اثربخشي تمرين درماني مبتني بر رويكرد Sahrmann در بيماران با سندروم درد مفصل پاتلوفمورال

The Effectiveness of Exercise Therapy Based on Sahrmann Approach in Patients with Patella-Femoral Pain Syndrome

سابقه و هدف: سندروم درد پاتلوفمورال شايعترين منشاء درد قدامي زانو مي باشد كه معمولا طي بالا و پايين رفتن از پله ها، چمپاتمه زدن، نشستن طولاني مدت و زانو زدن يات دويدن اتفاق مي افتد. اين مطالعه بمنظور مقايسه "فيزيوتراپي سنتي به تنهائي" و "فيزيوتراپي سنتي توام با تمرين درماني مبتني بر رويكرد Sahrmann" بر بهبود سندورم پاتلوفمورال انجام شد. مواد و روش­ها: اين مطالعه مداخله اي بر روي 30 بيمار مبتلا به سندروم درد پاتلوفمورال با سن 50-20 سال انجام شد. افراد به دو "گروه فيزيوتراپي سنتي" و "گروه درماني Sahrmann" تقسيم شدند. در گروه فيزيوتراپي سنتي، از روشهاي تحريك الكتريكي سطحي، كيسه گرم، اولتراسوند و تمرينات تقويتي و كششي زانو استفاده شد. در گروه درماني Sahrmann، علاوه بر فيزيوتراپي سنتي، از نواربندي خلفي ضربدري ران، تقويت و تمرينات عملكردي هيپ نيز استفاده شد. مداخلات در هر دو گروه به مدت 6 هفته اعمال شد. قبل و بلافاصله بعد از درمان، پرسشنامه كيفيت سطح زندگي (KOOS)، شدت درد زانو و حس مفصل زانو اندازه گيري و مقايسه شدند. يافته ­ها: در هر دو گروه، متغيرهاي شدت درد، مقياس KOOS و حس وضعيت زانو در پايان هفته ششم به طور معني داري بهبود يافتند(0/05

BACKGROUND and OBJECTIVE: Rotational impairment of the knee (excessive adduction and internal rotation of the hip during weight-bearing activities) and hip muscles weakness have been proposed as one of the risk factors of PFPS. The effects of correction of these impairments, which are not related directly to patella-femoral joint, have not been studied up to now. The aim of this study was to compare the effects of “conventional physiotherapy alone” and “combined conventional physiotherapy with exercise therapy based on Sahrmann approach” in patients with PFPS. METHODS: In this randomized controlled clinical trial, 30 patients with PFPS (aged 20-50) were participated. The participants were divided into two groups: "traditional physiotherapy group" and “Sahrmann treatment group”. In both groups, interventions were applied for 6 weeks. Patients in traditional physiotherapy group only received TENS, hot packs, ultrasound, and knee exercise therapy. But in Sahrmann treatment group, in addition to traditional physiotherapy, posterior X taping, hip muscle strengthening and functional training was used. Before and immediately after the end of 6th week, quality of life variables (using questionnaires KOOS), pain (using the Visual Analogue Scale), and position sense of the knee were measured. FINDINGS: In both groups, pain severity, KOOS scale and position sense of the knee at the end of sixth week significantly improved (p<0.05). In traditional physiotherapy group, mean pain score was decreased of 7.23±54.53 mm to 11.5±80.37 mm, mean score of KOOS questionnaire from 95.93± 6.12 to 73.26±6.23 and the average error of knee position of 57.1±98.4 to 2.28±1.15. In addition, in the Sahrmann treatment group, mean pain score was decreased from 59.93±7.75 mm to 40.2±5.36 mm, mean score of KOOS questionnaire from 95.73±10.94 to 71.4±7.87 and the average error of knee position of 6.18±9.1 to 2.99±1.11 degree at the end of the sixth week. CONCLUSION: Essentially, using of Sahrmann approach including “posterior X taping on thigh, strengthening of hip abductor, extensor and lateral rotators muscles”, compared to conventional physiotherapy, was not result in more effective improvement in patients with PFPS.