تأثیرتمرینات عصبی عضلانی بر قدرت عضلات هیپ، ناحیه مرکزی و مکانیک‌های پرش ـ فرود در ورزشکاران با بازسازی رباط صلیبی قدامی

نوع مقاله: مقاله پژوهشی

نویسندگان

1 دانشجوی دکتری آسیب شناسی و حرکات اصلاحی، دانشکده علوم ورزشی، دانشگاه اصفهان

2 دانشیار،گروه آسیب شناسی ورزشی و حرکات اصلاحی، دانشکده علوم ورزشی ، دانشگاه اصفهان

3 استادیار ،گروه آسیب شناسی ورزشی و حرکات اصلاحی، دانشکده علوم ورزشی، دانشگاه حکیم سبزواری

4 جراح زانو، استادیار دانشگاه علوم پزشکی مشهد

10.22084/rsr.2019.18377.1434

چکیده

زمینه و هدف: شیوع بالای آسیب مجدد رباط بازسازی شده یکی از مسائل پیچیده پس از عمل جراحی است. هدف از تحقیق حاضر تأثیر تمرینات عصبی عضلانی بر قدرت عضلات هیپ، ناحیه مرکزی و مکانیک‌های پرش ـ فرود در ورزشکاران با بازسازی رباط صلیبی قدامی بود.
روش بررسی: تعداد 24 ورزشکار با سابقه بازسازی رباط صلیبی قدامی به صورت هدفمند و در دسترس انتخاب و به‌صورت تصادفی به دو گروه تجربی و کنترل تقسیم شدند. قبل و بعد از پروتکل تمرینات عصبی عضلانی (8 هفته، 3 جلسه در هفته) از هر دو گروه ارزیابی قدرت ایزومتریک عضلات هیپ، استقامت عضلات ناحیه مرکزی و مکانیک‌های پرش فرود به ترتیب با استفاده از دینامومتر ایزوکنتیک، آزمون‌های ثبات مرکزی مک گیل و پرسشنامه امتیازدهی خطای پرش- فرود به عمل آمد. اطلاعات با استفاده از آزمون تی همبسته و آزمون آنوا برای اندازه ­های تکراری در سطح معناداری (05/0P<) مورد تجزیه و تحلیل قرار گرفت.  
یافته­ ها: نتایج تغییرات درون گروهی گروه تجربی نشان داد که میزان قدرت ایزومتریک عضلات، استقامت عضلات ناحیه مرکزی و امتیاز خطای پرش ـ فرود در پس‌آزمون نسبت به پیش‌آزمون بهبود معنی‌داری داشت (05/0>P) که این تغییرات در گروه کنترل معنی دار نبود. همچنین تغییرات بین گروهی در دو گروه تجربی و کنترل در تمام متغیرها (05/0>P) تفاوت معناداری را نشان داد.
نتیجه ­گیری: براساس این نتایج می­ توان نتیجه گرفت که بخش­ های بالای زانو اثر قابل توجهی روی استراتژی‌های کنترل حرکتی دارد. آگاهی از این امر می­ تواند عاملی برای طراحی بهتر برنامه‌های تمرینی جلوگیری از آسیب ACL و همچنین برنامه­ های جلوگیری از آسیب مجدد باشد.

کلیدواژه‌ها


Ardern, C. L., Webster, K. E., Taylor, N. F., & Feller, J. A. (2011), Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery two-thirds of patients have not returned by 12 months after surgery. The American journal of sports medicine, 39(3), 538-543.

Beynnon, B. D., Johnson, R. J., Abate, J. A., Fleming, B. C., & Nichols, C. E. (2005), Treatment of anterior cruciate ligament injuries, part I. The American journal of sports medicine, 33(10), 1579-1602.

Blackburn, J. T., & Padua, D. A. (2008), Influence of trunk flexion on hip and knee joint kinematics during a controlled drop landing. Clinical Biomechanics, 23(3), 313-319.

Boden, B. P., Dean, G. S., Feagin, J. A., & Garrett, W. E. (2000), Mechanisms of anterior cruciate ligament injury. Orthopedics, 23(6), 573-578.

Boden, B. P., Torg, J. S., Knowles, S. B., & Hewett, T. E. (2009), Video analysis of anterior cruciate ligament injury abnormalities in hip and ankle kinematics. The American journal of sports medicine, 37(2), 252-259.

