| Knee Osteoarthritis(Knee Osteoarthritis,KOA)is a common clinical osteoarthritis,which seriously affects the health of all human beings and brings a huge burden to all sectors of society.Clinically,pain and dysfunction are the main clinical manifestations.Due to long-term suffering from diseases,a series of problems such as mood disorders,insomnia and other decline in quality of life are also derived.Modern medicine points out that biomechanics plays a decisive role in the occurrence and progress of KOA,especially closely related to abnormal joint load,lower limb muscle strength,and lack of coordination.Gait analysis is a biomechanical research method that uses the principles of mechanics,processing methods and the knowledge of human anatomy and physiology to analyze the functional state of human walking.It can analyze all parts of the human body when walking,especially the lower limbs.Dynamic objective recording and quantitative analysis of the movement and force of the Vicon 3D motion capture system is currently the most advanced clinical gait research equipment.In addition,in the etiology of KOA,the comprehensive role of stress imbalance caused by changes in the lower limb force line in the occurrence and development of KOA has been widely recognized.Among them,the long axis X-ray of the lower limb weight bearing position is the most important clinical evaluation of the lower limb force line.Imaging methods.The theory of "muscles and bones imbalance" in traditional Chinese medicine macroscopically summarizes the pathological process of KOA.Earlier studies of spondylosis showed that muscular tissue constitutes the exogenous dynamic balance system of the knee joint,and the bone structure constitutes the endogenous static stability system of the knee joint,and the two are coordinated.If it breaks,it will gradually lose its function of binding bones and erecting organs.However,there is no relatively clear understanding of the pathophysiology of the "muscles and bones"function of lower limb KOA.Therefore,it is necessary to combine modern science and technology to clarify the "muscles and bones" functional status of KOA patients’ lower limbs.At present,exercise therapy has been strongly recommended by American Rheumatology as the first-line clinical choice for the prevention and treatment of KOA.Traditional Chinese medicine as a physical and mental exercise has also been widely used in the clinical treatment of KOA."Yi Jin Jing" is one of the representatives of traditional Chinese medicine.It has the potential effect of "the ability to clear the deficiencies without obstacles,and the ability to get rid of it without hindrance" for the physical and mental problems of KOA patients,so it can be applied to the clinical treatment of KOA among.However,at this stage,the overall clinical research on Yijinjing’s prevention and treatment of KOA is still relatively small,and the relevant clinical research methodology needs to be improved.Therefore,this article intends to carry out high-quality clinical randomized controlled trials in order to provide a stronger evidence-based basis for it.At the same time,the three-dimensional motion capture system is used to carry out analytical research on the movements of Yi Jin Jing exercises,and to explore the intrinsic sports biomechanical mechanism of exercises to prevent KOA.Part One:The characteristic study of the functional state of the lower limbs of KOA patientsObjective:To explore the characteristic study of the functional state of the muscles and bones of the lower limbs of KOA patients based on sports biomechanics.Methods:Thirty KOA patients(experi mental group)and healthy volunteers(control group)matching age,sex and occupation were recruited from the Tuina Department of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine and nearby communities for a case-control study.The Vicon three-dimensional motion capture system and surface electromyography were used to collect the temporal and spatial parameters,kinematics data,dynamics data and the root-mean-square amplitude of the lower extremity muscle activation in the subjects’ lower extremity gait respectively,so as to evaluate the"muscles of the lower extremities" "Function;use dynamic digital gastrointestinal-DRbody machine to collect lower limb hip,knee and ankle long axis weight bearing position X-ray,so as to realize the evaluation of the lower limb "bone" force line of KOA patients.SPSS25.0 statistical software was used to analyze and compare the differences in gait,lower extremity electromyography,and lower extremity force lines between the two groups.P<0.05 was considered as a significant statistical difference.Results:(1)Spatio-temporal parameter data:Comparing healthy people with KOA patients in one gait cycle,it is found that healthy people have larger step lengths,faster paces,longer duration of single support on the right side,and lower duration of double support.Two sets of data The differences were statistically significant(P<0.05);(2)Kinematics data:A comparison between healthy people and KOA patients in a gait cycle found that in addition to the extension angle,the knee joint of healthy people was in the sagittal plane(flexion/extension),coronal plane(adduction),horizontal plane(internal rotation/external rotation)have larger angles and range of motion.The comparison between groups found that only the flexion angle of the sagittal plane,the coronal adduction and abduction angles are statistically significant Difference(P<0.05),while the difference between the two groups in the coronal plane is not significant(P>0.05);(3)Kinetic data:In a gait cycle,healthy people compare with KOA patients and found that healthy people have greater stretching torque,The retraction moment is small,and the difference is statistically significant(P<0.05);while the flexion,abduction,internal rotation,and external rotation moments are not statistically