Esculier Jean-Francois, Bouyer Laurent J, Roy Jean-Sébastien
The Running Clinic, Lac beauport, QC, Canada.
Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Front Sports Act Living. 2023 Jan 16;4:1048655. doi: 10.3389/fspor.2022.1048655. eCollection 2022.
Gait modifications are commonly advocated to decrease knee forces and pain in runners with patellofemoral pain (PFP). However, it remains unknown if clinicians can expect immediate effects on symptoms. Our objectives were (1) to compare the immediate effects of gait modifications on pain and kinetics of runners with PFP; (2) to compare kinetic changes in responders and non-responders; and (3) to compare the effects between rearfoot strikers (RFS) and non-RFS. Sixty-eight runners with PFP (42 women, 26 men) ran normally on a treadmill before testing six modifications: 1- increase step rate by 10%; 2- 180 steps per minute; 3- decrease step rate by 10%; 4- forefoot striking; 5- heel striking; 6- running softer. Overall, there were more responders (pain decreased ≥1/10 compared with normal gait) during forefoot striking and increasing step rate by 10% (both 35%). Responders showed greater reductions in peak patellofemoral joint force than non-responders during all conditions except heel striking. When compared with non-RFS, RFS reduced peak patellofemoral joint force in a significant manner (< 0.001) during forefoot striking (partial = 0.452) and running softer (partial = 0.302). Increasing step rate by 10% reduced peak patellofemoral joint force in both RFS and non-RFS. Forty-two percent of symptomatic runners reported immediate reductions in pain during ≥1 modification, and 28% had reduced pain during ≥3 modifications. Gait modifications leading to decreased patellofemoral joint forces may be associated with immediate pain reductions in runners with PFP. Other mechanisms may be involved, given that some runners reported decreased symptoms regardless of kinetic changes.
步态调整通常被提倡用于减轻髌股疼痛（PFP）跑步者的膝关节受力和疼痛。然而，临床医生是否能期待症状立即得到改善仍不清楚。我们的目标是：（1）比较步态调整对PFP跑步者疼痛和动力学的即时影响；（2）比较有反应者和无反应者的动力学变化；（3）比较后足着地者（RFS）和非RFS之间的影响。68名PFP跑步者（42名女性，26名男性）在跑步机上正常跑步，然后测试六种调整方式：1.步频增加10%；2.每分钟180步；3.步频降低10%；4.前脚掌着地；5.脚跟着地；6.更轻柔地跑步。总体而言，在前脚掌着地和步频增加10%时，有反应者（与正常步态相比疼痛降低≥1/10）更多（均为35%）。在除脚跟着地外的所有情况下，有反应者的髌股关节峰值力比无反应者降低得更多。与非RFS相比，RFS在前脚掌着地（偏相关系数 = 0.452）和更轻柔地跑步（偏相关系数 = 0.302）时，髌股关节峰值力显著降低（<0.001）。步频增加10%使RFS和非RFS的髌股关节峰值力均降低。42%有症状的跑步者报告在至少一种调整方式下疼痛立即减轻，28%在至少三种调整方式下疼痛减轻。导致髌股关节力降低的步态调整可能与PFP跑步者的疼痛立即减轻有关。鉴于一些跑步者报告症状减轻而与动力学变化无关，可能涉及其他机制。
