مقایسه هماهنگی و تغییرپذیری هماهنگی مفاصل اندام تحتانی حین اجرای برش جانبی متقاطع در ورزشکاران با درد مزمن کشاله ران و افراد سالم: مطالعه مقطعی

نوع مقاله : مقاله پژوهشی اصیل

نویسندگان
بهنود جعفرپور 1
مهدی خالقی تازجی 2
امیر لطافتکار 2
علی عباسی 2
1 دانشجوی دکتری تخصصی، گروه بیومکانیک ورزشی، دانشکده تربیت ‌بدنی و علوم ورزشی، دانشگاه خوارزمی، تهران، ایران
2 دانشیار، گروه بیومکانیک ورزشی، دانشکده تربیت ‌بدنی و علوم ورزشی، دانشگاه خوارزمی، تهران، ایران
10.48305/jrrs.2023.41412.1024
چکیده
مقدمه: درد مزمن کشاله ران، وضعیت دردناک و شایعی است که منجر به اختلال در عملکرد و از دست دادن زمان شرکت در مسابقات ورزشی می‌شود. نرخ بالای شیوع، آناتومی پیچیده و توان‌بخشی طولانی مدت، از جمله چالش‌های این آسیب به شمار می‌رود. با وجود مطالعات بالینی و پزشکی گسترده در این حوزه، دورنمای بیومکانیکی درد کشاله ران در ورزشکاران به ویژه در زمینه شاخص‌های هماهنگی و تغییرپذیری، همچنان ناشناخته باقی مانده است. بنابراین، هدف از انجام پژوهش حاضر، مقایسه هماهنگی و تغییرپذیری مفاصل اندام تحتانی بین ورزشکاران با درد مزمن کشاله ران و افراد سالم در مانور برش جانبی بود.
مواد و روش‌ها: در این مطالعه، 28 بازیکن جوان فوتبال (14 نفر در گروه با درد مزمن کشاله ران و 14 نفر در گروه شاهد) مشارکت نمودند. به منظور جمع‌آوری داده‌های کینماتیک سه بعدی مفاصل اندام تحتانی، از دوربین‌های آنالیز حرکت استفاده شد. هماهنگی و تغییرپذیری هماهنگی مفاصل ران به زانو و زانو به ران در سه صفحه حرکتی با استفاده از روش فاز نسبی پیوسته محاسبه گردید. آزمون Independent t نیز به منظور مقایسه بین دو گروه مورد استفاده قرار گرفت.
یافته‌ها: آزمودنی‌های مبتلا به درد مزمن کشاله ران غیر هم‌فازی بیشتری را در هماهنگی مفصل ران به زانو در صفحه فرونتال (030/0 = P) و همچنین، تغییرپذیری بیشتری را در هماهنگی مفصل ران به زانو در صفحه فرونتال (015/0 = P)، زانو به مچ پا در صفحه فرونتال (035/0 = P) و ران به زانو در صفحه افقی (045/0 = P) نشان دادند.
نتیجه‎گیری: نتایج تحقیق حاضر، کاهش هماهنگی و افزایش تغییرپذیری هماهنگی اندام تحتانی در افراد مبتلا به درد مزمن کشاله ران را نشان داد که ممکن است منجر به استراتژی‌های جبرانی، تغییر توزیع نیروها و درد و آسیب‌های ثانویه شود.
کلیدواژه‌ها
کشاله ران
کینماتیک
درد
موضوعات
  1. Thorborg K, Rathleff MS, Petersen P, Branci S, Holmich P. Prevalence and severity of hip and groin pain in sub-elite male football: A cross-sectional cohort study of 695 players. Scand J Med Sci Sports 2017; 27(1): 107-14.
  2. Werner J, Hagglund M, Walden M, Ekstrand J. UEFA injury study: A prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 2009; 43(13): 1036-40.
  3. Franklyn-Miller A, Richter C, King E, Gore S, Moran K, Strike S, et al. Athletic groin pain (part 2): A prospective cohort study on the biomechanical evaluation of change of direction identifies three clusters of movement patterns. Br J Sports Med 2017; 51(5): 460-8.
  4. Delahunt E, McEntee BL, Kennelly C, Green BS, Coughlan GF. Intrarater reliability of the adductor squeeze test in gaelic games athletes. J Athl Train 2011; 46(3): 241-5.