Boling, M. C., Padua, D. A., & Alexander Creighton, R. (2009), Concentric and eccentric torque of the hip musculature in individuals with and without patellofemoral pain. Journal of Athletic Training, 44(1), 7-13.

Burnham, J. M., Yonz, M. C., Robertson, K. E., McKinley, R., Wilson, B. R., Johnson, D. L., . . . Noehren, B. (2016), Relationship of Hip and Trunk Muscle Function with Single Leg Step-Down Performance. Physical Therapy in Sport.

Chaudhari, A. M., & Andriacchi, T. P. (2006), The mechanical consequences of dynamic frontal plane limb alignment for non-contact ACL injury. Journal of biomechanics, 39(2), 330-338.

Cimino, F., Volk, B. S., & Setter, D. (2010), Anterior cruciate ligament injury: diagnosis, management, and prevention. Am Fam Physician, 82(8), 917-922.

Daniel, D. M., Stone, M. L., Dobson, B. E., Fithian, D. C., Rossman, D. J., & Kaufman, K. R. (1994), Fate of the ACL-injured patient a prospective outcome study. The American journal of sports medicine, 2(5), 632- 644.

Delahunt, E., Prendiville, A., Sweeney, L., Chawke, M., Kelleher, J., Patterson, M., & Murphy, K. (2012), Hip and knee joint kinematics during a diagonal jump landing in anterior cruciate ligament reconstructed females. Journal of Electromyography and Kinesiology, 22(4), 598-606.

Delahunt, E., Sweeney, L., Chawke, M., Kelleher, J., Murphy, K., Patterson, M., & Prendiville, A. (2012), Lower limb kinematic alterations during drop vertical jumps in female athletes who have undergone anterior cruciate ligament reconstruction. Journal of Orthopaedic Research, 30(1), 72-78.

Delfico, A. J., & Garrett, W. E. (1998), Mechanisms of injury of the anterior cruciate ligament in soccer players. Clinics in sports medicine, 17(4), 779-785.

DeMorat, G., Weinhold, P., Blackburn, T., Chudik, S., & Garrett, W. (2004), Aggressive quadriceps loading can induce noncontact anterior cruciate ligament injury. The American journal of sports medicine, 32(2), 477-483.

Dempsey, A. R., Lloyd, D. G., Elliott, B. C., Steele, J. R., Munro, B. J., & Russo, K. A. (2007), The effect of technique change on knee loads during sidestep cutting. Medicine & Science in Sports & Exercise, 39(10), 1765-1773.

Devita, P., & Skelly, W. A. (1992), Effect of landing stiffness on joint kinetics and energetics in the lower extremity. Med Sci Sports Exerc, 24(1), 108-115.

Dugan, S. A. (2005), Sports-related knee injuries in female athletes: what gives? American journal of physical medicine & rehabilitation, 84(2), 122-130.

Dunn, W. R., Spindler, K. P., & Consortium, M. (2010). Predictors of Activity Level 2 Years After Anterior Cruciate Ligament Reconstruction (ACLR) A Multicenter Orthopaedic Outcomes Network (MOON) ACLR Cohort Study. The American journal of sports medicine, 38(10), 2040-2050.

Fleming, B. C., Renstrom, P. A., Beynnon, B. D., Engstrom, B., Peura, G. D., Badger, G. J., & Johnson, R. J. (2001), The effect of weightbearing and external loading on anterior cruciate ligament strain. Journal of biomechanics, 34(2), 163-170.

Fukuda, Y., Woo, S. L. Y., Loh, J. C., Tsuda, E., Tang, P., McMahon, P. J., & Debski, R. E. (2003). A quantitative analysis of valgus torque on the ACL: a human cadaveric study. Journal of Orthopaedic Research, 21(6), 1107-1112.

Hartigan, E. H., Axe, M. J., & Snyder-Mackler, L. (2010), Time line for noncopers to pass return-to-sports criteria after anterior cruciate ligament reconstruction. Journal of orthopaedic & sports physical therapy, 40(3), 141-154.

Hewett, T. E., Di Stasi, S. L., & Myer, G. D. (2013), Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction. The American journal of sports medicine, 41(1), 216-224.

Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., . . .  Succop, P. (2005), Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes a prospective study. The American journal of sports medicine, 33(4), 492-501.

Hewett, T. E., Torg, J. S., & Boden, B. P. (2009), Video analysis of trunk and knee motion during non-contact anterior cruciate ligament injury in female athletes: lateral trunk and knee abduction motion are combined components of the injury mechanism. British journal of sports medicine, 43(6), 417-422.

