Willson John D, Binder-Macleod Stuart, Davis Irene S
University of Wisconsin-La Crosse, Physical Therapy Program, 4054 Health Science Center, 1725 State Street, La Crosse, WI 54601, USA.
Am J Sports Med. 2008 Aug;36(8):1587-96. doi: 10.1177/0363546508315592. Epub 2008 Apr 30.
Patellofemoral pain is especially common among female athletes and is traditionally associated with lower extremity mechanics thought to increase retropatellar stress. These detrimental mechanics may increase with exertion.
Differences in lower extremity mechanics during single-legged jumps between female athletes with and without patellofemoral pain will increase after exertion.
Controlled laboratory study.
Twenty women with patellofemoral pain and 20 healthy female controls participated in a functional lower extremity exertion protocol of repetitive single-legged jumps. Pain, exertion, hip and trunk strength, and 3-dimensional lower extremity joint mechanics were recorded at the beginning and end of the protocol.
The patellofemoral pain group reported increased pain at the conclusion of the protocol. However, all subjects terminated the protocol due to complaints of fatigue. Mean strength measurements for the patellofemoral pain group were 24% lower for lateral trunk flexion (P = .06), 13% lower for hip abduction (P = .09), and 14% lower for hip external rotation (P = .03) than for controls. Subjects with patellofemoral pain demonstrated greater contralateral pelvic drop at the end of the exertion protocol compared with the control group (P = .003). Group differences in lower extremity mechanics, including increased hip adduction angle, hip flexion angle, hip abduction angular impulse, and decreased hip internal rotation angles, were observed among women with patellofemoral pain throughout the exertion protocol. These group differences were consistent despite increased pain for the patellofemoral pain group after exertion. Both groups demonstrated decreased jump height, hip flexion and internal rotation, knee flexion, and hip extension impulse at the end of the protocol.
Women with patellofemoral pain demonstrated lower extremity mechanics that differed from the healthy control group during single-legged jumping, particularly at the hip. These differences do not appear to vary with exertion level or pain among patellofemoral pain subjects during single-legged jumps.
Lower extremity jumping mechanics appear to be consistently different among women with patellofemoral pain. Conservative treatment programs that include kinematic retraining as well as hip and trunk strengthening may improve patient outcomes and prevent recurrence of this common orthopaedic condition.
髌股疼痛在女性运动员中尤为常见，传统上与被认为会增加髌后压力的下肢力学因素有关。这些有害的力学因素可能会随着运动而增加。
有和没有髌股疼痛的女性运动员在单腿跳跃时下肢力学的差异在运动后会增大。
对照实验室研究。
20名患有髌股疼痛的女性和20名健康女性对照者参与了一项重复单腿跳跃的下肢功能运动方案。在方案开始和结束时记录疼痛、运动强度、髋部和躯干力量以及三维下肢关节力学情况。
髌股疼痛组在方案结束时报告疼痛加剧。然而，所有受试者均因疲劳抱怨而终止了方案。髌股疼痛组的平均力量测量结果显示，其侧方躯干屈曲比对照组低24%（P = 0.06），髋外展比对照组低13%（P = 0.09），髋外旋比对照组低14%（P = 0.03）。与对照组相比，患有髌股疼痛的受试者在运动方案结束时对侧骨盆下降更明显（P = 0.003）。在整个运动方案中，髌股疼痛女性在下肢力学方面存在组间差异，包括髋内收角度增加、髋屈曲角度增加、髋外展角冲量增加以及髋内旋角度减小。尽管运动后髌股疼痛组疼痛加剧，但这些组间差异仍然存在。两组在方案结束时均表现出跳跃高度降低、髋屈曲和内旋、膝关节屈曲以及髋伸展冲量降低。
患有髌股疼痛的女性在单腿跳跃时下肢力学与健康对照组不同，尤其是在髋部。在单腿跳跃过程中，这些差异在髌股疼痛受试者中似乎不会因运动水平或疼痛而有所不同。
患有髌股疼痛的女性下肢跳跃力学似乎始终存在差异。包括运动学再训练以及髋部和躯干强化的保守治疗方案可能会改善患者的治疗效果，并预防这种常见骨科疾病的复发。