  5. Mansourizadeh R, Letafatkar A, Khaleghi M. Effect of gait with turning on the muscle activity of selected muscles in patients with chronic groin pain. Research in Medicine 2020; 44(3): 503-11. [In Persian].
  6. Jorgensen SG, Oberg S, Rosenberg J. Treatment of longstanding groin pain: A systematic review. Hernia 2019; 23(6): 1035-44.
  7. Nielsen MF, Ishoi L, Juhl C, Holmich P, Thorborg K. Pain provocation tests and clinical entities in male football players with longstanding groin pain are associated with pain intensity and disability. Musculoskelet Sci Pract 2023; 63: 102719.
  8. Shakoor N, Hurwitz DE, Block JA, Shott S, Case JP. Asymmetric knee loading in advanced unilateral hip osteoarthritis. Arthritis Rheum 2003; 48(6): 1556-61.
  9. Sedaghati P, Alizadeh MH, Shirzad E, Ardjmand A. Review of sport-induced groin injuries. Trauma Mon 2013; 18(3): 107-12.
  10. Sharma H, Athar S, Kholiya K, Naqvi SA, Jain K, Goyal B, et al. Groin injury in athletes: A review. Journal of Survey in Fisheries Sciences 2023; 10(4S): 905-14.
  11. Daniels KAJ, King E, Richter C, Falvey E, Franklyn-Miller A. Changes in the kinetics and kinematics of a reactive cut maneuver after successful athletic groin pain rehabilitation. Scand J Med Sci Sports 2021; 31(4): 839-47.
  12. Dainese P, Booysen N, Mulasso A, Roppolo M, Stokes M. Movement retraining programme in young soccer and rugby football players: A feasibility and proof of concept study. J Bodyw Mov Ther 2023; 33: 28-38.
  13. Morrissey D, Graham J, Screen H, Sinha A, Small C, Twycross-Lewis R, et al. Coronal plane hip muscle activation in football code athletes with chronic adductor groin strain injury during standing hip flexion. Man Ther 2012; 17(2): 145-9.
  14. Holmich P. Long-standing groin pain in sportspeople falls into three primary patterns, a "clinical entity" approach: A prospective study of 207 patients. Br J Sports Med 2007; 41(4): 247-52.
  15. Mosler AB, Weir A, Eirale C, Farooq A, Thorborg K, Whiteley RJ, et al. Epidemiology of time loss groin injuries in a men's professional football league: A 2-year prospective study of 17 clubs and 606 players. Br J Sports Med 2018; 52(5): 292-7.
  16. Haroy J, Clarsen B, Thorborg K, Holmich P, Bahr R, Andersen TE. Groin problems in male soccer players are more common than previously reported. Am J Sports Med 2017; 45(6): 1304-8.
  17. Ekstrand J, Hilding J. The incidence and differential diagnosis of acute groin injuries in male soccer players. Scand J Med Sci Sports 1999; 9(2): 98-103.
  18. Demers MS, Pal S, Delp SL. Changes in tibiofemoral forces due to variations in muscle activity during walking. J Orthop Res 2014; 32(6): 769-76.
  19. Saito M, Niga S, Nihei T, Uomizu M, Ikezawa Y, Tsukada S. The cleft sign may be an independent factor of magnetic resonance imaging findings associated with a delayed return-to-play time in athletes with groin pain. Knee Surg Sports Traumatol Arthrosc 2021; 29(5): 1474-82.
  20. Drager J, Rasio J, Newhouse A. Athletic pubalgia (Sports Hernia): Presentation and treatment. Arthroscopy 2020; 36(12): 2952-3.
  21. Orr R, Hamidi J, Levy B, Halaki M. Epidemiology of injuries in Australian junior rugby league players. J Sci Med Sport 2021; 24(3): 241-6.
  22. Thorborg K, Reiman MP, Weir A, Kemp JL, Serner A, Mosler AB, et al. Clinical examination, diagnostic imaging, and testing of athletes with groin pain: An evidence-based approach to effective management. J Orthop Sports Phys Ther 2018; 48(4): 239-49.
