اثربخشی دوازده هفته تمرینات حسی حرکتی بر درد، بهبود حس عمقی، قدرت عضلانی و کنترل پاسچر در مردان مبتلا به سندروم درد کشککی رانی: یک کارآزمایی بالینی تک سوکور تصادفی شده

نوع مقاله : مقاله پژوهشی

نویسندگان

1 کارشناس ارشد گروه توانبخشی ورزشی، دانشکده تربیت بدنی و علوم ورزشی، دانشگاه بوعلی سینا، همدان، ایران

2 استاد گروه توانبخشی ورزشی، دانشکده تربیت بدنی و علوم ورزشی، دانشگاه بوعلی سینا، همدان، ایران

3 استادیار گروه حرکات اصلاحی و آسیب شناسی ورزشی، دانشکده علوم ورزشی، دانشگاه رازی، کرمانشاه، ایران

چکیده

مقدمه و اهداف
در بیماران با سندروم درد کشککی رانی اختلال در کنترل پاسچر گزارش شده است که دلایل آن درد، اختلال در حس عمقی و کاهش قدرت عضلانی می­ باشد. هدف مطالعه حاضر اثربخشی دوازده هفته تمرینات حسی-حرکتی بر درد، بهبود حس عمقی، قدرت عضلانی و کنترل پاسچر در مردان مبتلا به سندروم درد کشککی رانی است.
مواد و روش­ ها
مطالعه نیمه­ تجربی حاضر شامل 32 نفر بیمار مبتلا به سندروم درد کشککی رانی است که به­ صورت تصادفی به دو گروه تجربی (16 نفر) و کنترل (16 نفر) تقسیم شدند. متغیرهای مورد نظر شامل درد، حس عمقی زاویه 20 و 60 درجه، قدرت عضلانی چهارسررانی و آبداکتور ران و کنترل پاسچر ایستا بود که قبل از مداخله و بعد از مداخله ارزیابی شد. برای ارزیابی کنترل پاسچر از دستگاه تعادل سنج بایودکس، درد با مقیاس VAS، حس عمقی با گونیامتر و قدرت عضلانی از دینامومتر دستی استفاده شد. گروه تجربی طی یک دوره دوازده-هفته ­ای، 3 جلسه در هفته و هر جلسه 1 ساعت تمرینات حسی-حرکتی را انجام دادند و گروه کنترل طی این وهله زمانی تحت هیچ­ گونه مداخله درمانی قرار نگرفتند. برای تجزیه ­و­تحلیل داده­ ها از نرم ­افزار SPSS نسخه 21 و روش آماری کوواریانس استفاده شد.
یافته­ ها
نتایج تجزیه ­و تحلیل داده­ها نشان می­دهد که گروه تجربی نسبت به گروه کنترل پس از دوازده هفته تمرینات حسی-حرکتی بهبودی معناداری در کنترل پاسچر شاخص قدامی-خلفی (0/002=P)، شاخص داخلی–خارجی (0/001=P)، ثبات کلی (0/001=P)، کاهش درد (0/001=P)، بهبود حس عمقی 20 درجه (0/001=P)، حس عمقی 60 درجه (0/001=P) و قدرت عضلات چهارسررانی (0/002=P) و آبداکتور ران (0/0010=P) کسب کرده است.
نتیجه­ گیری
تمرینات حسی-حرکتی به­ صورت معناداری به کاهش درد، بهبود حس عمقی، قدرت و کنترل پاسچر افراد مبتلا به سندروم درد کشککی رانی منجر شد؛ در نتیجه به نظر می­رسد که می­توان از این تمرینات به ­عنوان یک پروتکل درمانی جامع در بهبود اختلالات متعددی در بیماران با سندروم درد کشککی رانی بهره جست.

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

Effect of Twelve Weeks of Sensorimotor Training on Pain, Improvement Proprioception, Muscle Strength, and Postural Control in Men with Patellofemoral Pain Syndrome: A Randomized Single-Blind Clinical Trial

نویسندگان [English]

  • Mohamadreza Ahmadi 1
  • Ali Yalfani 2
  • Farzaneh Gandomi 3
1 MSc, Department of Sports Rehabilitation, Faculty of Physical Education and Sport Sciences, Bu-Ali Sina University, Hamadan, Iran
2 Professor, Department of Sports Rehabilitation, Faculty of Physical Education and Sport Sciences, Bu-Ali Sina University, Hamadan, Iran
3 Assistant Professor, Sport Injuries and Corrective Exercises Department, Sport Sciences Faculty, Razi University, Kermanshah, Iran
چکیده [English]

