠正SI关节功能障碍。对照组进行下背部功能评估，但不接受关节手法治疗。在手法治疗或下背部功能评估前后，测量最大努力等长膝关节伸展时的膝关节伸肌力矩、肌肉抑制和肌肉激活情况。
患者双腿均表现出明显的肌肉抑制。功能评估显示所有受试者（23例有症状者和5例无症状者）均存在SI关节功能障碍。在进行SI关节手法治疗后，可以观察到治疗组患侧下肢的肌肉抑制显著降低了7.5%。治疗组对侧下肢以及对照组患侧和对侧下肢的肌肉抑制均未发生变化。两组的膝关节伸肌力矩和肌肉激活均无统计学上的显著变化。
本研究结果表明，SI关节手法治疗可减少膝关节伸肌的肌肉抑制。脊柱手法治疗可能是治疗下肢肌肉组织肌肉抑制的一种有效方法。
