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系統識別號 U0026-2008201915293800
論文名稱(中文) 不同自主先發性深層腹肌收縮策略對誘發下背痛患者腰椎多裂肌共同收縮之影響
論文名稱(英文) Effects of Different Volitional Preemptive Abdominal Contraction Strategies on Lumbar Multifidus Co-activation in Adults with Low Back Pain
校院名稱 成功大學
系所名稱(中) 物理治療學系
系所名稱(英) Department of Physical Therapy
學年度 107
學期 2
出版年 108
研究生(中文) 高潔妤
研究生(英文) Chieh-Yu Kao
學號 T66064027
學位類別 碩士
語文別 英文
論文頁數 95頁
口試委員 指導教授-蔡一如
口試委員-郭怡良
口試委員-王淑芬
中文關鍵字 自主先發性深層腹肌收縮  腹肌  多裂肌  超音波  肌電圖  下背痛 
英文關鍵字 volitional preemptive abdominal contraction  abdominal muscles  multifidus  ultrasonography  electromyography  low back pain 
學科別分類
中文摘要 背景與目的:下背痛是工作年齡人口中最常見的肌肉骨骼疾病,在下背痛患者中常可觀察到腰椎多裂肌的萎縮和其他深層核心肌群的活化延遲與活性下降。深層核心肌群的共同收縮對於維持脊椎穩定度十分重要,然而在臨床上很難特定活化腰椎多裂肌。在健康年輕人身上使用深層腹肌內縮策略已被證實可以誘發腰椎多裂肌的共同收縮,但是在下背痛患者身上使用這種自主先發性深層腹肌收縮策略是否也有效仍未可知。使用其他類型的自主先發性深層腹肌收縮策略(即深層腹肌外推策略)是否能誘發腰椎多裂肌的共同收縮也還缺乏實證。此外在不同姿勢下執行自主先發性深層腹肌收縮策略,是否會影響共同收縮反應也仍待釐清。因此,本篇研究的目的為探討不同自主先發性深層腹肌收縮策略在不同姿勢下對誘發下背痛患者腰椎多裂肌共同收縮之影響。
方法:本研究一共招募30位下背痛患者。分別使用超音波和肌電圖測量外側腹肌(腹外斜肌、腹內斜肌、腹橫肌)以及多裂肌(腰椎第4節/腰椎第5節和腰椎第5節/薦椎第1節)之肌肉厚度與肌肉活性。比較在執行3種自主先發性深層腹肌收縮策略時(不使用、深層腹肌內縮、深層腹肌外推)並配合3種姿勢下(臥姿、站姿、單腳站)之變化。每種情況(自主先發性深層腹肌收縮策略x姿勢)都會執行2次。資料統計使用3x3重複量測變異數分析,比較超音波和肌電圖之參數在3種自主先發性深層腹肌收縮策略配合3種姿勢下的變化與差異。當有顯著差異出現時則採用事後比較檢定。
結果:腰椎第4節/腰椎第5節和腰椎第5節/薦椎第1節之多裂肌在所有姿勢下,使用自主先發性深層腹肌收縮策略時比較不使用時,肌肉厚度與肌肉活性都有明顯增加。比較執行深層腹肌內縮和深層腹肌外推策略,深層腹肌內縮策略有顯著較高的腹橫肌特定活化比率,而深層腹肌外推策略則有顯著較高的腰椎多裂肌特定活化比率。
結論:不同自主先發性深層腹肌收縮策略在各種姿勢影響下,仍有助於誘發下背痛患者腰椎多裂肌和腹橫肌等深層脊椎穩定肌群活化。使用深層腹肌內縮策略能使腹橫肌更顯著活化,而使用深層腹肌外推策略則更有利於腰椎多裂肌活化。未來研究可以探討自主先發性深層腹肌收縮策略用於下背痛患者的訓練腰部多裂肌之長期效益。
英文摘要 Introduction and purpose: Low back pain (LBP) is the most common musculoskeletal complaints among adults of working age population. Lumbar multifidi (MF) atrophy and other deep core muscles delayed onset and decreased activation have been identified in the adults with LBP. Co-contraction of deep core muscles is critical for sustaining spinal stability while the MF is difficult to be specifically activated. Lumbar MF has proved to be co-activated during the abdominal drawing in healthy young adults. However, it is unknown whether such volitional preemptive abdominal contraction (VPAC) strategy is still effective in the adults with LBP. Whether other type of VPAC strategy (i.e., abdominal push out) could also induce the MF co-activation, and whether such responses might be affected by the postural conditions remain unknown. Thus, the purpose of this study was to investigate the effects of different VPAC strategies on co-activation of the lumbar MF in different postural conditions in the adults with LBP.
