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培训：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MR成像、肌肉骨骼放射学、EMG/生物力学、流变学和临床附睾学专家。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。在候选人的系主任和系主任的全力支持下，拟议的研究将在一个配备了三维运动分析实验室和MRI应用科学实验室的学术机构进行。使用慢性髌股关节疼痛（疼痛源于髌骨和股骨之间的关节）作为一个常见的肌肉骨骼疼痛条件的例子，拟议的研究旨在测试的一般假设，髌股关节疼痛（PFP）的发展异常髌股关节接触模式，这可能会导致改变关节应力。提出关节接触模式异常的部分原因是过度胫股旋转（股骨相对于胫骨的内侧旋转），这在运动过程中被夸大。具体目的将测试（1）PFP患者的髌股关节接触面积是否在幅度上减小或位置上改变，（2）胫股旋转对线、髌股对线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）是否增加，除了在步态活动期间相关的改变的肌肉募集之外。将从MRI和仪器运动分析（运动学、动力学和EMG）中获得数据，以检验这些假设。

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.