| Objective: Patella femoral pain syndrom(Patella femoral pain syndrom,PFPS) is a common clinical disease which caused by a variety of reasons of anterior knee diffuse pain, is also been one of the main causes of knee pain.Researches show that, the incidence of PFPS is about 10% ~ 40%, especially 10 ~35 year-old young people. If there is no effective treatment, PFPS will seriously affect the patient’s daily life and work. Therefore, it’s become a big issue of prevention and delaying the progress and treatment of PFPS.The most patients complained of posterior patella pain or around the patella pain, with crepitation rale, sudden weakness, joint swelling and intercurrent joint locking,especially when the knee flexion, more pain, many patients with sports had these significant symptoms.Now, the etiology of PFPS is also unclear, but the weakness of vastus medialis obliquus(vastus medialis oblique, VMO) is considered to be the main influence factors of PFPS. The imbalance of the muscle strength between vastus medialis obliquus(VMO) and vastus lateralis(vastus lateralis, VL)will lead to abnormal patellar tracking, making the patella sliding incorrectly in the femoral intercondylar block,which leads to pain when the knee flexion and extension. So, selective VMO muscles strength exercises is particularly important for the rehabilitation of patients with PFPS.The purpose of this study was to: use the electromyographic biofeedback therapy to training the VMO muscles, to regulate the relative activity between the VMO and the VL muscles, which can improve the patient’s patellar tracking, relieve the clinical symptoms, delay the progression of the disease.Methods:All the cases in this experimental research were consistent with the diagnostic standard of patellofemoral pain syndrome, aged at 18~45 years old;no obvious trauma of knee;patellofemoral extrusion test was positive;the knee pain for above 6 months;the pain got worse up/down stairs and squat;eliminate the knee synovial plica syndrome, half month plate injury, patellar tendonitis etc;two lower limbs had no fracture and operation history;accepting any physical therapy.According to the above criteria were selected 40 cases with PFPS of joint clinic in the Third Hospital of Hebei Medical University from 2013 October to 2014 June, all patients were randomly divided into two groups(the treatment group and the control group), 21 cases in the treatment group, male 8 cases, female 13 cases; age(36.9 + 6.6); 10 patients with single knee, 11 cases with double knee, with the course of disease was 6- 24 months. The control group of 19 cases, male 9 cases, female 10 cases, age(35.6 + 5.8); 9 patients with single knee, 10 cases of double knee, the course of disease was 6- 32 months. There was no significant difference in the basic situation of age, height, course of disease and body weight between the two groups(P>0.05). And all the patients signed the informed consent.The patients in control group use the routine rehabilitation therapy, including quadriceps femorisexercise,muscle stretch and acupuncture,massage. The cases in treatment group are giving the vastus medialis oblique(VMO) muscle strength training by the electromyographic biofeedback therapy, 1 times / day, 5 times / week;and at the same time,they all do what the control group’s do. And then all cases was assessed before the treatment and after 2 months of the treatment with Lysholm knee function score, Visual Analogy Scale(Visual Analogy Scale, VAS),and the surface electromyographic of VMO/VL.Results:(1) Before the treatment, the Lysholm knee function score of the two groups has no significant difference(P > 0.05); but after the treatment, the Lysholm function score between the two groups compared with before treatment were revealed significant difference(P < 0.05), and the treatment group of knee joint function score were improved more significantly, compared with the control group after treatment, the difference was significant difference(P < 0.05).(2)Two groups of patients with VAS score before the treatment, there was not significant difference(P > 0.05); after the treatment, when the patients were up and down the stairs, VAS scores were significantly improved in the two groups, the pain of all patients were reduced,the set of data shows that there was significant difference(P < 0.05), and the VAS scores of the treatment group compared with the control group after treatment, there was significant difference(P < 0.05).(3)Two groups of patients with VMO / VL surface electromyographic(s EMG)activity ratio before the treatment, there was no significant difference(P > 0.05);but after the rehabilitation after 8 weeks of treatment, two groups of patients with VMO / VL s EMG activity ratio was improved, and the patients in the experimental group after treatment compared with the control group,the data shows that there was significant difference(P < 0.05).Conclusions:(1) The vastus medialis oblique(VMO)muscles are part of the quadricep femoris muscle and they can control how the patella movement,known as patellar tracking.Regularquadriceps muscles strengthning exercises can not specifically target the VMO muscles.(2) Application of EMG biofeedback therapy for the vastus medialis obliquus(VMO)muscle strength training can effectively relieve the clinical symptoms of the patellofemoral pain syndrome, improve the knee function, reduce the knee pain and improve the patients’ quality of life. |
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