Courtney Carol A, Clark Jeffrey D, Duncombe Alison M, O'Hearn Michael A
Department of Physical Therapy, University of Illinois at Chicago, USA ; University of Illinois Medical Center, Chicago, USA.
J Man Manip Ther. 2011 Nov;19(4):212-22. doi: 10.1179/106698111X13129729552029.
Chronic lower quadrant injuries constitute a significant percentage of the musculoskeletal cases seen by clinicians. While impairments may vary, pain is often the factor that compels the patient to seek medical attention. Traumatic injury from sport is one cause of progressive chronic joint pain, particularly in the lower quarter. Recent studies have demonstrated the presence of peripheral and central sensitization mechanisms in different lower quadrant pain syndromes, such as lumbar spine related leg pain, osteoarthritis of the knee, and following acute injuries such as lateral ankle sprain and anterior cruciate ligament rupture. Proper management of lower quarter conditions should include assessment of balance and gait as increasing pain and chronicity may lead to altered gait patterns and falls. In addition, quantitative sensory testing may provide insight into pain mechanisms which affect management and prognosis of musculoskeletal conditions. Studies have demonstrated analgesic effects and modulation of spinal excitability with use of manual therapy techniques, with clinical outcomes of improved gait and functional ability. This paper will discuss the evidence which supports the use of manual therapy for lower quarter musculoskeletal dysfunction.
慢性下象限损伤在临床医生诊治的肌肉骨骼病例中占相当大的比例。虽然损伤情况可能各不相同，但疼痛往往是促使患者寻求医疗帮助的因素。运动造成的创伤是导致慢性关节疼痛逐渐加重的一个原因，尤其是在下肢。最近的研究表明，在不同的下象限疼痛综合征中存在外周和中枢敏化机制，如腰椎相关的腿部疼痛、膝关节骨关节炎，以及在急性损伤如外侧踝关节扭伤和前交叉韧带断裂之后。对下肢疾病的恰当管理应包括评估平衡和步态，因为疼痛加剧和病程延长可能导致步态模式改变和跌倒。此外，定量感觉测试可以深入了解影响肌肉骨骼疾病管理和预后的疼痛机制。研究表明手动治疗技术具有镇痛作用并能调节脊髓兴奋性，临床结果是步态和功能能力得到改善。本文将讨论支持使用手动治疗来处理下肢肌肉骨骼功能障碍的证据。
