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女性髋部相关疼痛患者在步态末期时髋关节和踝关节的动力学降低。

Females with hip-related pain demonstrate reduced kinetics at the hip and ankle during terminal stance of gait.

机构信息

Department of Biomedical Engineering, The Ohio State University, 140 W 19th Ave, Columbus, OH 43210, USA; Jameson Crane Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA.

Department of Physical Therapy, College of Health & Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave, Boston, MA 02215, USA.

出版信息

Gait Posture. 2023 Sep;105:99-103. doi: 10.1016/j.gaitpost.2023.07.284. Epub 2023 Jul 26.

Abstract

BACKGROUND

Individuals with hip-related pain (HRP) commonly report pain with walking and demonstrate altered movement patterns compared to healthy controls (HCs). Individuals with HRP may attempt to reduce pain during walking by decreasing kinetics and joint forces at the hip through increased use of the ankle during pushoff.

RESEARCH QUESTION

Do individuals with HRP have increased kinetics at the ankle and decreased kinetics at the hip during pushoff in gait compared to HCs, and do kinetic patterns differ between males and females with HRP?

METHODS

This retrospective observational study included 42 individuals with HRP and 20 HCs. Participants completed overground gait trials at their self-selected speed while kinematics and kinetics were recorded through a motion capture system and force plates. Peak internal hip and ankle moments and hip flexion and ankle plantarflexion angular impulse during terminal stance were used in general estimating equations for comparison of group by limb interactions for males and females separately, as well as a comparison of males and females within the HRP group.

RESULTS

Females with HRP demonstrated reduced hip flexion impulse on their involved limb (.070 Nms/kgm) compared to female HCs (.083Nms/kgm; p = .032), as well as reduced peak ankle plantarflexion moment (-.94Nm/kgm) compared to their contralateral limb (-.99Nm/kgm) and the involved limb of HRP males (-1.00Nm/kg*m) (p ≤ .007). There were no between-limb or between-group differences in hip or ankle peak moments or impulses in males.

SIGNIFICANCE

Females with HRP show decreased kinetics at both the hip and ankle; these patterns were not identified in males. Future investigations should examine whether increasing ankle kinetics during pushoff reduces pain at the hip, as this may be a valuable clinical treatment strategy.

摘要

背景

与髋关节相关疼痛(HRP)的个体在行走时通常会报告疼痛,并表现出与健康对照组(HCs)相比改变的运动模式。HRP 个体可能会通过在推进阶段增加踝关节的使用来减少髋关节的动力学和关节力,从而减轻行走时的疼痛。

研究问题

与 HCs 相比,HRP 个体在行走的推进阶段,踝关节的动力学是否增加,髋关节的动力学是否降低,以及 HRP 中男性和女性的动力学模式是否存在差异?

方法

这是一项回顾性观察性研究,纳入了 42 名 HRP 个体和 20 名 HCs。参与者以自身选择的速度完成了地面行走试验,同时通过运动捕捉系统和力板记录运动学和动力学。在终端站立期间,使用髋关节和踝关节的最大内部力矩以及髋关节的屈肌和踝关节的跖屈角冲量,通过一般估计方程对男性和女性的组间交互作用进行比较,以及 HRP 组内男性和女性的比较。

结果

HRP 女性在患病侧的髋关节屈肌冲量(.070 Nms/kgm)较 HCs 女性(.083Nms/kgm;p=0.032)减少,并且与对侧肢体(-.99Nm/kgm)和 HRP 男性的患病侧肢体(-1.00Nm/kgm)相比,踝关节的最大跖屈力矩(-0.94Nm/kg*m)也减少(p≤0.007)。男性在髋关节或踝关节的最大力矩或冲量方面,肢体之间或组之间均无差异。

意义

HRP 女性在髋关节和踝关节的动力学均降低;而男性中则未发现这些模式。未来的研究应该检查在推进阶段增加踝关节的动力学是否会减轻髋关节的疼痛,因为这可能是一种有价值的临床治疗策略。

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