Razi Journal of Medical Sciences

fa اثر تحریک فراجمجمه‌ای قشر حرکتی اولیه (M1)، بر نیروی عکس‌العمل زمین طی فرود در افراد دارای درد کشککی-رانی The Effect of Transcranial Stimulation of Primary Motor Cortex (M1) on the Ground Reaction Force During Landing in People with Patellofemoral Pain طب ورزش Sports Medicine پژوهشي Research <div style="text-align: justify;">زمینه و هدف: تحریک فراجمجمه ای قشر حرکتی اولیه به طور گستردهای در درمان چندین اختلال عصبی همچون درد کشککی-رانی مورد استفاده قرار میگیرد. لذا، هدف از پژوهش حاضر بررسی تاثیر تحریک فراجمجمه ای قشر حرکتی اولیه بر نیروی عکس العمل زمین طی فرود در افراد دارای درد کشککی-رانی بود. روش کار: تحقیق حاضر از نوع نیمهتجربی و آزمایشگاهی با طرح پیش آزمون و پس آزمون بود. جامعه آماری تحقیق حاضر کلیه مردان با عارضه درد کشککی-رانی با دامنه سنی 30-25 سال شهرستان اردبیل بود. نمونه آماری شامل 24 نفر بود که به صورت هدفمند و در دسترس در دو گروه تجربی و کنترل جای گرفتند. قبل و بعد از اثر تحریک فراجمجمه ای قشر حرکتی متغیر نیروهای عکسالعمل زمین با استفاده از دستگاه صفحه نیرو اندازهگیری شد. برای مقایسه میانگین بین گروهی از آزمون آنالیز واریانس دوسویه، و مقایسه میانگین درون گروهی از آزمون تیزوجی استفاده شد. برای تجزیه و تحلیل دادهها از نرم افزار SPSS نسخه 24 استفاده شد. یافته ها: نتایج نشان داد در گروه تجربی، تحریک فراجمجمهای قشر حرکتی اولیه بر نیروی عکسالعمل زمین در راستای قدامی-خلفی در مرحله جدا شدن پنجه پا طی پسآزمون در مقایسه با پیشآزمون به صورت معنادار کاهش پیدا کرد (035/0=P). همچنین در گروه تجربی، تحریک فراجمجمهای قشر حرکتی اولیه بر نیروی عکسالعمل زمین در راستای عمودی طی پسآزمون در مقایسه با پیشآزمون به صورت معنادار افزایش پیدا کرد (010/0=P). به علاوه در گروه تجربی، تحریک فراجمجمهای قشر حرکتی اولیه بر زمان رسیدن به اوج مولفه داخلی-خارجی (003/0=P) و قدامی-خلفی  (001/0=P) مرحله جدا شدن پنجه پا در پسآزمون در مقایسه با پیشآزمون به صورت معنادار افزایش پیدا کرد. نتیجه گیری: بر اساس نتایج بهنظر میرسد که تحریک فراجمجمه ای قشر حرکتی اولیه مغز (M1)، منجر به کاهش نیروهای عکسالعمل زمین، نرخ بارگذاری و بهبود فعالیت روزمره آزمودنی ها شد. لذا، میتوان از تحریک فرا جمجمه ای قشر حرکتی اولیه ارزش کلینیکی برای کاهش درد و آسیبهای ثانویه در نظر گرفت.</div> <div style="text-align: justify;">Background & Aims: Transcranial stimulation of the primary motor cortex is widely used in the treatment of several neurological disorders such as patellofemoral pain. Patellofemoral pain syndrome, is one of the most common orthopedic knee disorders among young and adult people (1). The prevalence of this complication in women is 2.23% higher compared to men. Most people with this syndrome are reported to be 18-35 years old with a prevalence of 13% (5). Based on these findings, interventions aimed at reducing injuries and forces during various activities and improving performance in the field of patellofemoral pain seem important. In this regard, researchers have used several methods (rest, weight intolerance, ice and heat therapy, anti-inflammatory drugs and physiotherapy treatments such as transcutaneous electrical nerve stimulation), interference currents, dynamic currents., water therapy, tipping) have been used for treatment. Transcranial direct current stimulation (tDCS) is also a non-invasive, painless and easy brain stimulation method that causes the excitability of brain pathways, for example from the cortex to the muscles (excitability of the motor cortex) and causes cortical flexibility. It can be (17). Studies have shown that transcranial stimulation of the primary motor cortex of the brain can lead to the improvement of patellofemoral pain by affecting the muscles of the knee joint (18, 19). Cranial direct current stimulation is a non-invasive technique that is used to change the activity of the cerebral cortex and is widely used in the treatment of several neurological disorders (20, 21). A weak electric current enters the brain through 2 electrodes that are placed on the skull of people (22). This form of flow is able to create changes in the electrical activity inside and outside the neuron, which leads to a change in the resting potential of the membrane and thus improves the efficiency of the nerve synapse. These adjustments are not enough to generate an action potential, but they are enough to change the response threshold of the stimulated neuron (23). Therefore, the aim of present study was to investigate the effect of transcranial stimulation of primary motor cortex on the ground reaction force during landing in people with patellofemoral pain. Methods: The present research was a semi-experimental and laboratory type with a pre-test and post-test design. The statistical population of the present study was men with patellofemoral pain syndrome with an age range of 25-30 years in Ardabil city, and 24 subjects were placed in two experimental and control groups. Before and after transcranial stimulation of variable motor cortex, ground reaction forces were measured using a force plate device. Among the inclusion criteria of the present study are things such as: 1) the presence of patellar pain that occurs during at least two activities, from the set of activities of squatting, running, lying, going up and down the stairs, and kneeling (28). 