스크랩 ＜외국논문＞ Hip Abductor Weakness in Runners with PFPS

[이영진(운동치료)]

Hip Abductor Weakness in Runners with PFPS

Patellofemoral pain syndrome (PFPS) accounts for approximately 20% of all running-related injuries. The influence of factors such as quadriceps muscle strength and quadriceps angle (Q angle) on patellofemoral pain has been directed to the joints both proximal and distal to the knee as potential contributors to PFPS. Weakness of the hip abductors and external rotators, as well as a low-arch foot structure, have purportedly been linked to altered hip and knee motions that may contribute to PFPS. Weakness of the hip abductors and external rotators, as well as a low-arch foot structure, have purportedly been linked to alter hip and knee motions that may contribute to PFPS. Over the course of prolonged running, fatigue may magnify these abnormal movement patterns.

Dierks et al from Indiana University studied the relationship between hip strength and hip kinematics during a prolonged run in a group of runners with PFPS and a group of uninjured runners. The investigators also assessed the relationship between arch height and frontal plane (knee adduction) motion during running. Twenty recreational runners with PFPS were gender-matched (5 men, 15 women) to a group of 20 uninjured runners. Prior to and immediately following a prolonged run, isometric muscle strength was assessed for the hip abductors and external rotators. The arch height index was also measured in the standing position. Reflective markers were placed on the pelvis and lower limb, and kinematic data were collected as patients ran at a self-selected pace on the treadmill. The same footwear was used for all patients. The prolonged run ended when 1 of the following events was achieved:

1.> 85% of the patient's maximum heart rate;
2.> a score of 17 (very hard) on the perceived exertion scale; pr
3.> a score of 7 (out of 10) on a visual analogue pain scale for patients in the PFPS group.

Runners with PFPS stopped their run 10 minutes before the uninjured group. When comparing the groups for hip strength over time, both groups for hip strength over time, both groups showed a significant decrease (p<.001) in hip abductor and external rotation strength at the end of the run. However, as a group, the PFPS runners strength (p=.045) when compared with the uninjured group (Figure 1). This weakness in hip abduction was associated with greater hip adduction angles that became more evident at the end of the run (r=-0.74).

The influence of foot structure, measured using the arch height index, did not show any difference between the groups. The results of foot type influence on PFPS need to be interpreted with caution, because the authors noted that the majority of patients in this study (39/40) had normal arch structures. Further exploration of the influence of low-arch foot structure on knee kinematics in patients with PFPS is warranted. These findings underscore the importance of addressing hip strength in runners with PFPS.

Dierks TA, Manal KT, Hamill J, Davis IS. Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run. J Orthop Sports Phys Ther 2008;38:448-456.

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