Middle Eastern Journal of Disability Studies

fa بررسی اثر تمرینات تعادلی و اغتشاشی بر درد و فعالیت عضلات زانو در زنان مبتلا به سندرم درد کشککی‌رانی حین بالا‌رفتن و پایین‌آمدن از پله Investigating the Effect of Balance and Perturbation Training on Pain and Knee Muscle Activity in Women with Patellofemoral Pain Syndrome in Up and Down Stepping توانبخشی Rehabilitation مقاله پژوهشی اصیل Original Research Article چکیده زمینه و هدف: سندرم درد کشککی‌رانی از اختلالات شایع‌تر اندام تحتانی است که موجب درد و اختلال در عملکرد اندام می‌شود. هدف از تحقیق حاضر بررسی اثر تمرینات تعادلی و اغتشاشی بر درد و فعالیت عضلات زانو در زنان مبتلا به سندرم درد کشککی‌رانی حین بالا‌رفتن و پایین‌آمدن از پله بود. روش‌بررسی: در این پژوهش نیمه‌تجربی از زنان مراجعه‌کننده به مراکز ارتوپدی شهر یزد و با تشخیص سندرم درد کشککی‌رانی تعداد سی نفر به‌صورت هدفمند و دردسترس وارد مطالعه شدند. سپس به‌طور تصادفی در دو گروه تجربی و گواه قرار گرفتند. گروه تجربی به‌مدت هیجده جلسه پروتکل تمرینی را انجام داد. قبل و بعد از تمرین میزان درد و فعالیت الکتریکی عضلات منتخب حین تکلیف پله اندازه‌گیری شد. تجزیه‌وتحلیل داده‌ها به‌کمک آزمون‌های تی همبسته و تی مستقل در سطح معناداری ۰٫۵=α صورت گرفت. یافته‌ها: نتایج نشان داد، در گروه تجربی، پس از شش هفته تمرین عصبی‌عضلانی به‌طور معناداری شدت درد (۰٫۰۰۱>p) و میزان فعالیت الکتریکی عضلهٔ پهن خارجی حین پایین‌آمدن از پله (۰٫۰۴۳=p) کاهش یافت. همچنین میزان فعالیت الکتریکی عضلهٔ پهن داخلی مایل حین بالا‌رفتن از پله (۰٫۰۰۱=p) و پایین‌آمدن از پله (۰٫۰۴۵=p) افزایش یافت. نتیجه‌گیری: تمرین عصبی‌عضلانی باعث بهبود درد و افزایش فعالیت عضلهٔ پهن داخلی مایل و کاهش فعالیت عضلهٔ پهن خارجی در زنان با سندرم درد کشککی‌رانی می‌شود؛ همچنین احتمالاً راستای کشکک و درد را بهبود می‌بخشد و می‌تواند در توان‌بخشی افراد مبتلا به سندرم درد کشککی‌رانی استفاده شود. Abstract Background & Objectives: Patellofemoral pain syndrome is one of the most common disorders of the lower limbs. It is a vague and widespread pain in the front of the knee and behind the patella that occurs during activities such as climbing and descending stairs, prolonged sitting, squatting, kneeling, running, and jumping. Possible causes of patellofemoral pain syndrome include a muscular imbalance between the quadriceps and hamstrings and neuromuscular defects. Neuromuscular disorders and changes in electromyography parameters, including the intensity of muscle activity and the time of muscle activation, cause abnormal outward movement of the patella and pressure disturbances on the surface of the patellofemoral joint, leading to pain and patellofemoral syndrome. In people with patellofemoral pain syndrome, the activation time and the extent of activity of the quadriceps muscle are difficult, and neuromuscular disorders are cited as the reason. Therefore, neuromuscular exercises are probably used to improve this syndrome. Hence, this research aimed to investigate the effect of balance and perturbation training on pain and knee muscle activity in women with patellofemoral pain syndrome during up–and–down stepping. Methods: The present research employed a quasi–experimental design with a pretest–posttest control group. The statistical population of the study consisted of women referring to orthopedic centers in Yazd City, Iran, with a diagnosis of patellofemoral pain syndrome under the supervision of a specialist physician. In this study, 30 women referred to orthopedic centers in Yazd, diagnosed with patellofemoral pain syndrome, were purposively selected based on availability and then randomly divided into two groups: an exercise group (n = 11) and a control group (n = 19). The inclusion criteria for the subjects in the study were as follows: women aged 18–45 years; unilateral or bilateral patellofemoral pain for more than three months; anterior or posterior pain in at least two instances of activities such as going up and down