Plastaras Christopher, McCormick Zack, Nguyen Cayli, Rho Monica, Nack Susan Hillary, Roth Dan, Casey Ellen, Carneiro Kevin, Cucchiara Andrew, Press Joel, McLean Jim, Caldera Franklin
Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Chicago, Illinois, USA.
Am J Sports Med. 2016 Jan;44(1):105-12. doi: 10.1177/0363546515611632. Epub 2015 Nov 13.
The current literature indicates that hip abduction weakness in female patients is associated with ipsilateral patellofemoral pain syndrome (PFPS) as part of the weaker hip abductor complex. Thus, it has been suggested that clinicians should consider screening female athletes for hip strength asymmetry to identify those at risk of developing PFPS to prevent the condition. However, no study to date has demonstrated that hip strength asymmetry exists in the early stages of PFPS.
To determine whether hip abduction strength asymmetry exists in female runners with early unilateral PFPS, defined as symptoms of PFPS not significant enough to cause patients to seek medical attention or prevent them from running at least 10 miles per week.
Controlled laboratory study.
This study consisted of 21 female runners (mean age, 30.5 years; range, 18-45 years) with early unilateral PFPS, who had not yet sought medical care and who were able to run at least 10 miles per week, and 36 healthy controls comparably balanced for age, height, weight, and weekly running mileage (mean, 18.5 mi/wk). Study volunteers were recruited using flyers and from various local running events in the metropolitan area. Bilateral hip abduction strength in both a neutral and extended hip position was measured using a handheld dynamometer in each participant by an examiner blinded to group assignment.
Patients with early unilateral PFPS demonstrated no significant side-to-side difference in hip abduction strength, according to the Hip Strength Asymmetry Index, in both a neutral (mean, 83.5 ± 10.2; P = .2272) and extended hip position (mean, 96.3 ± 21.9; P = .6671) compared with controls (mean, 87.0 ± 8.3 [P = .2272] and 96.6 ± 16.2 [P = .6671], respectively). Hip abduction strength of the affected limb in patients with early unilateral PFPS (mean, 9.9 ± 2.2; P = .0305) was significantly stronger than that of the weaker limb of control participants (mean, 8.9 ± 1.4; P = .0305) when testing strength in a neutral hip position; however, no significant difference was found when testing the hip in an extended position (mean, 7.0 ± 1.4 [P = .1406] and 6.6 ± 1.5 [P =.1406], respectively).
The study data show that early stages of unilateral PFPS in female runners is not associated with hip abduction strength asymmetry and that hip abduction strength tested in neutral is significantly greater in the affected limb in the early stages of PFPS compared with the unaffected limb. However, when tested in extension, no difference exists. Further studies investigating the early stages of PFPS are warranted.
Unlike patients with PFPS seeking medical care, early PFPS does not appear to be significantly associated with hip abduction strength asymmetry.
当前文献表明，女性患者的髋外展肌无力与同侧髌股关节疼痛综合征（PFPS）有关，这是较弱的髋外展肌群复合体的一部分。因此，有人建议临床医生应考虑对女性运动员进行髋部力量不对称筛查，以识别有发展为PFPS风险的人群，从而预防该病。然而，迄今为止，尚无研究表明PFPS早期存在髋部力量不对称。
确定早期单侧PFPS的女性跑步者是否存在髋外展力量不对称，早期单侧PFPS定义为PFPS症状不够严重，不足以导致患者就医或阻止其每周至少跑10英里。
对照实验室研究。
本研究包括21名早期单侧PFPS的女性跑步者（平均年龄30.5岁；范围18 - 45岁），她们尚未寻求医疗护理且每周能够至少跑10英里，以及36名年龄、身高、体重和每周跑步里程（平均18.5英里/周）相当均衡的健康对照者。研究志愿者通过传单和大都市地区的各种当地跑步活动招募。由对分组不知情的检查者使用手持测力计在每个参与者的中立位和髋伸展位测量双侧髋外展力量。
根据髋部力量不对称指数，早期单侧PFPS患者在中立位（平均83.5±10.2；P = 0.2272）和髋伸展位（平均96.3±21.9；P = 0.6671）的髋外展力量左右侧差异均无统计学意义，与对照组（分别为平均87.0±8.3 [P = 0.2272]和96.6±16.2 [P = 0.6671]）相比。在中立位测试力量时，早期单侧PFPS患者患侧的髋外展力量（平均9.9±2.2；P = 0.0305）明显强于对照参与者较弱侧的髋外展力量（平均8.9±1.4；P = 0.0305）；然而，在伸展位测试髋部时未发现显著差异（分别为平均7.0±1.4 [P = 0.1406]和6.6±1.5 [P = 0.1406]）。
研究数据表明，女性跑步者单侧PFPS的早期阶段与髋外展力量不对称无关，且在PFPS早期，中立位测试的患侧髋外展力量明显大于未受影响侧。然而，在伸展位测试时，不存在差异。有必要进一步研究PFPS的早期阶段。
与寻求医疗护理的PFPS患者不同，早期PFPS似乎与髋外展力量不对称无显著关联。
