踝关节支具对慢性踝关节不稳参与者功能锻炼期间下肢肌肉激活的影响。
Effect of ankle braces on lower extremity muscle activation during functional exercises in participants with chronic ankle instability.
作者信息
Feger Mark A, Donovan Luke, Hart Joe M, Hertel Jay
机构信息
University of Virginia, Charlottesville, VA, USA.
出版信息
Int J Sports Phys Ther. 2014 Aug;9(4):476-87.
BACKGROUND
Ankle bracing and rehabilitation are common methods to reduce the rate of recurrent ankle sprain in participants with chronic ankle instability (CAI). CAI participants utilize less muscle activity when performing functional exercises compared to healthy controls. The effect of ankle braces on muscle activity during functional exercises in participants with CAI has not been previously studied.
PURPOSE
To determine the effect of bracing on motor output as demonstrated by surface EMG amplitudes in participants with CAI during single limb, eyes closed balance, star excursion balance, forward lunge, and lateral hop exercises.
METHODS
A descriptive laboratory study was performed. Fifteen young adults with CAI performed functional exercises with and without ankle braces while surface EMG signals were recorded from the tibialis anterior, peroneus longus, lateral gastrocnemius, rectus femoris, biceps femoris, and gluteus medius. The main outcome measures were normalized surface EMG amplitudes (root mean square area) for each muscle, muscles of the shank (distal three muscles), muscles of the thigh (proximal three muscles), and total muscle activity (all six muscles) of the lower extremity. A paired t-test was performed for each dependent variable to compare conditions. The level of significance was set a priori at p ≤ 0.05 for all analyses.
RESULTS
During the forward lunge, bracing significantly reduced muscle activity pre-initial contact in the lateral gastrocnemius and post-initial contact in the peroneus longus. During the star excursion balance anterior reach the peroneus longus, lateral gastrocnemius, rectus femoris, and gluteus medius had significantly less muscle activity during braced trials. Bracing significantly reduced thigh and total muscle activity during the anterior reach and gluteus medius activity during the posterolateral reach. There were no differences between braced and unbraced conditions during the single limb eyes closed balance, star excursion balance posteromedial reach, or during lateral hop exercises.
CONCLUSIONS
Clinicians should be aware of the decreased muscle activity that occurs during common rehabilitation exercises when patients with CAI complete those activities while wearing ankle braces.
LEVEL OF EVIDENCE
Level III.
背景
踝关节支具和康复训练是降低慢性踝关节不稳（CAI）患者复发性踝关节扭伤发生率的常用方法。与健康对照组相比，CAI患者在进行功能锻炼时肌肉活动较少。此前尚未研究过踝关节支具对CAI患者功能锻炼期间肌肉活动的影响。
目的
确定支具对CAI患者在单腿闭眼平衡、星形偏移平衡、前弓步和侧向跳跃练习中表面肌电图振幅所显示的运动输出的影响。
方法
进行了一项描述性实验室研究。15名患有CAI的年轻成年人在佩戴和不佩戴踝关节支具的情况下进行功能锻炼，同时记录胫骨前肌、腓骨长肌、外侧腓肠肌、股直肌、股二头肌和臀中肌的表面肌电图信号。主要观察指标为每块肌肉、小腿肌肉（远端三块肌肉）、大腿肌肉（近端三块肌肉）以及下肢总肌肉活动（全部六块肌肉）的标准化表面肌电图振幅（均方根面积）。对每个因变量进行配对t检验以比较不同条件。所有分析的显著性水平预先设定为p≤0.05。
结果
在前弓步过程中，佩戴支具显著降低了外侧腓肠肌初始接触前以及腓骨长肌初始接触后的肌肉活动。在星形偏移平衡前伸过程中，佩戴支具试验期间腓骨长肌、外侧腓肠肌、股直肌和臀中肌的肌肉活动显著减少。佩戴支具在前伸过程中显著降低了大腿和总肌肉活动，在后外侧伸展过程中显著降低了臀中肌活动。在单腿闭眼平衡、星形偏移平衡后内侧伸展或侧向跳跃练习期间，佩戴支具和不佩戴支具的情况之间没有差异。
结论
临床医生应意识到，当CAI患者佩戴踝关节支具完成常见康复锻炼时，会出现肌肉活动减少的情况。
证据水平
三级。
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