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两种距下关节牵引形式对慢性踝关节不稳患者背屈活动范围和姿势控制的影响。

The Effect of 2 Forms of Talocrural Joint Traction on Dorsiflexion Range of Motion and Postural Control in Those With Chronic Ankle Instability.

出版信息

J Sport Rehabil. 2017 May;26(3):239-244. doi: 10.1123/jsr.2015-0152. Epub 2016 Aug 24.

Abstract

CONTEXT

Talocrural joint mobilizations are commonly used to address deficits associated with chronic ankle instability (CAI).

OBJECTIVE

Examine the immediate effects of talocrural joint traction in those with CAI.

DESIGN

Blinded, crossover.

SETTING

Laboratory.

PARTICIPANTS

Twenty adults (14 females; age = 23.80 ± 4.02 y; height = 169.55 ± 12.38 cm; weight = 78.34 ± 16.32 kg) with self-reported CAI participated. Inclusion criteria consisted of a history of ≥1 ankle sprain, ≥2 episodes of giving way in the previous 3 mo, answering "yes" to ≥4 questions on the Ankle Instability Instrument, and ≤24 on the Cumberland Ankle Instability Tool.

INTERVENTION

Subjects participated in 3 sessions in which they received a single treatment session of sustained traction (ST), oscillatory traction (OT), or a sham condition in a randomized order. Interventions consisted of four 30-s sets of traction with 1 min of rest between sets. During ST and OT, the talus was distracted distally from the ankle mortise to the end-range of accessory motion. ST consisted of continuous distraction and OT involved 1-s oscillations between the mid and end-range of accessory motion. The sham condition consisted of physical contact without force application. Preintervention and postintervention measurements of weight-bearing dorsiflexion, dynamic balance, and static single-limb balance were collected.

MAIN OUTCOME MEASURES

The independent variable was treatment (ST, OT, sham). The dependent variables included pre-to-posttreatment change scores for the WBLT (cm), normalized SEBTAR (%), and time-to-boundary (TTB) variables(s). Separate 1-way ANOVAs examined differences between treatments for each dependent variable. Alpha was set a priori at P < .05.

RESULTS

No significant treatment effects were identified for any variables.

CONCLUSION

A single intervention of ST or OT did not produce significant changes in weight-bearing dorsiflexion range of motion or postural control in individuals with CAI. Future research should investigate the effects of repeated talocrural traction treatments and the effects of this technique when combined with other manual therapies.

摘要

背景

距下关节松动术常用于解决慢性踝关节不稳定(CAI)相关的缺陷。

目的

研究 CAI 患者距下关节牵引的即刻效果。

设计

盲法,交叉设计。

地点

实验室。

参与者

20 名成年人(14 名女性;年龄=23.80±4.02 岁;身高=169.55±12.38cm;体重=78.34±16.32kg),自述有 CAI。纳入标准包括:既往有≥1 次踝关节扭伤史,近 3 个月内有≥2 次关节不稳史,在踝关节不稳量表(Ankle Instability Instrument)中≥4 个问题回答“是”,Cumberland 踝关节不稳工具(Cumberland Ankle Instability Tool)评分≤24。

干预

受试者参加了 3 次治疗,随机接受持续牵引(ST)、摆动牵引(OT)或假牵引治疗,每种治疗 1 次。干预措施包括 4 组 30s 的牵引,每组之间休息 1 分钟。在 ST 和 OT 中,距骨从踝穴远端向附属运动的终末端被牵开。ST 为连续牵开,OT 为在附属运动的中末端之间进行 1s 的摆动。假治疗仅为接触,无作用力施加。在预治疗和治疗后,测量负重背屈、动态平衡和静态单腿平衡。

主要观察指标

治疗(ST、OT、假)为自变量,WBLT(cm)、标准化 SEBTAR(%)和 TTB 变量的治疗前后差值为因变量。采用单因素方差分析比较不同治疗方法对各因变量的影响。预先设定 α 值为 P<0.05。

结果

未发现任何治疗方法对任何变量有显著影响。

结论

单次 ST 或 OT 干预不能显著改善 CAI 患者的负重背屈活动范围或姿势控制。未来的研究应调查重复距下关节牵引治疗的效果,以及该技术与其他手法治疗相结合的效果。

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