對髕骨股骨疼痛症候群治療的最佳運動探討

Investigate the most suitable exercises for patellofemoral pain syndrome

陳柏睿(Po-Jui Chen)

指導教授 ： 葉純妤

中山醫學大學/醫學科技學院/物理治療學系/碩士(2022年)

https://doi.org/10.6834/csmu202200155

摘要

背景與目的：臨床治療髕骨股骨疼痛症候群(patellofemoral pain syndrome, PFPS)以強化臀肌與膝伸直肌的運動為主，目的為改善髕骨偏移與膝關節動態外翻，但動作繁多，同時要執行很多種動作才能包含所需的肌肉群，目前也沒有研究提出哪些動作是最好的，因此本研究希望透過健康人在表面肌電圖 (surface electromyography, sEMG)，觀察復健常用的下肢運動中臀大肌、臀中肌、股內側肌及闊筋膜張肌之活化比例，找出最適合治療PFPS的訓練動作，之後請受試者執行挑選出來的訓練動作六周後，觀察肌肉力量與肌肉延展性是否有顯著變化，以及是否符合治療PFPS的條件，希望在臨床上可以簡化運動項目進而提升治療效率。研究方法：本研究使用便利取樣，透過sEMG，觀察受試者在執行11項運動動作時肌肉的活化強度 (percentage of maximal voluntary isometric contraction, % MVIC)，帶入本研究設計的公式，從中選出數值最高的前三名，請受試者執行此三項動作六周後，觀察肌肉力量 (臀大肌、臀中肌、闊筋膜張肌、股內側肌)、肌肉延展性 (股四頭肌、膕膀肌、腓腸肌、比目魚肌、髂腰肌)與膝外翻角度 (Q-angle)是否有顯著差異。結果：總共收納24位健康受試者（16男8女），平均年齡為22.29±4.01歲，平均BMI 為21.3±2.2 kg/m2。利用公式所計算出的結果，最好的前三名動作為單腳硬舉 (受測腳在空中)、單腳蹲 (受測腳在地面)、登階 (受測腳在台階)，使用成對樣本t檢定 (paired sample t-test)進行分析，發現六周介入後肌肉力量的部分都有顯著的增加：臀大肌 (p=0.000)、臀中肌 (p=0.000)、股內側肌 (p=0.000) 、闊筋膜張肌 (p=0.000)；肌肉延展性有顯著提升的部分為：股四頭肌 (p=0.004)、膕膀肌 (p=0.000)、腓腸肌 (p=0.001)、比目魚肌(p=0.009)、髂腰肌 (p=0.012)，沒有顯著改變的部分為膝外翻角度Q-angle (p=0.213)與闊筋膜張肌的延展性 (p=0.13)。結論：以健康人的sEMG表現，得到肌肉活化狀態最符合治療PFPS條件的前三名動作為單腳硬舉、單腳蹲、登階，並且對於增強肌肉力量與提升肌肉延展性有短期效果，未來希望可以實際運用在患者身上，若能有效的改善症狀，便能達到簡化訓練項目、提升治療效率的目標。

關鍵字

髕骨股疼痛症候群 髕骨股疼痛症候群 髕骨股疼痛症候群 髕骨股疼痛症候群 ； 表面肌電圖 ； 運動動作

並列摘要

Background and Purpose: The aim of the treatment for patellofemoral pain syndrome (PFPS) is emphasized on muscle strengthening for gluteal muscle and knee extensor, the purpose is to improve patellar maltracking and knee dynamic valgus. There are too many exercises that we must suggest a patient with PFPS if we want to include all muscles we need. So the main purpose of our study is to find the best movements in healthy people by using surface electromyography (sEMG) to observe which movement can activate certain muscle contraction we need (Gluteus maximum, Gluteus medius, Vastus medialis) and avoid activating too much contraction of tensor fascial latae (TFL). After getting the best movements, the healthy subjects are asked to finish 6 weeks training with these best movements. We are going to find out if there are significant changes in muscle strength and muscle flexibility. If the changes are satisfied with the principle for treating PFPS, then using these movements to treat patient can be more efficient in clinic. Methods: Our study is using convenience sampling and using sEMG to observe the muscle activation (% MVIC) in 11 movements frequently using in rehabilitation. We invent 3 formulars to estimate which movement are the best of 3. After the subjects doing these 3 movements for training 6 weeks, we are going to see if there are differences in muscle strength (Gluteus maximum, Gluteus medius, Vastus medialis, TFL), flexibility(quadriceps, hamstring, gastrocnemius, soleus, iliopsoas) and Q-angle. Results: 24 healthy subjects was included (16 male, 8 female), average age was 22.29±4.01 years old, average BMI was 21.3±2.2 kg/m2. The results of the best 3 movements we estimate by the formular we invented are single leg deadlift (foot on top), single leg squat (foot on floor), step up (foot on step). Using paired sample t-test to compare Q-angle, muscle strength, flexibility after 6 weeks training, there are significant differences on muscle strength: gluteus maximum (p=0.000), gluteus medius (p=0.000), vastus medialis (p=0.000), TFL (p=0.000); Significant differences on muscle flexibility: quadriceps (p=0.004), hamstring(p=0.000), gastrocnemius (p=0.001), soleus (p=0.009), iliopsoas (p=0.012); Without significant differences on Q-angle (p=0.213)and flexibility of TFL (p=0.13). Conclusion: sEMG finding on healthy subjects shows that single leg deadlift (foot on top), single leg squat (foot on floor), step up (foot on step) are the best 3 movements that match the principle for treating PFPS, and there are short term effects on increasing muscle strength and muscle flexibility. Future study is needed for using the movement on patients with PFPS to see if they can get same effects on improving muscle strength and flexibility.

並列關鍵字

patellofemoral pain syndrome ； surface electromyography ； exercise movement

參考文獻

Almeida, G. P. L., França, F. J. R., Magalhães, M. O., Burke, T. N., Marques, A. P. (2016). Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function. Revista brasileira de ortopedia, 51, 181-186.

Ayotte, N. W., Stetts, D. M., Keenan, G., Greenway, E. H. (2007). Electromyographical analysis of selected lower extremity muscles during 5 unilateral weight-bearing exercises. journal of orthopaedic sports physical therapy, 37(2), 48-55.

Bakhtiary, A. H., Fatemi, E. (2008). Open versus closed kinetic chain exercises for patellar chondromalacia. British journal of sports medicine, 42(2), 99-102.

Baldon, R. D. M., Serrão, F. V., Scattone Silva, R., Piva, S. R. (2014). Effects of functional stabilization training on pain, function, and lower extremity biomechanics in women with patellofemoral pain: a randomized clinical trial. journal of orthopaedic sports physical therapy, 44(4), 240-251.

Bishop, B. N., Greenstein, J., Etnoyer‐Slaski, J. L., Sterling, H., Topp, R. (2018). Electromyographic analysis of gluteus maximus, gluteus medius, and tensor fascia latae during therapeutic exercises with and without elastic resistance. International journal of sports physical therapy, 13(4), 668.