Background and Aims: Postural control disorder has been reported in Patellofemoral Pain Syndrome (PFPS) patients as the cause of pain, dysfunction in proprioception, and decreased muscle strength. The purpose of the present study was to investigate the effects of 12 weeks of sensorimotor training on pain, proprioception, strength, and postural control in PFPS patients.
Methods: A semi-experimental study was carried out on 32 patients with PFPS who were randomly divided into experimental (n = 16) and control (n = 16) groups. The variables measured included pain, knee proprioception angles of 20 and 60 degrees, muscular strength quadriceps, hip abductor, and postural control, which were evaluated before and after intervention. We evaluated postural control using Biodex Device, pain with VAS scale, knee proprioception with goniometer, and muscle Strength via dynamometer. The experimental group performed sensorimotor Training for 12 weeks, 3 times per week) and 1 hour per session; however, the control group did not receive any treatment during this time. SPSS, version 21, was used for data analysis running covariance statistical method.
Results: The results of data analysis showed that the experimental group had significant improvement in postural control index, Anterior-posterior index (P=0.002), medial-lateral Overall stability (P=0.001), pain reduction (P=0.001), knee proprioception of 20 degrees (P=0.001), knee proprioception of 60 degrees (P=0.001), muscle strength of quadriceps (P=0.002), and muscle strength of hip abductor (P=0.001) after 12 weeks of sensorimotor training.
Conclusions: Sensorimotor training significantly reduced pain and improved knee proprioception, muscles strength, and postural control in PFPS patients; therefore, it seems that these training can be used as a comprehensive treatment protocol for the treatment of multiple disorders in patients with PFPS.

کلیدواژه‌ها [English]

  • Patellofemoral pain syndrome
  • Muscle strength quadriceps
  • Muscle strength hip abductor
  • Postural control
  • Sensorimotor Training