Hui, C., Salmon, L. J., Kok, A., Maeno, S., Linklater, J., & Pinczewski, L. A. (2011), Fifteen-year outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft for “isolated” anterior cruciate ligament tear. The American journal of sports medicine, 39(1), 89-98.

Huston, L. J., Greenfield, M. L. V., & Wojtys, E. M. (2000), Anterior cruciate ligament injuries in the female athlete: potential risk factors. Clinical orthopaedics and related research, 372, 50-63.

Ireland, M. L. (1999), Anterior cruciate ligament injury in female athletes: epidemiology. Journal of Athletic Training, 34(2), 150.

Jamison, S. T., Pan, X., & Chaudhari, A. M. (2012), Knee moments during run-to-cut maneuvers are associated with lateral trunk positioning. Journal of biomechanics, 45(11), 1881-1885.

Jarvis, A. S. (2010), The association between measures of core stability and biomechanics of the trunk and knee during a single leg squat: The University Of North Carolina At Chapel Hill.

Johnson, D., & Fu, F. (1994), Anterior cruciate ligament reconstruction: why do failures occur? Instructional course lectures, 44, 391-406.

Khayambashi, K., Ghoddosi, N., Straub, R. K., & Powers, C. M. (2016), Hip Muscle Strength Predicts Noncontact Anterior Cruciate Ligament Injury in Male and Female Athletes A Prospective Study. The American journal of sports medicine, 44(2), 355-361.

Lessi, G. C., dos Santos, A. F., Batista, L. F., de Oliveira, G. C., & Serrão, F. V. (2016), Effects of fatigue on lower limb, pelvis and trunk kinematics and muscle activation: Gender differences. Journal of Electromyography and Kinesiology.

Leys, T., Salmon, L., Waller, A., Linklater, J., & Pinczewski, L. (2012), Clinical results and risk factors for Reinjury 15 Years After anterior cruciate ligament reconstruction a prospective study of hamstring and patellar tendon grafts. The American journal of sports medicine, 40(3), 595-605.

Lohmander, L. S., Englund, P. M., Dahl, L. L., & Roos, E. M. (2007), The long-term consequence of anterior cruciate ligament and meniscus injuries osteoarthritis. The American journal of sports medicine, 35(10), 1756-1769.

Lohmander, L., Östenberg, A., Englund, M., & Roos, H. (2004), High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis & Rheumatism, 50(10), 3145-3152.

Lyman, S., Koulouvaris, P., Sherman, S., Do, H., Mandl, L. A., & Marx, R. G. (2009), Epidemiology of anterior cruciate ligament reconstruction. J Bone Joint Surg Am, 91(10), 2321-2328.

Markolf, K. L., Burchfield, D. M., Shapiro, M. M., Shepard, M. F., Finerman, G. A., & Slauterbeck, J. L. (1995), Combined knee loading states that generate high anterior cruciate ligament forces. Journal of Orthopaedic Research, 13(6), 930-935.

McGill, S. M., Childs, A., & Liebenson, C. (1999), Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database. Archives of physical medicine and rehabilitation, 80(8), 941-944.

Miyasaka, K., Daniel, D., Stone, M., & Hirshman, P. (1991), The incidence of knee ligament injuries in the general population. Am J Knee Surg, 4(1), 3-8.

Myer, G. D., Chu, D. A., Brent, J. L., & Hewett, T. E. (2008), Trunk and hip control neuromuscular training for the prevention of knee joint injury. Clinics in sports medicine, 27(3), 425-448.

Padua, D. A., Marshall, S. W., Boling, M. C., Thigpen, C. A., Garrett Jr, W. E., & Beutler, A. I. (2009), The Landing Error Scoring System (LESS) is a valid and reliable clinical assessment tool of jump landing biomechanics: the JUMP-ACL study. The American journal of sports medicine, 37(10), 1996-2002.

Paterno, M. V., Ford, K. R., Myer, G. D., Heyl, R., & Hewett, T. E. (2007), Limb asymmetries in landing and jumping 2 years following anterior cruciate ligament reconstruction. Clinical Journal of Sport Medicine, 17(4), 258-262.

Paterno, M. V., Schmitt, L. C., Ford, K. R., Rauh, M. J., Myer, G. D., Huang, B., & Hewett, T. E. (2010), Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. The American journal of sports medicine, 38(10), 1968-1978.

