Doctoral Program, Division of Health Sciences, Graduate School of Health Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima 890-8544, Japan.
Miyakonojo Rehabilitation Academy, 5822-9 Oiwada-cho, Miyakonojo City, Miyazaki 885-0062, Japan.
J Healthc Eng. 2022 Aug 22;2022:1151753. doi: 10.1155/2022/1151753. eCollection 2022.
Unilateral knee extension restriction might change trunk alignment and increase mechanical load on the lumbar region during walking. We aimed to clarify lumbar region mechanical load during walking with restricted knee extension using a musculoskeletal model simulation. Seventeen healthy adult males were enrolled in this study. Participants walked 10 m at a comfortable velocity with and without restricted right knee extension of 15° and 30° using a knee brace. L4-5 joint moment, joint reaction force, and muscle forces around the lumbar region during walking were calculated for each condition. Peaks of kinetic data were compared among three gait conditions during 0%-30% and 50%-80% of the right gait cycle. Lumbar extension moment at early stance of the bilateral lower limbs was significantly increased in the 30° restricted condition ( ≤ 0.021). Muscle force of the multifidus showed peaks at stance phase of the contralateral side during walking, and the erector spinae showed force peaks at early stance of the bilateral lower limb. Muscle force of the multifidus and erector spinae increased with increasing degree of knee flexion ( ≤ 0.010), with a large effect size ( = 0.273-0.486). The joint force acting on L4-5 showed two peaks at early stance of the bilateral lower limbs during the walking cycle. The anterior and vertical joint force on L4-5 increased by 14.2%-36.5% and 10.0%-23.0% in walking with restricted knee extension, respectively ( ≤ 0.010), with a large effect size ( = 0.149-0.425). Restricted knee joint extension changed trunk alignment and increased the muscle force and the vertical and anterior joint force on the L4-5 joint during walking; this tendency became more obvious with increased restriction angle. Our results provide important information for therapists engaged in the rehabilitation of patients with knee contracture.
膝关节伸展受限可能会改变躯干的对线，并增加行走时腰部的机械负荷。我们旨在通过肌肉骨骼模型模拟来阐明膝关节伸展受限对行走时腰部区域的机械负荷的影响。本研究纳入了 17 名健康成年男性。参与者使用膝关节支具以舒适速度分别在膝关节伸展受限 15°和 30°的情况下行走 10 米。计算了在每种情况下行走时 L4-5 关节力矩、关节反作用力和腰部周围肌肉力。比较了三种步态条件下右侧步态周期 0%-30%和 50%-80%时动力学数据的峰值。双侧下肢在早期站立阶段的腰椎伸展力矩在 30°受限情况下显著增加（≤0.021）。多裂肌在对侧站立相时出现肌肉力峰值，竖脊肌在双侧下肢早期站立时出现肌肉力峰值。多裂肌和竖脊肌的肌肉力随着膝关节屈曲程度的增加而增加（≤0.010），效应量较大（=0.273-0.486）。L4-5 上的关节力在行走周期中双侧下肢的早期站立时出现两个峰值。在膝关节伸展受限的情况下，L4-5 的前向和垂直关节力分别增加了 14.2%-36.5%和 10.0%-23.0%（≤0.010），效应量较大（=0.149-0.425）。膝关节伸展受限改变了躯干的对线，并增加了行走时 L4-5 关节的肌肉力以及垂直和前向关节力；这种趋势随着限制角度的增加而变得更加明显。我们的研究结果为从事膝关节挛缩患者康复治疗的治疗师提供了重要信息。