Methods: Thirty adults with LBP participated in this study. Thickness and activity of the abdominal muscles including external obliques (EO), internal obliques (IO), and transversus abdominis (TrA) along with the MF at the L4/L5 and L5/S1 level were measured using the ultrasound imaging (USI) and surface electromyography (EMG) during 3 VPAC strategies (no-VPAC, NO; abdominal draw-in, AD; and abdominal push-out, AP) under 3 postural conditions (lying, upright standing and single leg standing). Two trials were obtained for each condition. 3x3 repeated measures ANOVAs were used to compare the differences between VPAC strategies (NO vs. AD vs. AP) and postural conditions (lying vs. quiet standing vs. single leg standing) for the USI and EMG variables. Post hoc analysis was conducted as indicated.
Results: Significant increases in muscle thickness change and muscle activity were found in the L4/L5 and L5/S1 MF during both VPAC strategies than the NO strategy in all postural conditions. Higher preferential activation ratios of L4/L5 and L5/S1 MF were found during the AP than the AD strategy, while higher preferential activation ratios of TrA were found during the AD than the AP strategy.
Conclusions: The VPAC strategies were effective on deep stabilizing spinal muscles activation including both TrA and MF in the adults with LBP despite postural challenges. The TrA recruitment was more evident during the AD strategy while more obvious MF recruitment during the AP strategy. Future studies should examine the long-term effects of the VPAC strategies on the lumbar MF training in patients with LBP.
論文目次 Chapter 1 Introduction 1
1.1 Background 1
1.2 Purposes and hypotheses 4
Chapter 2 Literature Review 6
2.1 Epidemiology of low back pain 6
2.2 Physical impairments of LBP 7
2.3 Morphological and neuromuscular changes in low back pain adults 9
2.3.1 Morphological changes 9
2.3.2 Neuromuscular changes 10
2.4 Concepts of spinal stability 13
2.5 Anatomy and functions of the local stabilizing spinal muscles 14
2.6 Effects of volitional preemptive abdominal contraction strategies 16
2.6.1 Abdominal draw-in maneuver 17
2.6.2 Abdominal bracing maneuver 18
2.7 Potential effects of the abdominal push-out maneuver 20
Chapter 3 Research Designs and Methodology 22
3.1 Participants 24
3.2 Instrumentations 24
3.2.1 Numeric rating scale (NRS) 24
3.2.2 Mandarin Chinese version of Oswestry Disability Index (ODI) 25
3.2.3 Chinese version of Fear-Avoidance Beliefs Questionnaire (FABQ) 25
3.2.4 Sonography measurement system 26
3.2.5 Wireless surface electromyography (EMG) system 28
3.3 Procedures 29
3.3.1 Basic data collection and examinations for low back pain 29
3.3.2 Volitional preemptive abdominal contraction strategies education 31
3.3.3 Postural conditions 32
3.3.4 Ultrasound imaging and electromyography data collection 33
3.4 Data reduction and analysis 36
3.4.1 Ultrasound imaging data 36
3.4.2 Electromyography data 38
3.5 Statistical analysis 39
Chapter 4 Results 40
4.1 Basic characteristics, pain history and results of physical examinations 40
4.2 Ultrasound imaging data 43
4.2.1 Muscle thickness change 43
4.2.2 Preferential activation ratio 55
4.3 Electromyography data 60
4.3.1 Muscle activities 60
4.3.2 Co-contraction index 72
Chapter 5 Discussions 75
5.1 MF co-activation 75
5.2 IO and TrA activations 76
5.3 EO activations 77
5.4 Postural condition effects 78
5.5 The characteristic descriptions of the participants 79
5.6 Clinical relevance 80
5.7 Limitations 81
Chapter 6 Conclusions 83
References 84
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張巧瑩(2008)。中文版恐懼迴避信念量表之心理計量特性。國立陽明大學物理治療暨輔助科技學系碩士論文,台北市。
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