Kaiser Permanente Southern California Orthopaedic Physical Therapy Residency Program, Woodland Hills, CA, USA.
J Orthop Sports Phys Ther. 2010 Feb;40(2):112-9. doi: 10.2519/jospt.2010.3110.
Case report.
To highlight the effects of an intervention program consisting of strengthening and neuromuscular reeducation of the gluteus maximus in an elite triathlete with exercise-associated muscle cramping (EAMC).
Researchers have described 2 theories concerning the etiology of EAMC: (1) muscle fatigue and (2) electrolyte deficit. As such, interventions for EAMC typically consist of stretching/strengthening of the involved muscle and/or supplements to restore electrolyte imbalances.
The patient was a 42-year-old male triathlete with a primary complaint of recurrent cramping of his right hamstring muscle, which prevented him from completing races at his desired pace. Strength testing revealed gluteus maximus muscle weakness bilaterally. Electromyographic (EMG) analysis (surface electrodes, 1560 Hz) revealed that the right hamstrings were being activated excessively during terminal swing and the first half of the stance phase (48.1% maximum voluntary isometric contraction [MVIC]).
Following the intervention, the patient was able to complete 3 triathlons without hamstring cramping. Strength testing revealed that the right hip extension strength improved from 35.6 to 54.7 kg, and activation of the hamstrings during terminal swing and the first half of the stance phase decreased to 36.4% of MVIC.
A program of gluteus maximus strengthening and neuromuscular training eliminated EAMC of the hamstrings in this patient. Given that the hamstrings and gluteus maximus work as agonists to decelerate the thigh during terminal swing phase and control hip flexion during loading response of running, we postulate that strengthening of the gluteus maximus decreased the relative effort required by the hamstrings, thus reducing EAMC. The results of the EMG evaluation that was performed as part of this case report provides support for this hypothesis.
Therapy, level 4.
研究设计：病例报告。
目的：强调强化和臀大肌神经肌肉再教育干预方案对运动相关性肌肉痉挛（EAMC）的精英铁人三项运动员的影响。
背景：研究人员已经描述了两种关于 EAMC 病因的理论：（1）肌肉疲劳和（2）电解质缺乏。因此，EAMC 的干预措施通常包括涉及肌肉的伸展/强化以及补充剂以恢复电解质失衡。
病例描述：患者是一名 42 岁男性铁人三项运动员，主要抱怨右侧腿筋反复痉挛，这使他无法以期望的速度完成比赛。力量测试显示双侧臀大肌无力。肌电图（EMG）分析（表面电极，1560Hz）显示，右腿在末期摆动和起始步幅的前半段过度激活（48.1%最大自主等长收缩[MVIC]）。
结果：干预后，患者能够完成 3 次铁人三项比赛而没有腿筋痉挛。力量测试显示，右侧髋关节伸展力量从 35.6 公斤提高到 54.7 公斤，末期摆动和起始步幅的前半段腿筋的激活降低到 MVIC 的 36.4%。
讨论：臀大肌强化和神经肌肉训练计划消除了该患者的腿筋 EAMC。由于腿筋和臀大肌作为在末期摆动阶段使大腿减速并在跑步的负荷反应期间控制髋关节屈曲的拮抗剂，我们假设臀大肌的强化降低了腿筋的相对工作量，从而减少了 EAMC。作为该病例报告的一部分进行的 EMG 评估的结果支持这一假设。
证据水平：治疗，4 级。
