Blyton Sarah J, Snodgrass Suzanne J, Pizzari Tania, Birse Samantha M, Likens Aaron D, Edwards Suzi
School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, New South Wales, Australia.
Discipline of Physiotherapy, The University of Newcastle, Callaghan, New South Wales, Australia.
Gait Posture. 2023 Mar;101:124-133. doi: 10.1016/j.gaitpost.2023.01.018. Epub 2023 Feb 4.
Growing evidence suggests that identifying movement variability alterations in pathological vs. healthy gait may further understanding of injury mechanisms related to gait biomechanics; however, in the context of running and musculoskeletal injuries the role of movement variability remains unclear.
What is the impact of a previous musculoskeletal injury on running gait variability?
Medline, CINAHL, Embase, Cochrane library and SPORTDiscus were searched from inception until February 2022. Eligibility criteria were (a) included a musculoskeletal injury group, (b) compared running biomechanics data to a control group, (c) measured movement variability for at least one dependent variable, (d) provided a statistical between-group comparison of variability outcomes. Exclusion criteria were neurological conditions impacting gait, upper body musculoskeletal injuries and age < 18 years old. A summative synthesis was performed instead of a meta-analysis due to methodological heterogeneity.
Seventeen case-control studies were included. The most common deviations in variability observed among the injured groups were: (1) high and low knee-ankle/foot coupling variability and (2) low trunk-pelvis coupling variability. Significant (p < 0.05) between-group differences in movement variability were identified in 8 of 11; 73% of studies of runners with injury-related symptoms, and 3 of 7; 43% of studies of recovered or asymptomatic populations.
This review identified limited to strong evidence that running variability is altered in adults with a recent history of injury for specific joint couplings only. Individuals with ankle instability or pain employed altered running strategies more often than those who have recovered from injury. Altered variability strategies have been proposed to contribute to future running-related injuries, therefore these findings are relevant to clinicians managing active populations.
越来越多的证据表明，识别病理性步态与健康步态中运动变异性的改变，可能会进一步加深对与步态生物力学相关的损伤机制的理解；然而，在跑步和肌肉骨骼损伤的背景下，运动变异性的作用仍不明确。
既往肌肉骨骼损伤对跑步步态变异性有何影响？
检索了Medline、CINAHL、Embase、Cochrane图书馆和SPORTDiscus数据库，检索时间从建库至2022年2月。纳入标准为：（a）包括肌肉骨骼损伤组；（b）将跑步生物力学数据与对照组进行比较；（c）测量至少一个因变量的运动变异性；（d）提供组间变异性结果的统计学比较。排除标准为影响步态的神经系统疾病、上肢肌肉骨骼损伤以及年龄<18岁。由于方法学异质性，进行了汇总综合分析而非荟萃分析。
纳入了17项病例对照研究。在受伤组中观察到的变异性最常见偏差为：（1）膝关节-踝关节/足部耦合变异性高和低；（2）躯干-骨盆耦合变异性低。11项研究中有8项发现组间运动变异性存在显著（p<0.05）差异；73%的有损伤相关症状跑步者的研究，以及7项研究中的3项；43%的康复或无症状人群的研究。
本综述发现，仅有有限到有力的证据表明，近期有损伤史的成年人仅在特定关节耦合方面跑步变异性会发生改变。踝关节不稳定或疼痛的个体比已从损伤中恢复的个体更频繁地采用改变的跑步策略。已提出改变的变异性策略会导致未来与跑步相关的损伤，因此这些发现与管理活跃人群的临床医生相关。
