A Meta-Analysis to Determine if Lower Extremity Muscle Strengthening Should Be Included in Military Knee Overuse Injury-Prevention Programs

作者：Kollock Roger O; Andrews Corey; Johnston Ashlyn; Elliott Teresa; Wilson Alan E; Games Kenneth E; Sefton JoEllen M^*

来源：Journal of Athletic Training, 2016, 51(11): 919-926.

DOI：10.4085/1062-6050-51.4.09

• hip strength
• patellofemoral pain syndrome
• iliotibial band syndrome
• warfighters

Context: Knee overuse injuries are the most common musculoskeletal complaints in military trainees and are common in active-duty warfighters. Muscle strengthening is usually recommended; however, research is conflicting in this area, which makes it difficult to develop effective screening, prevention, and training interventions for warfighters.
Objective: To determine if lower extremity muscular weakness contributes to knee overuse injuries and identify specific muscular involvement.
Data Sources: We searched MEDLINE, PubMed, Web of Science, SPORTDiscus, CINAHL, and Military & Government Collection and reference lists of relevant articles published between January 1, 2000, and January 1, 2013.
Study Selection: For inclusion, requirements were uninjured and injured groups; provision of the sample size, means, and standard deviations for all groups; identification of the specific muscles assessed; and clearly defined knee injury.
Data Extraction: Sample size, sex, and muscle strength means and standard deviations.
Data Synthesis: Twenty-five studies met these criteria. We used the Scottish Intercollegiate Guidelines Network algorithm to determine the appropriate tool for appraising article quality. Unweighted random-effects model meta-analyses were conducted. Separate meta-analyses were performed for the moderators of strength measurement scale (absolute or normalized muscle strength), muscle group, and sex. A weighted random-effects model with a Hedges g effect metric and 95% confidence intervals were used for comparison across studies.
Conclusions: Our meta-analysis suggests that individuals with symptoms of a knee overuse injury have lower absolute and normalized hip muscle strength. Specifically, they had lower absolute hip external-rotator, knee-extensor, and knee-flexor strength, as well as lower normalized hip external-rotator, hipextensor, and hip-abductor strength, compared with asymptomatic control participants. The findings suggest a possible link between lower hip and thigh strength and knee overuse injuries. Further research is needed to determine if weakness is a cause or a result of knee overuse injuries before screening and intervention can be developed for at-risk warfighters.

• 出版日期2016-11