مراجع

  1. Smith BE, Selfe J, Thacker D, Hendrick P, Bateman M, Moffatt F, Rathleff MS, Smith TO, Logan P. Incidence and prevalence of patellofemoral pain: a systematic review and meta-analysis. PloS one. 2018;13(1):577-78.##
  2. Witvrouw E, Callaghan MJ, Stefanik JJ, Noehren B, Bazett-Jones DM, Willson JD, Earl-Boehm JE, Davis IS, Powers CM, McConnell J, Crossley KM. Patellofemoral pain: consensus statement from the 3rd International Patellofemoral Pain Research Retreat held in Vancouver, September 2013. Br J Sports Med. 2014 Mar 1;48(6):411-4. ##
  3. Petersen W, Rembitzki I, Liebau C. Patellofemoral pain in athletes. J sports Med. 2017;8:143. ##
  4. Rathleff MS, Samani A, Olesen JL, Roos EM, Rasmussen S, Madeleine P. Effect of exercise therapy on neuromuscular activity and knee strength in female adolescents with patellofemoral pain—an ancillary analysis of a cluster randomized trial. J Clinical Biomechanics. 2016 May 1;34:22-9. ##
  5. Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scandinavian journal of medicine & science in sports. 2010 Oct;20(5):725-30. ##
  6. Ferrari D, Briani RV, de Oliveira Silva D, Pazzinatto MF, Ferreira AS, Alves N, de Azevedo FM. Higher pain level and lower functional capacity are associated with the number of altered kinematics in women with patellofemoral pain. Gait & posture. 2018 Feb1;60:268-72. ##
  7. Myer GD, Ford KR, Foss KD, Goodman A, Ceasar A, Rauh MJ, Divine JG, Hewett TE. The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clinical biomechanics. 2010 Aug 1;25(7):700-7. ##
  8. Sinclair JK, Selfe J, Taylor PJ, Shore HF, Richards JD. Influence of a knee brace intervention on perceived pain and patellofemoral loading in recreational athletes. Clinical Biomechanics. 2016 Aug 1;37:7-12. ##
  9. Keet JH, Gray J, Harley Y, Lambert MI. The effect of medial patellar taping on pain, strength and neuromuscular recruitment in subjects with and without patellofemoral pain. Physiotherapy. 2007 Mar 1;93(1):45-52. ##
  10. Lankhorst NE, van Middelkoop M, Crossley KM, Bierma-Zeinstra SM, Oei EH, Vicenzino B, Collins NJ. Factors that predict a poor outcome 5–8 years after the diagnosis of patellofemoral pain: a multicentre observational analysis. Br J Sports Med. 2016 Jul 1;50(14):881-6. ##
  11. Dingenen B, Janssens L, Luyckx T, Claes S, Bellemans J, Staes FF. Postural stability during the transition from double-leg stance to single-leg stance in anterior cruciate ligament injured subjects. Clinical Biomechanics. 2015 Mar1;30(3):283-9. ##
  12. Li Y, Kakar RS, Fu YC, Walker M, Brown CN, Oswald TS, Simpson KJ. Postural control of individuals with spinal fusion for adolescent idiopathic scoliosis. Clinical Biomechanics. 2019 Jan 1;61:46-51. ##
  13. Ivanenko Y, Gurfinkel VS. Human postural control. Frontiers in neuroscience. 2018 Mar 20;12:171. ##
  14. Choi CJ, Lim HW, Park MK, Cho JG, Im GJ. Does the Kyphotic Change Decrease the Risk of Fall? Gait Posture 2011;4:118–21. ##
  15. Melzer I, Damry E, Landau A, Yagev R. The influence of an auditory–memory attention-demanding task on postural control in blind persons. Clinical biomechanics. 2011 May 1;26(4):358-62. ##
  16. Loram ID. Postural control and sensorimotor integration. ##
  17. Zeinalzadeh A, Talebian S, Naghdi S, Salavati M, Nazary-Moghadam S, Zeynalzadeh Ghoochani B. Effects of vision and cognitive load on static postural control in subjects with and without patellofemoral pain syndrome. Physiotherapy theory and practice. 2018 Apr3;34(4):276-85. ##
  18. Lee SP, Souza RB, Powers CM. The influence of hip abductor muscle performance on dynamic postural stability in females with patellofemoral pain. Gait & posture. 2012 Jul 1;36(3):425-9. ##
  19. Ojaghi SM, Kamali F, Ghanbari A, Ebrahimi S, Nematollahi AR. Effects of taping and elastic bandage on postural control in athletes with patellofemoral pain: A randomized control trial. Galen Medical Journal. 2015 Jul 3;4(3):82-9. ##
  20. Ali yalfani, Zahra raeisi. investigate changes distribution of force  and center of pressure fluctuations in women with and without patellofemoral pain syndrome in static condition. J sports Med. 2015 May 7;22(1):57-68. ##
  21. Röijezon U, Clark NC, Treleaven J. Proprioception in musculoskeletal rehabilitation. Part 1: Basic science and principles of assessment and clinical interventions. Manual therapy. 2015 Jun 1;20(3):368-77. ##
  22. Falk EE, Seeley MK, Hunter I, Park J, Hopkins JT. Effect of experimental anterior knee pain on measures of static and dynamic postural control. Athletic Training and Sports Health Care. 2014 Jan3;6(1):7-14.  ##
