Patellofemoral Pain: Tibiofemoral Rotation Impairments

描述(由申请人提供)：拟议研究的长期目标是更好地了解下肢对齐和运动障碍导致肌肉骨骼疼痛状况发展的机制。利用这些知识，候选人的长期职业目标是测试康复和预防策略对患有各种肌肉骨骼疼痛状况的人的效果。实现这些目标的发展计划包括四个主要领域的培训：磁共振成像(MRI)、运动控制、高级关节生物力学和肌电(EMG)。指导开发计划的是候选人的主要顾问，一位肌肉骨骼疼痛发展的运动控制方面的专家。咨询委员会的其他成员包括磁共振成像、肌肉骨骼放射学、肌电/生物力学、风湿学和临床附属学方面的专家。培训的形式将是有组织的阅读，出席课程讲座，以及有组织的实验室和临床经验。在候选人系主任和院长的全力支持下，拟议的研究将在一个配备三维运动分析实验室和核磁共振应用科学实验室的学术机构进行。以慢性髌股关节疼痛(源于髌骨和股骨之间的关节疼痛)作为常见肌肉骨骼疼痛的一个例子，拟议的研究旨在检验这样一种普遍假设，即对于异常的髌股关节接触模式，可能会导致关节应力改变，从而发展成髌股疼痛(PFP)。异常的关节接触模式被认为部分是由于过度的胫股旋转(股骨相对于胫骨的内侧旋转)，在运动中被夸大了。特定的目标将测试(1)PFP患者的髌股关节接触面积是否减少或位置改变，(2)胫股旋转对齐、髌股对齐和髌股关节接触面积之间是否存在关联，(3)PFP患者的胫股旋转运动和力矩(扭矩)增加，以及步态活动中相关的肌肉补充改变。数据将从MRI和仪器化运动分析(运动学、动力学和肌电)中获得，以验证这些假设。

DESCRIPTION (provided by applicant): The long-term goal of the proposed research is to better understand the mechanisms by which lower extremity alignment and movement impairments contribute to the development of musculoskeletal pain conditions. Utilizing this knowledge, the candidate's long-term career goals are to test the effects of rehabilitation and prevention strategies in people with a variety of musculoskeletal pain conditions. The development plan to achieve these goals consists of training in four major areas: magnetic resonance imaging (MRI), motor control, advanced joint biomechanics, and electromyography (EMG). Guiding the development plan is the candidate's primary advisor, an expert in motor control aspects of musculoskeletal pain development. Additional members of the advisory committee include, experts in MR imaging, musculoskeletal radiology, EMG/biomechanics, rheumatology, and clinical epidimiology. Training will be in the form of structured readings, attendance of course lectures, and structured laboratory and clinical experiences. With full support from the candidate's department chair and dean, the proposed research will be conducted at an academic institution equipped with a 3-dimensional motion analysis laboratory and a MRI applied sciences laboratory. Using chronic patellofemoral pain (pain originating from the articulation between the patella and femur) as an example of a common musculoskeletal pain condition, the proposed studies are designed to test the general hypothesis that patellofemoral pain (PFP) develops in response to abnormal patellofemoral joint contact patterns, which presumably lead to altered joint stress. Abnormal joint contact patterns are proposed to develop in part from excessive tibiofemoral rotation (medial rotation of the femur with respect to the tibia), which is exaggerated during movement. Specific aims will test whether or not (1) patellofemoral joint contact area is reduced in magnitude or altered in location in individuals with PFP, (2) there is an association between tibiofemoral rotational alignment, patellofemoral alignment, and patellofemoral joint contact area, and (3) individuals with PFP have increased tibiofemoral rotation motion and moments (torques), in addition to associated altered muscle recruitment during gait activities. Data will be obtained from MRI and instrumented motion analysis (kinematics, kinetics, and EMG) to test these hypotheses.