Medial Collapse Movement Impairments associated with Patellofemoral Pain

描述（由申请人提供）：慢性髌股疼痛（膝盖骨周围疼痛）是最常见和最可能使人衰弱的肌肉骨骼疼痛疾病之一，但对疼痛发生的机制知之甚少。最广泛接受的理论认为，当髌股关节受到升高的应力（单位面积的力）时，疼痛就会发生。一个最近提出的因素，有助于增加髌股关节应力是一个运动障碍，包括内侧塌陷的下肢在负重。内侧塌陷被描述为股骨过度内收和内侧旋转、膝关节外翻增加和胫骨外侧旋转增加的组合。然而，在髌股关节疼痛（PFP）患者中，尚未发现定义内侧塌陷的运动学缺陷。此外，尚不清楚这些运动学缺陷是否可以减少，如果可以，改善的运动模式是否会导致疼痛减轻。拟议的初步研究的广泛，长期目标是更好地了解下肢运动障碍和PFP患者的症状行为之间的关系。具体而言，本研究将测试1）PFP患者在行走、爬楼梯和下蹲期间是否表现出内侧塌陷，2）与内侧塌陷相关的运动学模式是否可在单次治疗中修改，以及3）修改的运动学模式是否对应于疼痛的变化。40例受试者将参与（20例PFP，20例无痛）。当受试者使用1）他们的首选模式、1）夸大的内侧塌陷模式和3）校正的内侧塌陷模式执行运动任务时，将使用三维运动分析系统和视觉模拟疼痛量表获得数据。PFP个体的运动学模式以及运动学和症状行为之间的关系的知识将提供对导致疼痛发展的机械因素的深入了解，并有助于指导未来的研究，旨在调查下肢运动障碍，膝关节对齐和髌骨软骨特性之间的关系，以及测试PFP干预和预防策略的研究。公共卫生相关性：慢性髌股关节疼痛（膝盖骨周围疼痛）是一种常见的、可能使人衰弱但知之甚少的疾病。了解导致髌股关节疼痛（PFP）的特定运动故障以及个人纠正运动故障的能力将为这种情况的康复和预防策略提供信息。最终，患有PFP的人数以及与这种情况相关的残疾和费用将减少。

DESCRIPTION (provided by applicant): Chronic patellofemoral pain (pain around the knee cap) is one of the most common and potentially debilitating musculoskeletal pain conditions, yet the mechanism of pain development is poorly understood. The most widely accepted theory suggests that pain develops when the patellofemoral joint is subjected to elevated stress (force per unit area). One recently proposed factor contributing to increased patellofemoral joint stress is a movement impairment consisting of medial collapse of the lower extremity during weightbearing. Medial collapse has been described as a combination of excessive adduction and medial rotation of the femur, increased knee valgus, and increased lateral tibial rotation. The kinematic faults that define medial collapse, however, have not been identified in individuals with patellofemoral pain (PFP). Furthermore, it is not clear whether these kinematic faults can be reduced and if so, whether the improved movement pattern leads to a reduction in pain. The broad, long-term objective of the proposed preliminary study is to better understand the relationship between lower extremity movement impairments and symptom behavior in individuals with PFP. Specifically, this study will test whether or not 1) individuals with PFP demonstrate medial collapse during walking, stair climbing and squatting, 2) the kinematic patterns associated with medial collapse are modifiable within a single session, and 3) modified kinematic patterns correspond to changes in pain. Forty subjects will participate (20 PFP, 20 pain-free). Data will be obtained using a 3-dimensional motion analysis system and a visual analog pain scale as subjects perform movement tasks using 1) their preferred pattern, 1) an exaggerated medial collapse pattern, and 3) a corrected medial collapse pattern. Knowledge of the kinematic patterns of individuals with PFP and the relationship between kinematics and symptom behavior will provide insight into the mechanical factors contributing to pain development and help guide future studies aimed at investigating relationships between lower extremity movement impairments, knee joint alignment, and patellar cartilage properties, as well as studies that test intervention and prevention strategies for PFP. PUBLIC HEALTH RELEVANCE: Chronic patellofemoral pain (pain around the knee cap) is a common, potentially debilitating yet poorly understood condition. Knowledge of the specific movement faults that contribute to patellofemoral pain (PFP) and the capacity of individuals to correct the movement faults will inform rehabilitation and prevention strategies for this condition. Ultimately, the number of individuals with PFP, and the disability and cost associated with this condition would be reduced.