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髋关节屈肌拉伸训练计划对老年人步态的影响。

Effect of a hip flexor-stretching program on gait in the elderly.

作者信息

Kerrigan D Casey, Xenopoulos-Oddsson Annette, Sullivan Meaghan J, Lelas Jennifer J, Riley Patrick O

机构信息

Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA 22903-2981, USA.

出版信息

Arch Phys Med Rehabil. 2003 Jan;84(1):1-6. doi: 10.1053/apmr.2003.50056.

Abstract

OBJECTIVES

To test whether a reduction in peak hip extension during the terminal stance phase of walking in elderly compared with young adult subjects represents a hip flexor contracture impairment rather than some dynamic consequence and to test the hypothesis that stretching the hip flexors improves both static and dynamic peak hip extension, as well as other age-related gait changes about the ankle.

DESIGN

A double-blinded, randomized, controlled trial.

SETTING

Stretching exercises were performed in the subjects' homes. Pre- and postassessments were performed in a gait laboratory.

PARTICIPANTS

Ninety-six healthy elderly individuals in 2 groups: treatment (n=47) and control (n=49).

INTERVENTION

The treatment group received a 1-time instruction in hip flexor stretching, whereas the control group received a 1-time instruction in shoulder abductor stretching. Participants in each group were asked to perform stretching exercises on their own twice daily for 10 weeks.

MAIN OUTCOME MEASURES

Static and dynamic peak hip extension, peak anterior pelvic tilt, and other peak kinematic and kinetic variables during the gait cycle.

RESULTS

There was a modest improvement in static peak hip extension as measured by a goniometer within the treatment group (mean +/- standard deviation, 6.1 degrees +/-2.5 degrees to 7.7 degrees +/-3.6 degrees, P=.032) compared with no change in the control group. At comfortable walking speed, dynamic hip extension tended to increase in the treatment group (5.1 degrees +/-9.7 degrees to 7.1 degrees +/-8.0 degrees, P=.103) compared with no real change in the control group (5.3 degrees +/-8.9 degrees to 5.4 degrees +/-7.5 degrees, P=.928). Similarly, at fast walking speed, dynamic hip extension tended to increase in the treatment group (6.4 degrees +/-9.8 degrees to 8.4 degrees +/-8.0 degrees, P=.093) compared with no change in the control group. Changes in ankle kinematics and kinetics included a significant improvement in peak ankle plantarflexion and a tendency to improved ankle power generation.

CONCLUSION

The static and dynamic trends to improvement in peak hip extension were of similar magnitude, suggesting that age-related reduction in peak hip extension during gait is the result of a static hip flexion contracture rather than a dynamic consequence. Additionally, age-related changes in ankle kinematics and kinetics may be secondarily related to hip flexion contracture impairment rather than impairment at the ankle per se. This study was limited by the exercises being unsupervised and relying on 1-time instruction. A more rigorous and supervised hip flexor-stretching exercise program may yield more substantial improvements in gait parameters.

摘要

目的

测试与年轻成年人相比,老年人在步行终末支撑期髋部伸展峰值降低是否代表髋部屈肌挛缩损伤而非某些动态结果,并测试拉伸髋部屈肌可改善静态和动态髋部伸展峰值以及其他与年龄相关的踝关节步态变化这一假设。

设计

一项双盲、随机、对照试验。

设置

伸展运动在受试者家中进行。在步态实验室进行前后评估。

参与者

96名健康老年人,分为2组:治疗组(n = 47)和对照组(n = 49)。

干预

治疗组接受一次髋部屈肌拉伸指导,而对照组接受一次肩部外展肌拉伸指导。每组参与者被要求每天自行进行两次伸展运动,持续10周。

主要观察指标

步态周期中的静态和动态髋部伸展峰值、骨盆前倾峰值以及其他峰值运动学和动力学变量。

结果

与对照组无变化相比,治疗组通过角度计测量的静态髋部伸展峰值有适度改善(平均值±标准差,从6.1°±2.5°至7.7°±3.6°,P = 0.032)。在舒适步行速度下,治疗组的动态髋部伸展趋于增加(从5.1°±9.7°至7.1°±8.0°,P = 0.103),而对照组无实际变化(从5.3°±8.9°至5.4°±7.5°,P = 0.928)。同样,在快速步行速度下,治疗组的动态髋部伸展趋于增加(从6.4°±9.8°至8.4°±8.0°,P = 0.093),而对照组无变化。踝关节运动学和动力学的变化包括踝关节跖屈峰值显著改善以及踝关节产生功率的趋势改善。

结论

髋部伸展峰值改善的静态和动态趋势幅度相似,表明步态中与年龄相关的髋部伸展峰值降低是静态髋部屈曲挛缩的结果而非动态结果。此外,踝关节运动学和动力学的年龄相关变化可能继发于髋部屈曲挛缩损伤而非踝关节本身的损伤。本研究受限于运动无监督且依赖一次性指导。更严格且有监督的髋部屈肌拉伸运动计划可能会使步态参数有更显著的改善。

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