significant(P>0.05);for the vertical return force,healthy people are more KOA patients were smaller,and the difference between the two groups was statistically significant(P<0.05);(4)Surface electromyography:lower extremity flexors and extensors-rectus femoris,medial femoris,lateral femoris,biceps femoris,gastrocnemius in KOA patients The RMS of the lateral head was lower than that of healthy people,and the difference was statistically significant(P<0.05);(5)Lower limb force line:KOA patients had a smaller varus angle and a larger tibial angle,and the difference was statistically significant(P<0.05)0.05),while the knee physiological valgus angle and joint space angle in the KOA group showed larger angles,but the difference was not statistically significant(P>0.05);(6)KOA patients’valgus angle was negatively correlated with the VAS score(r=-0.824,P<0.01),the tibiofemoral angle is positively correlated with VAS score(r=0.723,P<0.01);lower limb extensor amplitude is negatively correlated with VAS score(r=0.723,P<0.01),flexor amplitude is correlated with Negative correlation of VAS score(r=-0.828,P<0.01).Conclusion:(1)The lower extremity muscles of patients with KOA show uncoordinated activation of the flexors and extensors,and the pathological changes of the lower extremity force line bias can partially explain the "muscles and bones imbalance" in Chinese medicine.The biomechanical connotation of KOA,they are positively related to the clinical symptoms of KOA pain(2)The modern biomechanical pathological state of "muscles and bones imbalance" is mainly manifested in kinematic changes such as pace,step length decline,and joint range of motion;and The knee joint flexion and extension moments decrease,the adduction moment increases,and the vertical return force decreases.Part Two:Clinical Randomized Controlled Trial Study of Yi Jin Jing Gong Method Preventing and Treating KOAObjective:To verify the clinical efficacy of Yijinjing in preventing and treating KOA patients,and to provide evidence-based evidence for Yijinjing method to prevent and treat KOA.Methods:Fifty KOA patients were recruited from the Tuina Department of Yueyang Hospital.The patients were randomly divided into Yijin Jinggong method group and conventional stretching training group using random envelope method.The intervention methods mainly included 6 weeks of offline training and 6 weeks of home exercises.In addition,patients were asked to do home exercises for 20 minutes a day.Patients in the physical therapy group received recommended stretching training,and the Yijinjing group continued to practice exercises.For the exercises,both groups will receive the teaching content related to the knee joint.The clinical efficacy of patients with clinical pain,dysfunction,quality of life,mood disorder,etc.,as well as the muscle and bone biomechanics data of lower limb kinematics,dynamics,surface electromyography,and lower limb force lines were evaluated at the baseline of enrollment and at the 12th week of the intervention.SPSS25.0 statistical analysis was used to compare the differences in clinical efficacy and lower limb biomechanics between the two groups of patients,and P<0.05 was considered as a significant statistical difference.Results:(1)Pain and dysfunction:After the intervention,the comparison within the group showed:VAS,WOMAC pain,stiffness,dysfunction,Berg balance scale scores of the two groups were significantly lower than the scores before the intervention,and the difference was statistically significant(P<0.05);Comparison between groups showed no significant difference in pain and dysfunction scores between the two groups(P>0.05);(2)Quality of life:Comparison within groups after intervention showed:SF-36 physical health and mental health scores of the two groups The scores were significantly higher than those before the intervention,and the difference was statistically significant(P<0.05);the comparison between the two groups showed that the SF-36 mental health score of the two groups was better than the stretching group,and the difference was statistically significant(P<0.05).0.05);There was no statistically significant difference in SF-36 physical health scores between the two groups(P>0.05);(3)Mood disorder:intra-group comparison after intervention showed that the two groups of Baker Depression Scale and Perceived Stress Scale scores were better than those of intervention The former score decreased significantly,and the difference was statistically significant(P<0.05);comparisons between groups showed that the Baker Depression Scale and Perceived Stress Scale scores in the Gongfa group were lower,and the difference was statistically significant(P<0.05);(4)Physical activity and social support:After the intervention,the comparison within the group showed:;the scores of the two groups of social support scale were significantly higher than the scores before the intervention,and the difference was statistically significant(P<0.05);the comparison between the groups showed no significant difference between the two groups(P>0.05);(5 gait spatiotemporal parameters:comparison within the group after the intervention showed that the two groups showed changes in step length,faster pace,shorter double support time,and longer right single support time compared to before intervention.Statistically significant(P<0.05);comparison between groups showed no statistical difference between the two groups(P>0.05);(6)Gait kinematics parameters:flexion,adduction,abduction,internal rotation,The peak value of the external rotation angle and the maximum range of motion in the sagittal and coronal planes were larger than before the intervention,and the difference was statistically significant(P<0.05),while the extension angle and the maximum range of motion in the frontal plane had no significant changes before and after(P>0.05);The comparison between groups showed that the peak flexion angle of the Gongfa