  23. Naserpour M, Goharpey S, Saki A, Mohammadi Z. Dynamic postural control during step down task in patients with patellofemoral pain syndrome. Journal of Physical Therapy Science. 2018;30(10):1289-92. ##
  24. Willson JD, Kernozek TW, Arndt RL, Reznichek DA, Straker JS. Gluteal muscle activation during running in females with and without patellofemoral pain syndrome. Clinical biomechanics. 2011Aug1;26(7):735-40. ##
  25. Carvalho AP, Almeida GP, Magalhães MO, França FJ, Ramos LA, Comachio J, Marques AP. Dynamic postural stability and muscle strength in patellofemoral pain: Is there a correlation?. The Knee. 2016 Aug 1;23(4):616-21. ##
  26. Page P. Sensorimotor training: A “global” approach for balance training. Journal of bodywork and movement therapies. 2006 Jan 1;10(1):77-84. ##
  27. Ahmed AF. Effect of sensorimotor training on balance in elderly patients with knee osteoarthritis. Journal of AdvancedResearch.2011Oct1;2(4):305-11. ##
  28. Ahmad I, Noohu MM, Verma S, Singla D, Hussain ME. Effect of sensorimotor training on balance measures and proprioception among middle and older age adults with diabetic peripheral neuropathy. Gait & posture. 2019 Oct 1;74:114-20. ##
  29. Roper JL, Harding EM, Doerfler D, Dexter JG, Kravitz L, Dufek JS, Mermier CM. The effects of gait retraining in runners with patellofemoral pain: A randomized trial. Clinical biomechanics. 2016 Jun 1;35:14-22. ##
  30. Liao TC, Powers CM. Tibiofemoral kinematics in the transverse and frontal planes influence the location and magnitude of peak patella cartilage stress: An investigation of runners with and without patellofemoral pain. Clinical Biomechanics. 2019 Feb 1;62:72-8. ##
  31. Rathleff MS, Samani A, Olesen JL, Roos EM, Rasmussen S, Madeleine P. Effect of exercise therapy on neuromuscular activity and knee strength in female adolescents with patellofemoral pain—an ancillary analysis of a cluster randomized trial. Clinical Biomechanics. 2016 May 1;34:22-9. ##
  32. Clifford AM, Holder-Powell H. Postural control in healthy individuals. Clinical biomechanics. 2010 Jul 1;25(6):546-51. ##
  33. Yakut E, Bayar B, Meriç A, Bayar K, Yakut Y. Reliability and validity of reverse visual analog scale (right to left) in different intensity of pain. The Pain Clinic. 2003 Mar 1;15(1):1-6. ##
  34. Derakhshani A, Letafatkar A, Abbasi A. Comparison of the effects of sensorimotor training programs on pain, electromyography and kinematics in patients with scapular downward rotation syndrome. Physical Therapy in Sport. 2018 Nov 1;34:66-75. ##
  35. Bennell K, Bartam S, Crossley K, Green S. Outcome measures in patellofemoral pain syndrome: test retest reliability and inter-relationships. Physical Therapy in Sport. 2000 May 1;1(2):32-41. ##
  36. Rajabi R, Karimizadeh Ardakani M. determine the reliability of Iranian new tool measure for ankle proprioception. Journal of sport medicine. 2013;12:43-52. ##
  37. Callaghan MJ, Selfe J, McHenry A, Oldham JA. Effects of patellar taping on knee joint proprioception in patients with patellofemoral pain syndrome. Manual therapy. 2008 Jun 1;13(3):192-9. ##
  38. Salahzadeh Z, Maroufi N, Salavati M, Aslezaker F, Morteza N, Rezaei Hachesu P. Proprioception in subjects with patellofemoral pain syndrome: using the sense of force accuracy. Journal of Musculoskeletal Pain. 2013 Dec1;21(4):341-9. ##
  39. Rinne MB, Pasanen ME, Miilunpalo SI, Oja P. Test-retest reproducibility and inter-rater reliability of a motor skill test battery for adults. International Journal of Sports Medicine. 2001 Apr;22(03):192-200. ##
  40. Rome K, Dixon J, Gray M, Woodley R. Evaluation of static and dynamic postural stability in established rheumatoid arthritis: exploratory study. Clinical Biomechanics. 2009 Jul 1;24(6):524-6. ##
  41. Dunn JC, Iversen MD. Interrater reliability of knee muscle forces obtained by hand-held dynamometer from elderly subjects with degenerative back pain. Journal of Geriatric Physical Therapy. 2003 Sep 1;26(3):23. ##
  42. Ali yalfani, Zahra raeisi. Comparsion of lower limb strength, Q angle, varus and valgus knee musclein women with patellofemoral pain syndrome. Contemporary Research in sport management. 2013 jan 2;23(4):37-127. ##
  43. Goto S, Aminaka N, Gribble PA. Lower-Extremity Muscle Activity, Kinematics, and Dynamic Postural Control in Individuals With Patellofemoral Pain. Journal of sport rehabilitation. 2018 Nov 1;27(6):505-12. ##
  44. Toumi H, Best TM, Pinti A, Lavet C, Benhamou CL, Lespessailles E. The role of muscle strength & activation patterns in patellofemoral pain. Clinical biomechanics. 2013 Jun 1;28(5):544-8. ##
  45. Powers CM. Rehabilitation of patellofemoral joint disorders: a critical review. Journal of Orthopaedic & Sports Physical Therapy. 1998 Nov;28(5):345-54.##