  23. Taylor R, Vuckovic Z, Mosler A, Agricola R, Otten R, Jacobsen P, et al. Multidisciplinary assessment of 100 athletes with groin pain using the Doha agreement: high prevalence of adductor-related groin pain in conjunction with multiple causes. Clin J Sport Med 2018; 28(4): 364-9.
  24. Hegedus EJ, Stern B, Reiman MP, Tarara D, Wright AA. A suggested model for physical examination and conservative treatment of athletic pubalgia. Phys Ther Sport 2013; 14(1): 3-16.
  25. Janse van RL, Dare M, Louw Q, Crous L, Cockroft J, Williams L, et al. Pelvic and hip kinematics during single-leg drop-landing are altered in sports participants with long-standing groin pain: A cross-sectional study. Phys Ther Sport 2017; 26: 20-6.
  26. Heijboer WMP, Weir A, Vuckovic Z, Fullam K, Tol JL, Delahunt E, et al. Inter-examiner reliability of the Doha agreement meeting classification system of groin pain in male athletes. Scand J Med Sci Sports 2023; 33(2): 189-96.
  27. Shian B, Larson ST. Abdominal wall pain: Clinical evaluation, differential diagnosis, and treatment. Am Fam Physician 2018; 98(7): 429-36.
  28. Hu QL, Chen DC. Approach to the patient with chronic groin pain. Surg Clin North Am 2018; 98(3): 651-65.
  29. Daneshvar A, Sadeghi H, Borhani Kakhki Z, Taghva M. Effects of one stage of exhaustive global fatigue on coordination and variability of the joints of the trunk in elite rowers. Journal of Rehabilitation Medicine 2021; 10(1): 158-67. [In Persian].
  30. Stergiou N, Harbourne R, Cavanaugh J. Optimal movement variability: A new theoretical perspective for neurologic physical therapy. J Neurol Phys Ther 2006; 30(3): 120-9.
  31. Clayton HM, Hobbs SJ. The role of biomechanical analysis of horse and rider in equitation science. Appl Anim Behav Sci 2017; 190: 123-32.
  32. Stergiou N, Decker LM. Human movement variability, nonlinear dynamics, and pathology: Is there a connection? Hum Mov Sci 2011; 30(5): 869-88.
  33. Baida SR, Gore SJ, Franklyn-Miller AD, Moran KA. Does the amount of lower extremity movement variability differ between injured and uninjured populations? A systematic review. Scand J Med Sci Sports 2018; 28(4): 1320-38.
  34. Konig N, Taylor WR, Baumann CR, Wenderoth N, Singh NB. Revealing the quality of movement: A meta-analysis review to quantify the thresholds to pathological variability during standing and walking. Neurosci Biobehav Rev 2016; 68: 111-9.
  35. Shirzad Araghi E, Naserpour H, Khaleghi Tazji M, Letafatkar A. Comparing the timing of electromyographic activity of selected lumbar-pelvic muscles during a cross-cutting maneuver in football players with athletic groin pain and healthy peers. Journal of Rehabilitation Medicine 2023; 11(6): 922-35. [In Persian].
  36. Delahunt E, Thorborg K, Khan KM, Robinson P, Holmich P, Weir A. Minimum reporting standards for clinical research on groin pain in athletes. Br J Sports Med 2015; 49(12): 775-81.
  37. Palsson A, Kostogiannis I, Ageberg E. Altered lumbo-pelvic control in patients with longstanding hip and groin pain compared to healthy controls. Osteoarthritis and Cartilage 2018; 26: S341.
  38. Dutaillis B, Opar DA, Pataky T, Timmins RG, Hickey JT, Maniar N. Trunk, pelvis and lower limb coordination between anticipated and unanticipated sidestep cutting in females. Gait Posture 2021; 85: 131-7.
  39. Pollard CD, Heiderscheit BC, van Emmerik RE, Hamill J. Gender differences in lower extremity coupling variability during an unanticipated cutting maneuver. J Appl Biomech 2005; 21(2): 143-52.
  40. Weir G, van ER, Jewell C, Hamill J. Coordination and variability during anticipated and unanticipated sidestepping. Gait Posture 2019; 67: 1-8.