group was larger,and the Gongfa group was better,and the difference between the groups was statistically significant(P<0.05);(7)Gait dynamics parameters:comparison within the group after intervention showed:After the intervention,the flexion and extension joint torques of the two groups were higher than before the intervention,and the Z-axis vertical return force and the adductor joint torque were reduced,and the difference was statistically significant(P<0.05);while the abduction,internal rotation,and external rotation joints There was no significant change before and after the torque(P>0.05);the comparison between the groups showed that the buckling torque in the Gongfa group was larger,and the vertical return force was smaller.The difference was statistically significant(P<0.05).There was no academic difference between the other parameter groups(P>0.05);(8)Surface EMG RMS:Comparison within groups after intervention showed that the RMS of rectus femoris,medial femoris,lateral femoris,biceps femoris,and lateral head of gastrocnemius were all higher in the two groups than before intervention.The difference was statistically significant(P<0.05);comparison between groups showed that the two groups of flexor-biceps femoris and gastrocnemius lateral head exercise group showed lower scores,the exercise group was better than the stretching group,and there was a difference between the groups It is statistically significant(P<0.05),and there is no statistical difference between the other parameter groups(P>0.05);(9)Lower limb force line:after intervention,both within and between groups:varus angle,femoral tibial angle,There was no significant change in knee physiological valgus angle and clearance angle,and the difference was not statistically significant(P>0.05).Conclusion:(1)Yijinjing exercises can improve the clinical symptoms of pain and dysfunction in patients with KOA;improve the walking ability of patients and increase the range of joint motion;in addition,Yijinjing exercises can improve the quality of life of patients and improve mood disorders,etc.Better than conventional stretching training;(2)Yijinjing exercise can increase the activation of flexor and extensor muscles,increase the knee joint flexion and extension torque,and reduce the joint adduction torque,which may be the comprehensive biomechanical mechanism of Yijinjing onset(3)Yijin Meridian exercises can improve knee joint muscle activation,joint movement,and other "maintenance" properties,but cannot change the nature of knee joint force lines."First" academic thinking.Part Three:Analytical Research on Movement Biomechanics of Yi Jin Jing Gong MethodObjective:To apply motion capture to analyze the intervention of Yijin Jing,and to explore the biomechanical mechanism of the lower limbs.Methods:Recruit 18 Yi Jin Jing exercise experts from Shanghai University of Traditional Chinese Medicine Hospital and related exercise research institutions.The three-dimensional motion capture system was used to collect the dynamic data of the three-dimensional moments of the hip,knee,ankle and the vertical reaction force of the lower limbs under the subjects’ normal gait and exercise operation tasks.SPSS25.0 statistical analysis was used to compare the differences in lower limb dynamics among subjects in different task states and different exercise methods,and P<0.05 was considered as a significant statistical difference.Result:On the sagittal plane of the hip joint,the five movements of Yi Jin Jing(landing in three plates,the first position of the Wei Tuo offering the pestle,picking the stars and changing the fight,pulling the nine oxtail backwards,and spreading the wings)are the same as normal walking flexion and extension There are significant differences in peak torque compared with normal walking(P<0.05);on the coronal plane of the hip joint,the five exercises have significant differences compared with the adduction and abduction moments of normal walking,and both Greater than normal walking(P<0.05);on the level of the hip joint,there is no difference in peak torque between the five actions and normal walking(P>0.05).On the sagittal plane of the knee joint,the five movements are significantly different from the peak flexion and extension moments of normal walking,and they are all greater than those of normal walking(P<0.05);on the coronal plane of the knee joint,the five exercises are different from those of normal walking.There was a significant difference between the adduction and abduction moments of normal walking,and they were all smaller than those of normal walking(P<0.05);at the level of the hip joint,there was no difference between the peaks of the five actions and the normal walking moments(P>0.05).In the sagittal,coronal,and horizontal planes of the ankle joint,the peak moments of Yijinjing(the five movements of flexion,extension,adduction,abduction,internal rotation,and external rotation are all greater than those of normal walking,and the differences are all significantly different(P<0.05).The comparison of the vertical return force peaks of the five exercises and normal walking showed that the exercises showed a lower peak return force,and the difference was statistically significant(P<0.05).Conclusion:(1)Yijinjing exercise exercises can increase the hip,knee,joint flexion and extension moments and the three-dimensional joint moments of the ankle joint.This indicates that the hip,knee,and ankle muscle groups need to be recruited during the exercises.Can play a role in increasing muscle strength;(2)The knee joint adduction torque is lower during the operation of the exercise;(3)The increase in the strength of the hip,knee and ankle muscles of the lower limbs and the decrease in the medial load of the knee may be the exercise the lower limb dynamics mechanism of reducing KOA pain and improving the functional status of patients. |
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