Ho Kai-Yu, Wallace Connan, Aquino Jeno, Broadwell Bryce, Whimple Makenzie, Liang Jing Nong
Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, United States.
Front Hum Neurosci. 2024 Sep 6;18:1427091. doi: 10.3389/fnhum.2024.1427091. eCollection 2024.
In individuals with patellofemoral pain (PFP), addressing increased knee valgus during weight-bearing activities typically involves strengthening weak hip muscles. However, recent literature highlights the role of altered descending central control in abnormal movements associated with PFP. While transcranial direct current stimulation (tDCS) has demonstrated the capacity to enhance neuroplasticity, its application targeting the corticomotor function of gluteal muscles in PFP remains unexplored. This study aimed to investigate the effects of combining bimodal tDCS with exercise on frontal plane kinematics in individuals with PFP. The hypothesis was that bimodal tDCS, specifically targeting the corticomotor function of the gluteal muscles, would augment the effectiveness of exercise interventions in improving frontal plane kinematics compared to sham stimulation.
Ten participants with PFP participated in two sessions involving either bimodal tDCS or sham stimulation, concurrently with hip strengthening exercises. Weight-bearing tasks, including single leg squat, single leg landing, single leg hopping, forward step-down, and lateral step-down, were performed and recorded before and after each session. Pain visual analog scale (VAS) scores were also documented. A one-way ANOVA with repeated measures was employed to compare kinematics, while a Friedman test was used to compare VAS across the three conditions (pre-test, post-tDCS, and post-Sham).
We observed no significant differences in trunk lean angle, hip and knee frontal plane projection angles, or dynamic valgus index among the three conditions during the five weight-bearing tasks. VAS scores did not differ across the three conditions.
A single session of tDCS did not demonstrate immediate efficacy in enhancing frontal plane kinematics or relieving pain in individuals with PFP. Considering observed positive outcomes in other neurological and orthopedic populations with multi-session tDCS applications, suggesting potential cumulative effects, further research is essential to explore the effects of multi-session tDCS on weight-bearing movement and underlying neurophysiology in individuals with PFP.
在患有髌股疼痛（PFP）的个体中，解决负重活动期间增加的膝外翻通常涉及加强薄弱的髋部肌肉。然而，最近的文献强调了下行中枢控制改变在与PFP相关的异常运动中的作用。虽然经颅直流电刺激（tDCS）已证明具有增强神经可塑性的能力，但其针对PFP中臀肌皮质运动功能的应用仍未得到探索。本研究旨在调查双模式tDCS与运动相结合对PFP个体额面运动学的影响。假设是，与假刺激相比，专门针对臀肌皮质运动功能 的双模式tDCS将增强运动干预在改善额面运动学方面的效果。
十名患有PFP的参与者参加了两个阶段，分别接受双模式tDCS或假刺激，并同时进行髋部强化锻炼。在每个阶段前后进行并记录负重任务，包括单腿深蹲、单腿落地、单腿跳跃、向前下台阶和侧向 下台阶。还记录了疼痛视觉模拟量表（VAS）评分。采用重复测量的单因素方差分析来比较运动学，而使用Friedman检验来比较三种情况（预测试、tDCS后和假刺激后）下的VAS。
在五项负重任务中，我们观察到三种情况下的躯干倾斜角度、髋部和膝部额面投影角度或动态外翻指数没有显著差异。三种情况下的VAS评分没有差异。
单次tDCS在增强PFP个体的额面运动学或缓解疼痛方面未显示出即时疗效。考虑到在其他神经系统和骨科人群中多疗程tDCS应用观察到的积极结果，表明可能存在累积效应，进一步研究对于探索多疗程tDCS对PFP个体负重运动和潜在神经生理学的影响至关重要。
