Jayaseelan Dhinu J, Courtney Carol A, Kecman Michael, Alcorn Daniel
The George Washington University, Program in Physical Therapy. Washington, DC, USA.
University of Illinois at Chicago, Program in Physical Therapy. Chicago, IL, USA.
Int J Sports Phys Ther. 2014 Dec;9(7):991-1003.
Quadriceps weakness is a common finding following knee injuries or surgery, and can be associated with significant functional limitations. This weakness or muscle inhibition may be due to central inhibitory mechanisms, rather than local peripheral dysfunction. Lumbopelvic manipulation has been shown to effect efferent muscle output by altering nociceptive processing. The purpose of this report is to describe the physical therapy management of anterior knee pain and chronic quadriceps weakness utilizing side-lying rotational lumbar thrust manipulation and therapeutic exercise for an individual eight months status-post ACL reconstruction.
A 20 year-old male presented to physical therapy eight months following anterior cruciate ligament (ACL) reconstruction of the left knee with primary complaints of residual anterior knee pain and quadriceps weakness. The subject was treated with a multimodal approach using side-lying rotational lumbar thrust manipulation in addition to therapeutic exercise.
The subject was seen in physical therapy for eight sessions over eight weeks. Lower Extremity Functional Scale (LEFS) scores improved from 58/80 to 72/80, quadriceps force, measured by hand-held dynamometry (HHD), was improved from 70.6 lbs to 93.5 lbs and the subject was able to return to pain free participation in recreational sports.
Therapeutic exercises can facilitate improved quadriceps strength, however, in cases where quadriceps weakness persists and there is concurrent pain, other interventions should be considered. In this case, lower quarter stabilization exercise and lumbar thrust manipulation was associated with improved functional outcomes in a subject with anterior knee pain and quadriceps weakness. Side-lying rotational lumbar thrust manipulation may be a beneficial adjunctive intervention to exercise in subjects with quadriceps weakness.
5, Single case report.
股四头肌无力是膝关节损伤或手术后常见的表现，且可能伴有明显的功能受限。这种无力或肌肉抑制可能是由于中枢抑制机制，而非局部外周功能障碍。腰椎骨盆手法已被证明可通过改变伤害性刺激处理来影响传出肌肉输出。本报告的目的是描述一名左膝前交叉韧带重建术后8个月的患者，采用侧卧位旋转腰椎推按手法和治疗性运动对其前膝疼痛和慢性股四头肌无力进行的物理治疗管理。
一名20岁男性在左膝前交叉韧带（ACL）重建术后8个月前来接受物理治疗，主要主诉为残留的前膝疼痛和股四头肌无力。该患者接受了多模式治疗，除治疗性运动外，还采用了侧卧位旋转腰椎推按手法。
该患者在8周内接受了8次物理治疗。下肢功能量表（LEFS）评分从58/80提高到72/80，通过手持测力计（HHD）测量的股四头肌力量从70.6磅提高到93.5磅，并且该患者能够无痛地恢复参加娱乐性运动。
治疗性运动可促进股四头肌力量的改善，然而，在股四头肌无力持续且伴有疼痛的情况下，应考虑其他干预措施。在本病例中，下半身稳定运动和腰椎推按手法与一名前膝疼痛和股四头肌无力患者的功能改善相关。侧卧位旋转腰椎推按手法可能是股四头肌无力患者运动的有益辅助干预措施。
5，单病例报告。