stairs; sitting for a long time with bent knees, pain in squatting more than 90 degrees; running, jumping, and squatting; and pain in at least one test including pain when pressing the patella directly on the femoral condyles in full knee extension (Waldron's test) or pain in the patella when applying resistance to the upper part of the patella during isometric contraction of the quadriceps muscle (Clark sign). Before the start of the exercise program, the electrical activity of the vastus medialis, vastus lateralis, and biceps femoris muscles was measured using an electromyography device, and pain was assessed using the visual analog scale (VAS). Subsequently, the training group underwent a balance and perturbation training protocol for 6 weeks, consisting of three sessions per week and a total of 18 sessions. Meanwhile, the subjects in the control group continued their normal daily activities as usual. After completing the exercises, the posttest was conducted in the same environment as the two groups. Paired t test and independent t test analyses at the α=0.5 level of significance were used to analyze the data. All statistical operations were performed by SPSS software version 25. Results: The results showed that, after 6 weeks of balance and perturbation training, the pain intensity in the training group decreased significantly (p<0.001), and the electrical activity of the vastus lateralis muscle during downward stepping in the training group also decreased (p=0.043). Also, the extent of electrical activity of the vastus medialis muscle during upward stepping in the training group (p=0.001) and the extent of electrical activity of the vastus medialis muscle during downward stepping in the training group (p=0.045) increased. Thus, the implementation of the intervention had an effect. Conclusion: Neuromuscular training improves pain and increases vastus medialis muscle activity in the task of up and down stepping and decreases vastus lateralis muscle activity in the task of down stepping in women with patellofemoral pain syndrome. It also likely improves patellar alignment and reduces pain, and can be used in the rehabilitation of individuals with patellofemoral pain syndrome. سندرم درد کشککی‌رانی, تمرینات تعادلی, تمرینات اغتشاشی, درد, الکترومایوگرافی Patellofemoral pain syndrome, Balance exercises, Perturbation training, Pain, Electromyography 46 46 http://jdisabilstud.org/browse.php?a_code=A-11-3650-1&slc_lang=fa&sid=1 Fateme Zare فاطمه زارع fateme.zare.2009@gmail.com 100319475328460066664 100319475328460066664 No PhD Student, Department of Sport Injuries & Corrective Exercises, University of Tehran, Tehran, Iran دانشجوی دکتری، دانشگاه تهران، تهران، ایران Mohammad Karimi Zade محمد کریمی زاده m.karimizadeh@ut.ac.ir 100319475328460066665 100319475328460066665 Yes Associate Professor, Department of Sport Injuries & Corrective Exercises, University of Tehran, Tehran, Iran دانشیار گروه آسیب‌شناسی و حرکات اصلاحی دانشکدهٔ تربیت‌بدنی، دانشگاه تهران، تهران، ایران Yosef Moghadas یوسف مقدس moghadas@ut.ac.ir 100319475328460066666 100319475328460066666 No Associate Professor, Department of Sport Injuries & Corrective Exercises, University of Tehran, Tehran, Iran دانشیار گروه آسیب‌شناسی و حرکات اصلاحی دانشکدهٔ تربیت‌بدنی، دانشگاه تهران، تهران، ایران Hooman Minoonejad هومن مینونژاد h.minoonejad@ut.ac.ir 100319475328460066667 100319475328460066667 No Associate Professor, Department of Sport Injuries & Corrective Exercises, University of Tehran, Tehran, Iran دانشیار گروه آسیب‌شناسی و حرکات اصلاحی دانشکدهٔ تربیت‌بدنی، دانشگاه تهران، تهران، ایران Hamid Abbasi حمید عباسی habbassi@yazd.ac.ir 100319475328460066668 100319475328460066668 No Assistant Professor, Department of Sports Science, Yazd University, Yazd, Iran استادیار گروه علوم ورزشی دانشگاه یزد، یزد، ایران