A 10% Increase in Step Rate Improves Running Kinematics and Clinical Outcomes in Runners With Patellofemoral Pain at 4 Weeks and 3 Months
A 10% Increase in Step Rate Improves Running Kinematics and Clinical Outcomes in Runners With Patellofemoral Pain at 4 Weeks and 3 Months
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DOI：
10.1177/0363546519879693
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发表时间：
2019-10-28
影响因子：
4.8
通讯作者：
Herrington, Lee
中科院分区：
文献类型：
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作者：
Bramah, Christopher;Preece, Stephen J.;Herrington, Lee
背景：在患有膝股关节痛(PFP)的跑步者中，经常可以观察到异常的额平面髋关节和骨盆运动学。步态保留干预已被证明可以改善跑步运动学，因此对患有PFP的跑步者可能是有益的。目的：研究跑步步速增加10%是否会影响患有PFP的跑步者髋部和骨盆的额面运动学以及临床结果。研究设计：病例系列；证据水平，4.方法：患有PFP的跑步者接受三维步态分析，以确认基线时存在异常的额面髋部和/或骨盆运动学。共有12名额面、髋关节和/或骨盆运动学标准差高于参考数据库的参与者被邀请接受步态再训练干预。在基线、再训练后4周和3个月时记录跑步运动学以及疼痛的临床结果和功能结果。步态再训练包括使用可听到的节拍器将步速提高10%的单次训练。参与者被要求继续他们的正常跑步，同时使用全球定位系统、智能手表和可听到的节拍器自我监测他们的步速。结果：步态再训练后，在4周和3个月的随访中，跑步运动学和临床结果均有显著改善。用后Bonferroni校正的重复测量方差分析(P<；.016)显示最大对侧骨盆下降量(平均差3.12度[95%CI，1.88度-4.37度])、髋关节内收(MD，3.99度[95%CI，2.01度-5.96度])和膝关节屈曲(MD，4.09度[95%CI，0.04度-8.15度])显著减少，以及自我报告的每周跑步量显著增加(MD，13.78公里[95%CI，4.62~22.93公里)和最长无痛跑(MD，6.84公里[95%可信区间3.05~10.62公里])。Friedman检验和特殊的Wilcoxon符号等级检验显示，在过去一周中，最严重疼痛的数字评级量表和下肢功能量表有显著改善。结论：步速增加10%的单次步态再训练可显著改善PFP跑步者的跑步运动学、疼痛和功能。在3个月的随访中，这些改善保持不变。重要的是在基线时评估异常跑步运动学，以确保步态干预措施具有适当的靶向性。注册号码：NCT03067545(ClinicalTrials.gov标识)
Background: Aberrant frontal-plane hip and pelvis kinematics have been frequently observed in runners with patellofemoral pain (PFP). Gait retaining interventions have been shown to improve running kinematics and may therefore be beneficial in runners with PFP. Purpose: To investigate whether a 10% increase in the running step rate influences frontal-plane kinematics of the hip and pelvis as well as clinical outcomes in runners with PFP. Study Design: Case series; Level of evidence, 4. Methods: Runners with PFP underwent a 3-dimensional gait analysis to confirm the presence of aberrant frontal-plane hip and/or pelvis kinematics at baseline. A total of 12 participants with frontal-plane hip and/or pelvis kinematics 1 standard deviation above a reference database were invited to undergo the gait retraining intervention. Running kinematics along with clinical outcomes of pain and functional outcomes were recorded at baseline, 4 weeks after retraining, and 3 months. Gait retraining consisted of a single session where step rate was increased by 10% using an audible metronome. Participants were asked to continue their normal running while self-monitoring their step rate using a global positioning system smartwatch and audible metronome. Results: After gait retraining, significant improvements in running kinematics and clinical outcomes were observed at 4-week and 3-month follow-up. Repeated-measures analysis of variance with post hoc Bonferroni correction (P < .016) showed significant reductions in peak contralateral pelvic drop (mean difference [MD], 3.12 degrees [95% CI, 1.88 degrees-4.37 degrees]), hip adduction (MD, 3.99 degrees [95% CI, 2.01 degrees-5.96 degrees]), and knee flexion (MD, 4.09 degrees [95% CI, 0.04 degrees-8.15 degrees]) as well as significant increases in self-reported weekly running volume (MD, 13.78 km [95% CI, 4.62-22.93 km]) and longest run pain-free (MD, 6.84 km [95% CI, 3.05-10.62 km]). Friedman test with a post hoc Wilcoxon signed-rank test showed significant improvements on a numerical rating scale for worst pain in the past week and the Lower Extremity Functional Scale. Conclusion: A single session of gait retraining using a 10% increase in step rate resulted in significant improvements in running kinematics, pain, and function in runners with PFP. These improvements were maintained at 3-month follow-up. It is important to assess for aberrant running kinematics at baseline to ensure that gait interventions are targeted appropriately. Registration: NCT03067545 (ClinicalTrials.gov identifier)