[進階肌動學] 為什麼我的PFPS老是不會好 Why the strengthening is not working to PFPS

許多的跑者都曾經或現在依然有膝蓋疼痛的問題
髕骨股骨疼痛症候群(PFPS)是一大部分這些雜症的總稱
PFPS來自於髕骨與股骨摩擦產生的發炎與疼痛
特別常見於下面這種跑姿
Many runners have/had knee pain problem.
Patella Femoral Pain Syndrome (PFPS) is a common term to conclude most of those pain.
The definition of PFPS is the friction between knee cap and femur that causes the symptom.
This symptom can be found especially with the runner who runs like this.

https://www.researchgate.net/publication/45100927_Patellofemoral_Pain_Syndrome

上面這張圖有兩種常見的錯誤跑姿出現
但我們先把重點放在支撐腳上
這種情況有人稱為膝外翻, 膝蓋碰撞, 或是特倫得堡步態
我們從後方觀察可以見到下列特色
1. 骨盆往對側掉
2. 過度髖內收/內轉
3. 膝蓋外展
上面這三點會造成髕骨的向外位移
There are two common running posture error in this picture.
But let's focusing on supporting knee first.
Some may call this knee valgus, knocked knee, or Trendelengberg gait
We can observe three features from back view:
1. Contralateral pelvic drop
2. Excessive hip Adduction/Internal rotation
3. Knee Abduction
Those features can lead to the lateral tracking of the knee cap

傳統上對於PFPS的治療很直觀
訓練控制骨盆以及股骨動作的肌肉就好棒棒可以解決問題呢
你做了大腿外展運動, 蚌殼外轉運動....等等
可是為什麼老是反反覆覆, 或者多跑一下就又不行了呢
The traditional treatment concept to PFPS is simple.
Training those muscles that control pelvis and hip movement can solve it.
You've done hip abduction exercise, clam exercise....etc.
But you're still suffered from it or the pain always comes and goes.

過去幾年的研究可以告訴我們這個問題的解答
在前瞻性研究的部份
臀部的肌肉力量對於預測PFPS的產生/此種步態的產生完全沒有預測力
但在橫斷面研究發現
有PFPS的人會有臀部肌力減少的現象
這指向了一個結果：臀部無力是PFPS造成的結果
而Wilson et al 2009的研究指出
臀中肌的啟動時間與耐力是唯二針對跑步過度髖內收的良好預測因子
結論：PFPS是一個神經肌肉控制失能的結果
Past researches might provide the answer to this question
Prospective researches showed the hip strength can not predict the present of PFPS.
Cross Section studies showed the population with PFPS has decreased hip strength.
That said, the HIP STRENGTH INSUFFICIENCY IS THE RESULT OF  PFPS.
According to Wilson et al 2009,
the GluMed onset time and duration are the only two factors can be used to predict excessive hip adduction.
In conclusion: PFPS IS THE RESULT OF NEUROMUSCULAR DYSFUNCTION

Add by Misato Alexandre on March 11, 2015 In Leg Exercises

針對有PFPS或是上面跑姿的跑者
單純的肌力訓練無法解決他們的問題
檢查他們的神經肌肉控制能力
並且給予動態的訓練配合適當的回饋
才能真正的解決跑步姿勢的問題以及讓他們健康的重回路上
To the runners with PFPS or the poor running posture,

simple strengthen program can not solve their problem.

Checking their ability of neuromuscular control,

Giving them dynamic training with appropriate feedback,

then you can truly help them to get rid of the pain and learn how to run properly.

本著作由I-Chen Liu, PT, MS製作，以創用CC 姓名標示-非商業性-相同方式分享 4.0 國際 授權條款釋出。