2) performing the single-leg squat test on the leg up to an angle of 45 degrees for 10 seconds and reporting pain at least three or higher by the person on the visual pain chart (29). Also, the conditions for the subjects to leave include a history of surgery, a history of mental illnesses, skin diseases, cardiovascular diseases, diabetes, receiving a rehabilitation program within three months before entering the study, a history of injury in lower limbs, deformities in the trunk, neurological, rheumatologically and other musculoskeletal diseases in the lower limbs and pain in the back, pelvis and sacroiliac region, history of vertigo, uncorrected vision problems and inner ear disorders, and unwillingness to cooperate Cited. Two-way analysis of variance was used to compare the mean between groups, and paired t-test was used to compare the mean within the group. SPSS version 24 software was used for data analysis. Results: The results showed that in the experimental group, the transcranial stimulation of the primary motor cortex on the ground reaction force in the anterior-posterior direction during the push-off phase during the post-test significantly decreased compared to the pre-test (P=0.035). Also, in the experimental group, the transcranial stimulation of the primary motor cortex on the ground reaction force in the vertical direction during the post-test significantly increased compared to the pre-test (P=0.010). In addition, in the experimental group, the transcranial stimulation of the primary motor cortex on the time to peak of the medial-lateral (P=0.003) and anterior-posterior (P=0.001) components of the push -off phase significantly increased in the post-test compared to the pre-test. Conclusion: Based on the results, it seems that transcranial stimulation of the primary motor cortex (M1) of the brain led to a reduction in ground reaction forces, loading rate, and improvement in daily activities of the subjects. Based on previous studies, the occurrence of disturbance in the peak of the ground reaction forces and the time to reach it in people with patellofemoral pain reflects the loss of intermuscular coordination and the adoption of simple movement strategies (37, 38). Probably, due to pain, sufferers of this syndrome use a simple movement pattern to feel less pain. Based on previous studies, the results have shown that the transcranial stimulation of the primary motor cortex has led to the reduction of patellofemoral pain, so that the reduction of pain in these patients can lead to the improvement of their performance in various activities (39). In the present research, the results showed that the component of the ground reaction force in the anterior-posterior direction decreased during landing, which indicates the improvement of the displacement of the center of pressure and balance during landing. Based on the hypothesis of stiffness of the ankle muscles, direct current stimulation of the brain's andales activates the descending corticospinal projections and increases the stability of the ankle joint (40). On the other hand, in explaining the results related to the peak of the ground reaction forces, it can be said that the longer the time to reach the peak of the ground reaction forces increases, the more effective the forces are in any physical activity such as walking, running, and descending from The step is reduced and as a result the probability of injury will be less (51). In the current research, the time to reach the peak of the ground reaction forces in the internal-external, anterior-posterior directions showed a significant increase. Therefore, transcranial stimulation of the primary motor cortex can be considered of clinical value for reducing pain and secondary injuries.</div> نیروی عکس‌العمل زمین, درد کشککی-رانی, تحریک فراجمجمه‌ای, فرود Ground Reaction Force, Patellofemoral Pain, Transcranial Stimulation, Landing 1 12 http://rjms.iums.ac.ir/browse.php?a_code=A-10-7437-1&slc_lang=fa&sid=1 Mohsen Barghamadi محسن برغمدی barghamadi@uma.ac.ir 3900319475328460087516 3900319475328460087516 Yes Associate Professor of Sports Biomechanics, Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran دانشیار بیومکانیک ورزشی، گروه بیومکانیک ورزشی، دانشکده علوم تربیتی و روانشناسی، دانشگاه محقق اردبیلی، اردبیل، ایران Mohsen Gholizadeh محسن قلی زاده 3900319475328460087517 0009-0007-0556-9916 No MSc in Sports Biomechanics, Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran کارشناس ارشد بیومکانیک ورزشی، گروه بیومکانیک ورزشی، دانشکده علوم تربیتی و روانشناسی، دانشگاه محقق اردبیلی، اردبیل، ایران Khashayar Alapour خشایار علاپور 3900319475328460087518 0009-0008-3665-2234 No PhD Student, Islamic Azad University, Sari Branch, Iran دانشجوی دکتری فیزیولوژی ورزشی، دانشگاه آزاد اسلامی واحد ساری، ایران Ebrahim Piri ابراهیم پیری 3900319475328460087519 3900319475328460087519 No PhD Student in Sports Biomechanics, Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran دانشجوی دکتری بیومکانیک ورزشی، گروه بیومکانیک ورزشی، دانشکده علوم تربیتی و روانشناسی، دانشگاه محقق اردبیلی، اردبیل، ایران Ali Fakourian علی فکوریان 3900319475328460087520 3900319475328460087520 No Assistant Professor of Sports Physiology, Department of Sports Physiology, Faculty of Physical Education and Sports Sciences, Shahid Sattari Air Force University, Tehran, Iran استادیار فیزیولوژی ورزشی، گروه فیزیولوژی ورزشی، دانشکده تربیت بدنی و علوم ورزشی، دانشگاه نیروی هوایی شهید ستاری، تهران، ایران Ali Nosrati Heshi علی نصرتی هشی 3900319475328460087521 3900319475328460087521 No PhD Student of sports physiology, Department of Sports Physiology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran دکتری فیزیولوژی ورزشی، گروه فیزیولوژی ورزشی، دانشکده علوم تربیتی و روانشناسی، دانشگاه محقق اردبیلی، اردبیل، ایران