Rudolph, K. S., Axe, M. J., Buchanan, T. S., Scholz, J. P., & Snyder-Mackler, L. (2001), Dynamic stability in the anterior cruciate ligament deficient knee. Knee Surgery, Sports Traumatology, Arthroscopy, 9(2), 62-71.

Salmon, L., Russell, V., Musgrove, T., Pinczewski, L., & Refshauge, K. (2005), Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 21(8), 948- 957.

Sampson, N. R., Beck, N. A., Baldwin, K., Ganley, T., & Wells, L. (2011), Knee injuries in children and adolescents: has there been an increase in ACL and mensicus tears in recent years. Paper presented at the American Academy of Pediatrics National Conference and Exhibition, Boston, MA.

Sheehan, F. T., Sipprell, W. H., & Boden, B. P. (2012), Dynamic sagittal plane trunk control during anterior cruciate ligament injury. The American journal of sports medicine, 40(5), 1068-1074.

Shelbourne, K. D., Gray, T., & Haro, M. (2009), Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. The American journal of sports medicine, 37(2), 246-251.

Shin, C. S., Chaudhari, A. M., & Andriacchi, T. P. (2009), The effect of isolated valgus moments on ACL strain during single-leg landing: a simulation study. Journal of biomechanics, 42(3), 280-285.

Shin, C. S., Chaudhari, A. M., & Andriacchi, T. P. (2011), Valgus plus internal rotation moments increase anterior cruciate ligament strain more than either alone. Med Sci Sports Exerc, 43(8), 1484-1491.

Spindler, K. P., Huston, L. J., Wright, R. W., Kaeding, C. C., Marx, R. G., Amendola, A., . . . Harrell, F. E. (2011), The prognosis and predictors of sports function and activity at minimum 6 years after anterior cruciate ligament reconstruction a population cohort study. The American journal of sports medicine, 39(2), 348-359.

Tate, J., Suckut, T., Wages, J., Lyles, H., & Perrin, B. (2017), The Associations Between Hip Strength And Hip Kinematics During A Single Leg Hop In Recreational Athletes Post Acl Reconstruction Compared To Healthy Controls. International journal of sports physical therapy, 12(3), 341.

Timoney, J. M., Inman, W. S., Quesada, P. M., Sharkey, P. F., Barrack, R. L., Skinner, H. B., & Alexander, A. H. (1993), Return of normal gait patterns after anterior cruciate ligament reconstruction. The American journal of sports medicine, 21(6), 887-889.

Traina, S. M., & Bromberg, D. F. (1997), ACL injury patterns in women. Orthopedics, 20(6), 545-549.

van Mechelen, W. (1992), Running injuries. Sports medicine, 14(5), 320-335.

Voigt, C., Schönaich, M., & Lill, H. (2006), Anterior cruciate ligament reconstruction: state of the art. European Journal of Trauma, 32(4), 332-339.

Von Porat, A., Roos, E., & Roos, H. (2004), High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Annals of the rheumatic diseases, 63(3), 269-273.

Webster, K. E., & Feller, J. A. (2016), Exploring the high reinjury rate in younger patients undergoing anterior cruciate ligament reconstruction. The American journal of sports medicine, 0363546516651845.

White, K. (2014), The effects of neuromuscular training on the ability to return-to-activity for the ACL reconstructed athlete. University of Delaware.

Wordeman, S. C., & Hewett, T. E. (2016), Research-Based and Clinical Considerations for Effective Neuromuscular Training to Prevent Second Anterior Cruciate Ligament Injury. Operative Techniques in Sports Medicine, 24(1), 7-11.

Wright, R. W., Dunn, W. R., Amendola, A., Andrish, J. T., Bergfeld, J., Kaeding, C. C., . . . Wolcott, M. (2007), Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction A prospective MOON cohort study. The American journal of sports medicine, 35(7), 1131-1134.

Zazulak, B. T., Hewett, T. E., Reeves, N. P., Goldberg, B., & Cholewicki, J. (2007a), Deficits in neuromuscular control of the trunk predict knee injury risk a prospective biomechanical-epidemiologic study. The American journal of sports medicine, 35(7), 1123-1130.

Zazulak, B. T., Hewett, T. E., Reeves, N. P., Goldberg, B., & Cholewicki, J. (2007b), The effects of core proprioception on knee injury a prospective biomechanical-epidemiological study. The American journal of sports medicine, 35(3), 368-373.