PDF(Pubmed)
Abstract：
Joint hypermobility is a common clinical finding amongst hereditary connective tissue disorders that is observed in pediatric rheumatological settings, and often associated with chronic pain. Joint hypermobility may also contribute to deficits in physical functioning and physical activity, but previous findings have been inconsistent. It is possible that physical activity impairment in joint hypermobility may be due to chronic aberrant movement patterns subsequent to increased joint laxity.
As part of a larger randomized pilot trial of juvenile onset fibromyalgia (JFM), a secondary analysis was conducted to explore whether adolescents with JFM and joint hypermobility differed from non-joint hypermobility peers in terms of pain, daily functioning, and biomechanics (i.e., kinetics and kinematics) during a moderately vigorous functional task.
From the larger sample of adolescents with JFM (N = 36), 13 adolescents (36.1%) met criteria for joint hypermobility and 23 did not have joint hypermobility. Those with joint hypermobility exhibited poorer overall functioning (Md = 20, Q1,Q3 [5.8, 7.6] vs. Md = 29, Q1,Q3 [5.1, 7.6]) but there were no differences in pain (Md = 6.9, Q1,Q3 [22, 33], vs. Md = 6.45, Q1,Q3 [15, 29.5]). Inspection of time-series plots suggests those with joint hypermobility exhibited decreased hip flexion and frontal plane hip moment (e.g., resistance to dynamic valgus) during the landing phase (early stance) and greater hip and knee transverse plane moments during the propulsion phase (late stance) of the drop vertical jump task (DVJ). No other differences in lower extremity biomechanics were observed between study groups.
In this exploratory study, there were small but notable differences in biomechanics between patients with JFM who also had joint hypermobility versus those without joint hypermobility during a landing and jumping task (e.g., DVJ). These differences may indicate decreased joint stiffness during landing, associated with increased joint laxity and decreased joint stability, which may put them at greater risk for injury. Further study with a larger sample size is warranted to examine whether these biomechanical differences in patients with JFM and joint hypermobility affect their response to typical physical therapy or exercise recommendations.
As part of a larger randomized pilot trial of juvenile onset fibromyalgia (JFM), a secondary analysis was conducted to explore whether adolescents with JFM and joint hypermobility differed from non-joint hypermobility peers in terms of pain, daily functioning, and biomechanics (i.e., kinetics and kinematics) during a moderately vigorous functional task.
From the larger sample of adolescents with JFM (N = 36), 13 adolescents (36.1%) met criteria for joint hypermobility and 23 did not have joint hypermobility. Those with joint hypermobility exhibited poorer overall functioning (Md = 20, Q1,Q3 [5.8, 7.6] vs. Md = 29, Q1,Q3 [5.1, 7.6]) but there were no differences in pain (Md = 6.9, Q1,Q3 [22, 33], vs. Md = 6.45, Q1,Q3 [15, 29.5]). Inspection of time-series plots suggests those with joint hypermobility exhibited decreased hip flexion and frontal plane hip moment (e.g., resistance to dynamic valgus) during the landing phase (early stance) and greater hip and knee transverse plane moments during the propulsion phase (late stance) of the drop vertical jump task (DVJ). No other differences in lower extremity biomechanics were observed between study groups.
In this exploratory study, there were small but notable differences in biomechanics between patients with JFM who also had joint hypermobility versus those without joint hypermobility during a landing and jumping task (e.g., DVJ). These differences may indicate decreased joint stiffness during landing, associated with increased joint laxity and decreased joint stability, which may put them at greater risk for injury. Further study with a larger sample size is warranted to examine whether these biomechanical differences in patients with JFM and joint hypermobility affect their response to typical physical therapy or exercise recommendations.
摘要：
背景：关节过度活动是在小儿风湿病环境中观察到的遗传性结缔组织疾病中常见的临床发现，常伴有慢性疼痛.关节过度活动也可能导致身体功能和身体活动的缺陷，但是以前的发现并不一致。关节过度活动的身体活动障碍可能是由于关节松弛度增加后的慢性异常运动模式所致。
方法：作为青少年发作性纤维肌痛（JFM）的较大随机试点试验的一部分，进行了次要分析，以探讨JFM和关节过度活动的青少年在疼痛方面是否与非关节过度活动的同龄人不同，日常运作，和生物力学(即，动力学和运动学）在中等强度的功能任务中。
结果：从JFM青少年的较大样本（N=36）中，13名青少年（36.1％）符合关节活动过度标准，23名青少年没有关节活动过度。那些关节过度活动的患者表现出较差的整体功能（Md=20，Q1，Q3[5.8，7.6]与Md=29,Q1,Q3[5.1,7.6]),但疼痛无差异(Md=6.9,Q1,Q3[22,33],vs.Md=6.45,Q1,Q3[15,29.5])。对时间序列图的检查表明，关节过度活动的人表现出髋关节屈曲和额平面髋关节力矩降低（例如，对动态外翻的抵抗力）在降落阶段（早期站立）以及在降落垂直跳跃任务（DVJ）的推进阶段（后期站立）期间更大的臀部和膝盖横向平面力矩。在研究组之间没有观察到下肢生物力学的其他差异。
结论：在这项探索性研究中，在着陆和跳跃任务期间，也有关节过度活动的JFM患者与没有关节过度活动的JFM患者之间的生物力学存在很小但显着的差异（例如，DVJ).这些差异可能表明着陆期间关节刚度降低。与关节松弛增加和关节稳定性降低相关，这可能会使他们面临更大的受伤风险。有必要进行更大样本量的进一步研究，以检查JFM和关节过度活动患者的这些生物力学差异是否会影响他们对典型物理治疗或运动建议的反应。
方法：作为青少年发作性纤维肌痛（JFM）的较大随机试点试验的一部分，进行了次要分析，以探讨JFM和关节过度活动的青少年在疼痛方面是否与非关节过度活动的同龄人不同，日常运作，和生物力学(即，动力学和运动学）在中等强度的功能任务中。
结果：从JFM青少年的较大样本（N=36）中，13名青少年（36.1％）符合关节活动过度标准，23名青少年没有关节活动过度。那些关节过度活动的患者表现出较差的整体功能（Md=20，Q1，Q3[5.8，7.6]与Md=29,Q1,Q3[5.1,7.6]),但疼痛无差异(Md=6.9,Q1,Q3[22,33],vs.Md=6.45,Q1,Q3[15,29.5])。对时间序列图的检查表明，关节过度活动的人表现出髋关节屈曲和额平面髋关节力矩降低（例如，对动态外翻的抵抗力）在降落阶段（早期站立）以及在降落垂直跳跃任务（DVJ）的推进阶段（后期站立）期间更大的臀部和膝盖横向平面力矩。在研究组之间没有观察到下肢生物力学的其他差异。
结论：在这项探索性研究中，在着陆和跳跃任务期间，也有关节过度活动的JFM患者与没有关节过度活动的JFM患者之间的生物力学存在很小但显着的差异（例如，DVJ).这些差异可能表明着陆期间关节刚度降低。与关节松弛增加和关节稳定性降低相关，这可能会使他们面临更大的受伤风险。有必要进行更大样本量的进一步研究，以检查JFM和关节过度活动患者的这些生物力学差异是否会影响他们对典型物理治疗或运动建议的反应。