  41. Wyatt HE, Weir G, Jewell C, van Emmerik REA, Hamill J. Stable coordination variability in overground walking and running at preferred and fixed speeds. J Appl Biomech 2021; 37(4): 299-303.
  42. Dai B, Garrett WE, Gross MT, Padua DA, Queen RM, Yu B. The effects of 2 landing techniques on knee kinematics, kinetics, and performance during stop-jump and side-cutting tasks. Am J Sports Med 2015; 43(2): 466-74.
  43. Dalvandpour N, Zareei M, Abbasi H, Abdoli B, Mohammadian MA, Rommers N, et al. Focus of attention during ACL injury prevention exercises affects improvements in jump-landing kinematics in soccer players: A randomized controlled trial. J Strength Cond Res 2023; 37(2): 337-42.
  44. Mohammadian M, Sadeghi H, Khaleghi TM, Maloney SJ. The relationship between vertical stiffness during bilateral and unilateral hopping tests performed with different strategies and vertical jump performances. Eur J Sport Sci 2022; 22(2): 182-9.
  45. Hamill J, Palmer C, van Emmerik RE. Coordinative variability and overuse injury. Sports Med Arthrosc Rehabil Ther Technol 2012; 4(1): 45.
  46. Robertson D, Caldwell G, Hamill J, Kamen G, Whittlesey S. Research methods in biomechanics. 2nd Champaign, IL: Human Kinetics; 2013.
  47. Havens KL, Sigward SM. Joint and segmental mechanics differ between cutting maneuvers in skilled athletes. Gait Posture 2015; 41(1): 33-8.
  48. Chiu SL, Chang CC, Chou LS. Inter-joint coordination of overground versus treadmill walking in young adults. Gait Posture 2015; 41(1): 316-8.
  49. Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 2015; 49(12): 768-74.
  50. Tak I, Engelaar L, Gouttebarge V, Barendrecht M, Van den Heuvel S, Kerkhoffs G, et al. Is lower hip range of motion a risk factor for groin pain in athletes? A systematic review with clinical applications. Br J Sports Med 2017; 51(22): 1611-21.
  51. Parenteau G, Gaudreault N, Chambers S, Boisvert C, Grenier A, Gagne G, et al. Functional movement screen test: A reliable screening test for young elite ice hockey players. Phys Ther Sport 2014; 15(3): 169-75.
  52. Mansourizadeh R, Letafatkar A, Franklyn-Miller A, Khaleghi-Tazji M, Baker JS. Segmental coordination and variability of change in direction in long-standing groin pain. Gait Posture 2020; 77: 36-42.
  53. Schmidt RA. Motor schema theory after 27 years: Reflections and implications for a new theory. Res Q Exerc Sport 2003; 74(4): 366-75.
  54. Edwards S, Brooke HC, Cook JL. Distinct cut task strategy in Australian football players with a history of groin pain. Phys Ther Sport 2017; 23: 58-66.
  55. Kipp K, Palmieri-Smith RM. Principal component based analysis of biomechanical inter-trial variability in individuals with chronic ankle instability. Clin Biomech (Bristol, Avon) 2012; 27(7): 706-10.
  56. Miller RH, Meardon SA, Derrick TR, Gillette JC. Continuous relative phase variability during an exhaustive run in runners with a history of iliotibial band syndrome. J Appl Biomech 2008; 24(3): 262-70.
  57. Newell KM, Kugler PN, van Emmerik REA, Mcdonald PV. Search Strategies and the Acquisition of Coordination. In: Wallace SA, editor. Advances in psychology perspectives on the coordination of movement. 61th Amsterdam, Holland: North-Holland; 1989. p. 85-122.
  58. Herb CC, Chinn L, Dicharry J, McKeon PO, Hart JM, Hertel J. Shank-rearfoot joint coupling with chronic ankle instability. J Appl Biomech 2014; 30(3): 366-72.
  59. Kulig K, Joiner DG, Chang YJ. Landing limb posture in volleyball athletes with patellar tendinopathy: a pilot study. Int J Sports Med 2015; 36(5): 400-6.
  60. Hodges PW, Tucker K. Moving differently in pain: A new theory to explain the adaptation to pain. Pain 2011; 152(3 Suppl): S90-S98.
پژوهش در علوم توانبخشی
دوره 18، شماره 1
1401
صفحه 66-73