Gerbrands T A, Pisters M F, Vanwanseele B
Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands; Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, The Netherlands.
Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands; Physical Therapy Science, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands; Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, The Netherlands.
Clin Biomech (Bristol). 2014 Aug;29(7):828-34. doi: 10.1016/j.clinbiomech.2014.05.005. Epub 2014 May 27.
The progression of medial knee osteoarthritis seems closely related to a high external knee adduction moment, which could be reduced through gait retraining. We aimed to determine the retraining strategy that reduces this knee moment most effective during gait, and to determine if the same strategy is the most effective for everyone.
Thirty-seven healthy participants underwent 3D gait analysis. After normal walking was recorded, participants received verbal instructions on four gait strategies (Trunk Lean, Medial Thrust, Reduced Vertical Acceleration, Toe Out). Knee adduction moment and strategy-specific kinematics were calculated for all conditions.
The overall knee adduction moment peak was reduced by Medial Thrust (-0.08Nm/Bw·Ht) and Trunk Lean (-0.07Nm/Bw·Ht), while impulse was reduced by 0.03Nms/Bw·Ht in both conditions. Toeing out reduced late stance peak and impulse significantly but overall peak was not affected. Reducing vertical acceleration at initial contact did not reduce the overall peak. Strategy-specific kinematics (trunk lean angle, knee adduction angle, first peak of the vertical ground reaction force, foot progression angle) showed that multiple parameters were affected by all conditions. Medial Thrust was the most effective strategy in 43% of the participants, while Trunk Lean reduced external knee adduction moment most in 49%. With similar kinematics, the reduction of the knee adduction moment peak and impulse was significantly different between these groups.
Although Trunk Lean and Medial Thrust reduced the external knee adduction moment overall, individual selection of gait retraining strategy seems vital to optimally reduce dynamic knee load during gait.
膝关节内侧骨关节炎的进展似乎与较高的膝关节外展力矩密切相关，而通过步态再训练可以降低该力矩。我们旨在确定在步态期间最有效地降低这种膝关节力矩的再训练策略，并确定相同的策略是否对每个人都是最有效的。
37名健康参与者接受了三维步态分析。记录正常行走后，参与者收到关于四种步态策略（躯干倾斜、内侧推力、降低垂直加速度、脚尖外展）的口头指示。计算所有情况下的膝关节内收力矩和特定策略的运动学参数。
内侧推力（-0.08Nm/体重·身高）和躯干倾斜（-0.07Nm/体重·身高）使整体膝关节内收力矩峰值降低，而在这两种情况下冲量均降低了0.03Nms/体重。脚尖外展显著降低了后期支撑期峰值和冲量，但整体峰值未受影响。在初始接触时降低垂直加速度并未降低整体峰值。特定策略的运动学参数（躯干倾斜角度、膝关节内收角度、垂直地面反作用力的第一个峰值、足部前进角度）表明，所有情况均影响多个参数。43%的参与者中内侧推力是最有效的策略，而49%的参与者中躯干倾斜最大程度地降低了膝关节外展力矩。在运动学相似的情况下，这些组之间膝关节内收力矩峰值和冲量的降低存在显著差异。
尽管躯干倾斜和内侧推力总体上降低了膝关节外展力矩，但个体选择步态再训练策略对于在步态期间最佳地降低动态膝关节负荷似乎至关重要。