  46. Negahban H, Etemadi M, Naghibi S, Emrani A, Yazdi MJ, Salehi R, Bousari AM. The effects of muscle fatigue on dynamic standing balance in people with and without patellofemoral pain syndrome. Gait & posture. 2013 Mar 1;37(3):336-9. ##
  47. Lee SP, Souza RB, Powers CM. The influence of hip abductor muscle performance on dynamic postural stability in females with patellofemoral pain. Gait & posture. 2012 Jul 1;36(3):425-9. ##
  48. Zemková E, Hamar D. The effect of task-oriented sensorimotor exercise on visual feedback control of body position and body balance. Human Movement. 2010 Dec 1;11(2):119-23. ##
  49. McCaskey MA, Schuster-Amft C, Wirth B, de Bruin ED. Effects of postural specific sensorimotor training in patients with chronic low back pain: study protocol for randomised controlled trial.Trials. 2015 Dec;16(1):571. ##
  50. McCaskey MA, Wirth B, Schuster-Amft C, de Bruin ED. Postural sensorimotor training versus sham exercise in physiotherapy of patients with chronic non-specific low back pain: An exploratory randomised controlled trial. PloS one. 2018 Mar 9;13(3):e0193358. ##
  51. Hwang JA, Bae SH, Do Kim G, Kim KY. The effects of sensorimotor training on anticipatory postural adjustment of the trunk in chronic low back pain patients. Journal of physical therapy science. 2013;25(9):1189-92. ##
  52. Peterka RJ. Sensorimotor integration in human postural control. Journal of neurophysiology. 2002 Sep 1;88(3):1097-118. ##
  53. Talimkhani A, Nodehi Moghadam A, Ghamkhar L, Amiri Arimi S. The immediate effect of the whole body vibration on postural control in young adults. Journal of Modern Rehabilitation. 2016 Mar 15;9(7):28-36. ##
  54. Tsauo JY, Cheng PF, Yang RS. The effects of sensorimotor training on knee proprioception and function for patients with knee osteoarthritis: a preliminary report. Clinical Rehabilitation. 2008 May;22(5):448-57. ##
  55. Elshazly FA, Nambi G, Elnegamy TE. Comparative study on virtual reality training (VRT) over sensory motor training (SMT) in unilateral chronic osteoarthritis–A randomized control trial. Int J Med Res Health Sci. 2016 Jan 1;5(8):7-16. ##
  56. Machado S, Cunha M, Velasques B, Minc D, Teixeira S, Domingues CA, Silva JG, Bastos VH, Budde H, Cagy M, Basile L. Sensorimotor integration: basic concepts, abnormalities related to movement disorders and sensorimotor training-induced cortical reorganization. Rev Neurol. 2010 Oct 1;51(7):427-36. ##
  57. Prentice WE. Rehabilitation techniques in sports medicine. Dubuque, IA, USA: WCB/McGraw-Hill; 2015. ##
  58. Bruhn S, Kullmann N, Gollhofer A. The effects of a sensorimotor training and a strength training on postural stabilisation, maximum isometric contraction and jump performance. International journal of sports medicine. 2004 Jan;25(01):56-60.##
  59. Frank JS, Earl M. Coordination of posture and movement. Physical therapy. 1990 Dec 1;70(12):855-63. ##
  60. Nagai T, Bates NA, Hewett TE, Schilaty ND. Paradoxical relationship in sensorimotor system: Knee joint position sense absolute error and joint stiffness measures. Clinical Biomechanics. 2019 Jul 1;67:34-7. ##
  61. Page P, Frank C, Lardner R. Assessment and treatment of muscle imbalance: the Janda approach. Journal of orthopedic & sports physical therapy. 2011 Oct;41(10):799-800. ##
  62. Ludwig O, Fröhlich M, Schmitt E. Therapy of poor posture in adolescents: Sensorimotor training increases the effectiveness of strength training to reduce increased anterior pelvic tilt. Cogent Medicine. 2016 Dec 31;3(1):1262094. ##
  63. Moutzouri M, Coutts F, Gliatis J, Billis E, Tsepis E, Gleeson N. Early initiation of home-based sensori-motor training improves muscle strength, activation and size in patients after knee replacement: a secondary analysis of a controlled clinical trial. BMC musculoskeletal disorders. 2019 Dec;20(1):231. ##
  64. Ahmed AF. Effect of sensorimotor training on joint proprioception and isokinetic strength ratios in subjects with unilateral functional ankle instability. Bulletin of Faculty of Physical Therapy. 2010;15(2). ##
  65. Arvidsson I, Eriksson E, Knutsson E, Arner S. Reduction of pain inhibition on voluntary muscle activation by epidural analgesia. Orthopedics. 1986 Oct 1;9(10):1415-9. ##
  66. Lederman E. Neuromuscular rehabilitation in manual and physical therapy. Edinburgh: Churchill Livingstone. 2010;178. ##
دوماهنامه علمی - پژوهشی طب توانبخشی
دوره 10، شماره 1
فروردین و اردیبهشت 1400
صفحه 1-13

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سابقه مقاله

  • تاریخ دریافت: 21 آذر 1398
  • تاریخ بازنگری: 28 فروردین 1399
  • تاریخ پذیرش: 02 اردیبهشت 1399
  • تاریخ اولین انتشار: 01 فروردین 1400

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