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各种肌肉骨骼疼痛状况的影响。实现这些目标的发展计划包括四个主要领域的训练：磁共振成像（MRI）、运动控制、高级关节生物力学和肌电图（EMG）。指导发展计划的是候选人的主要顾问，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、肌电图/生物力学、风湿病学和临床流行病学方面的专家。培训将以结构化阅读、出席课程讲座、结构化实验室和临床经验的形式进行。在系主任及院长的全力支持下，本研究将在设有三维运动分析实验室及核磁共振应用科学实验室的学术机构进行。以慢性髌骨疼痛（源于髌骨和股骨之间的关节的疼痛）作为常见肌肉骨骼疼痛的一个例子，提出的研究旨在验证髌骨疼痛（PFP）的发展是对异常的髌骨关节接触模式的反应，这可能导致关节应力的改变。异常的关节接触模式部分是由过度的胫股旋转（股骨相对于胫骨的内侧旋转）引起的，这种旋转在运动过程中被夸大了。具体目标将测试(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，以及(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和仪器运动分析（运动学、动力学和肌电图）中获得，以测试这些假设。

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.