有和没有髌股疼痛综合征的受试者的髋部和膝部力量及神经肌肉活动比较。
Comparison of hip and knee strength and neuromuscular activity in subjects with and without patellofemoral pain syndrome.
作者信息
Bolgla Lori A, Malone Terry R, Umberger Brian R, Uhl Timothy L
出版信息
Int J Sports Phys Ther. 2011 Dec;6(4):285-96.
PURPOSE/BACKGROUND: Historically, patellofemoral pain syndrome (PFPS) has been viewed exclusively as a knee problem. Recent findings have suggested an association between hip muscle weakness and PFPS. Altered neuromuscular activity about the hip also may contribute to PFPS; however, more limited data exist regarding this aspect. Most prior investigations also have not concurrently examined hip and knee strength and neuromuscular activity in this patient population. Additional knowledge regarding the interaction between hip and knee muscle function may enhance the current understanding of PFPS. The purpose of this study was to compare hip and knee strength and electromyographic (EMG) activity in subjects with and without PFPS.
METHODS
Eighteen females with PFPS and 18 matched controls participated in this study. First, surface EMG electrodes were donned on the gluteus medius, vastus medialis, and vastus lateralis. Strength measures then were taken for the hip abductors, hip external rotators, and knee extensors. Subjects completed a standardized stair-stepping task to quantify muscle activation amplitudes during the loading response, single leg stance, and preswing intervals of stair descent as well as to determine muscle onset timing differences between the gluteus medius and vastii muscles and between the vastus medialis and vastus lateralis at the beginning of stair descent.
RESULTS
Females with PFPS demonstrated less strength of the hip muscles. They also generated greater EMG activity of the gluteus medius and vastus medialis during the loading response and single leg stance intervals of stair descent. No differences existed with respect to onset activation of the vastus medialis and vastus lateralis. All subjects had a similar delay in gluteus medius onset activation relative to the vastii muscles.
CONCLUSION
Rehabilitation should focus on quadriceps and hip strengthening. Although clinicians have incorporated gluteus medius exercise in rehabilitation programs, additional attention to the external rotators may be useful.
LEVEL OF EVIDENCE
目的/背景：从历史上看，髌股疼痛综合征（PFPS）一直被单纯视为一种膝关节问题。最近的研究结果表明，髋部肌肉无力与PFPS之间存在关联。髋部神经肌肉活动的改变也可能导致PFPS；然而，关于这方面的数据较为有限。大多数先前的研究也没有同时检查该患者群体的髋部和膝部力量以及神经肌肉活动。关于髋部和膝部肌肉功能相互作用的更多知识可能会增进目前对PFPS的理解。本研究的目的是比较有和没有PFPS的受试者的髋部和膝部力量以及肌电图（EMG）活动。
方法
18名患有PFPS的女性和18名匹配的对照组参与了本研究。首先，将表面肌电电极置于臀中肌、股内侧肌和股外侧肌上。然后测量髋外展肌、髋外旋肌和膝伸肌的力量。受试者完成一项标准化的上楼梯任务，以量化在楼梯下降的负重反应、单腿站立和摆动前期期间的肌肉激活幅度，以及确定在楼梯下降开始时臀中肌与股四头肌之间以及股内侧肌与股外侧肌之间的肌肉起始时间差异。
结果
患有PFPS的女性表现出髋部肌肉力量较弱。她们在楼梯下降的负重反应和单腿站立期间也产生了更大的臀中肌和股内侧肌肌电活动。股内侧肌和股外侧肌的起始激活没有差异。所有受试者的臀中肌起始激活相对于股四头肌都有类似的延迟。
结论
康复应侧重于股四头肌和髋部强化。尽管临床医生已将臀中肌锻炼纳入康复计划，但额外关注外旋肌可能会有帮助。
证据水平
4级。
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