Lack Simon, Barton Christian, Woledge Roger, Laupheimer Markus, Morrissey Dylan
Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, England, United Kingdom.
Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, England, United Kingdom.
Clin Biomech (Bristol). 2014 Nov;29(9):1056-62. doi: 10.1016/j.clinbiomech.2014.08.005. Epub 2014 Aug 23.
Evidence shows that anti-pronating foot orthoses improve patellofemoral pain, but there is a paucity of evidence concerning mechanisms. We investigated the immediate effects of prefabricated foot orthoses on (i) hip and knee kinematics; (ii) electromyography variables of vastus medialis oblique, vastus lateralis and gluteus medius during a functional step-up task, and (iii) associated clinical measures.
Hip muscle activity and kinematics were measured during a step-up task with and without an anti-pronating foot orthoses, in people (n=20, 9 M, 11 F) with patellofemoral pain. Additionally, we measured knee function, foot posture index, isometric hip abductor and knee extensor strength and weight-bearing ankle dorsiflexion.
Reduced hip adduction (0.82°, P=0.01), knee internal rotation (0.46°, P=0.03), and decreased gluteus medius peak amplitude (0.9mV, P=0.043) were observed after ground contact in the 'with orthoses' condition. With the addition of orthoses, a more pronated foot posture correlated with earlier vastus medialis oblique onset (r=-0.51, P=0.02) whilst higher Kujala scores correlated with earlier gluteus medius onset (r=0.52, P=0.02).
Although small in magnitude, reductions in hip adduction, knee internal rotation and gluteus medius amplitude observed immediately following orthoses application during a task that commonly aggravates symptoms, offer a potential mechanism for their effectiveness in patellofemoral pain management. Given the potential for cumulative effects of weight bearing repetitions completed with a foot orthoses, for example during repeated stair ascent, the differences are likely to be clinically meaningful.
有证据表明，抗旋前足矫形器可改善髌股关节疼痛，但关于其作用机制的证据较少。我们研究了预制足矫形器对（i）髋部和膝部运动学；（ii）在功能性上台阶任务中股内侧斜肌、股外侧肌和臀中肌的肌电图变量，以及（iii）相关临床指标的即时影响。
在有髌股关节疼痛的人群（n = 20，9名男性，11名女性）进行上台阶任务时，测量佩戴和不佩戴抗旋前足矫形器时的髋部肌肉活动和运动学。此外，我们还测量了膝关节功能、足姿势指数、等长髋外展肌和膝伸肌力量以及负重时踝关节背屈。
在“佩戴矫形器”状态下，地面接触后观察到髋内收减少（0.82°，P = 0.01）、膝内旋减少（0.46°，P = 0.03）以及臀中肌峰值幅度降低（0.9mV，P = 0.043）。佩戴矫形器后，足姿势越旋前与股内侧斜肌起始越早相关（r = -0.51，P = 0.02），而较高的库贾拉评分与臀中肌起始越早相关（r = 0.52，P = 0.02）。
尽管幅度较小，但在通常会加重症状的任务中，佩戴矫形器后立即观察到的髋内收、膝内旋和臀中肌幅度的降低，为其在髌股关节疼痛管理中的有效性提供了一种潜在机制。鉴于使用足矫形器完成负重重复动作（例如在反复上楼梯过程中）可能产生累积效应，这些差异可能具有临床意义。
