Background

In patients with peripheral arterial disease and presenting intermittent claudication (PAD-IC), the pain due to ischemia impacts gait parameters, particularly in cases of unilateral disease. Deterioration of gait parameters in a pathological context is frequently associated with increased coactivation (simultaneous activation of agonist and antagonist muscles around a joint).

Research question

Does unilateral PAD-IC affect the coactivation pattern during walking? Does the coactivation pattern change with increasing pain intensity?

Method

We evaluated symptomatic and asymptomatic legs in 17 subjects with unilateral PAD-IC and 16 without PAD-IC (control group), during walking. Tibialis anterior (TA) and gastrocnemius medialis (GM) electromyographic activity, and peaks of vertical ground reaction force were recorded in this prospective study. We analyzed the coactivation index (CI_(GM/TA)) during three periods (pain-free, pain and maximum pain) and phases of the gait cycle. Statistical analysis was carried out using the ANOVA procedure.

Results

During single support, CI_(GM/TA) increases in the symptomatic leg during the pain period (+28 %) and in the asymptomatic leg during the maximum pain period (+29 %). During second double support, CI_(GM/TA) increases in the symptomatic leg only (+49 %). In these gait phases, pain elicits differences in CI_(GM/TA) between legs (p < 0.05). Second peak force decreases in the symptomatic leg only (−9%) and is negatively correlated with CI_(GM/TA) during the three periods (r = −0.57; −0.76 and −0.78 respectively, p < 0.05). No difference is found in the control group.

Significance

The appearance and development of pain in the lower limbs is associated with a higher level of CI_(GM/TA), revealing a compensatory gait pattern in PAD-IC patients. Optimal prevention, rehabilitation and re-training strategies for PAD-IC patients should take into consideration neuromuscular compensatory mechanisms between asymptomatic and symptomatic legs.

中文翻译：

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间歇性lau行患者在跑步机行走过程中腿部肌肉的共激活模式

背景

在患有周围动脉疾病并出现间歇性c行的患者中，由于缺血引起的疼痛会影响步态参数，尤其是在单侧疾病的情况下。在病理情况下步态参数的恶化通常与共激活（同时激活关节周围激动剂和拮抗肌的激活）有关。

研究问题

单边PAD-IC是否会影响步行过程中的共激活模式？共激活模式会随着疼痛强度的增加而改变吗？

方法

在步行过程中，我们评估了17例单侧PAD-IC和16例无PAD-IC的受试者的有症状和无症状腿（对照组）。这项前瞻性研究记录了胫前肌（TA）和腓肠肌（GM）的肌电图活动以及垂直地面反作用力的峰值。我们分析了步态周期三个阶段（无痛，疼痛和最大疼痛）和阶段的共激活指数（CI _{（GM / TA）}）。使用ANOVA程序进行统计分析。

结果

在单次支持期间，CI _{（GM / TA）}在疼痛期的有症状腿部增加（28％），而在最大疼痛期的无症状腿部增加（29％）。在第二次双重支持期间，CI _{（GM / TA）}仅在有症状的腿中增加（+49％）。在这些步态阶段，疼痛引起两腿间CI _{（GM / TA）的}差异（p <0.05）。第二峰值力在腿症状仅（-9％）减小，与CI呈负相关_{（GM / TA）}在三个周期（R = -0.57; -0.76和-0.78分别，P <0.05）。在对照组中没有发现差异。

意义

下肢疼痛的出现和发展与CI _{（GM / TA）}升高有关，揭示了PAD-IC患者的代步方式。对于PAD-IC患者，最佳的预防，康复和再培训策略应考虑无症状和有症状的双腿之间的神经肌肉补偿机制。