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系統識別號 U0026-3006201514223400
論文名稱(中文) 足球選手之腰痛研究:例行核心運動訓練外加髂腰肌鬆動術之療效與分析
論文名稱(英文) The effect of additional myofacial release to core stability training for football players with iliopsoas related 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 103
學期 2
出版年 104
研究生(中文) 胡晢容
研究生(英文) Che-Jung Hu
學號 T66991062
學位類別 碩士
語文別 英文
論文頁數 76頁
口試委員 口試委員-林麗娟
口試委員-蔡一如
指導教授-陳文玲
中文關鍵字 腰椎失穩  髂腰肌緊縮  核心穩定訓練  下背痛 
英文關鍵字 instability  iliopsoas tightness  core stability training  low back pain 
學科別分類
中文摘要 研究背景: 腰椎失穩與髂腰肌緊縮是兩種常見於背痛複雜成因常見的原因之一。過去文獻指出腰椎失穩可能是由於髂腰肌緊縮,衍生出包括疼痛、以及骨盆周圍相關肌群之柔軟度與肌力不足等相關臨床症狀而導致。另一方面,運動員腰痛與髂腰肌緊縮之流行率均頗高,可能因此影響運動表現。近年來許多文獻指出與廣泛的應用核心穩定訓練,做為下背痛的基本復健計畫。然而至今卻鮮有文獻針對呈現髂腰肌緊縮相關背痛之運動員,檢定其腰椎穩定度,並探討僅憑核心穩定訓練介入,或進一步外加髂腰肌鬆動術治療後,在相關臨床表徵與運動員運動表現方面的療效與效果。研究目的:本研究主要是要探討腰椎核心穩定訓練計畫在髂腰肌緊縮相關背痛之運動員身上之療效,進而檢定外加髂腰肌筋膜徒手技巧治療計畫後可能產生的療效。研究方法:本研究共徵召22位高中足球選手,進行理學檢查與臨床測試評估,並依檢測結果分成同時呈現腰椎失穩及髂腰肌緊縮者7人、僅腰椎失穩或髂腰肌緊縮者各4人、以及健康控制組7人等4小組。接下來,所有受試者,皆需接受10週腰椎核心穩定訓練計畫。之後,針對呈現髂腰肌緊縮的受試者,將額外繼續接受4週的肌筋膜徒手治療以及常規足球訓練。至於其餘無髂腰肌緊縮之表徵之運動員,則僅接受常規足球訓練。本研究將於延攬之初進行首次評估,經過兩個月的介入前對照階段後進行二度評估,然後介入腰椎核心穩定訓練計畫之後進行三度評估,最後再介入髂腰肌筋膜徒手技巧治療,並進行四度評估以結束整個療效追蹤。評估項目包括一系列之理學檢查、臨床測試評估、背部肌肉肌電活動評估與運動表現之評估。結果:受試者於兩個月的對照階段前後,並未呈現任何顯著之變化。經過10週腰椎核心穩定訓練計畫後,僅腰椎失穩及無髂腰肌緊縮組,呈現顯著的腰椎失穩比例下降、疼痛減輕與動作過程中背部肌肉肌電活動下降以及局部肌力與運動表現顯著改善的現象(p<0.05)。另外,所有呈現髂腰肌緊縮的受試者,則需經過4週額外肌筋膜徒手治療後,才呈現類似的進步,例如腰椎失穩比例下降、疼痛減輕與動作過程中背部肌肉肌電活動下降,髂腰肌與髖關節旋轉肌群柔軟度顯著增加以及局部肌力與運動表現顯著改善(p<0.05)。
結論:本研究提供具體證據支持,無髂腰肌緊縮之足球選手接受10週例行性腰椎核心穩定訓練計畫後,能夠有效改善腰椎失穩比例、疼痛、動作過程中背部肌肉肌電活動表現、局部肌力以及運動表現。反之,呈現髂腰肌緊縮之足球選手,則需於完成4週額外肌筋膜徒手治療後,才能出現顯著之改善。綜上所述,本研究結果間接證明髂腰肌緊縮可能是腰椎失穩的主要原因之一,此發現對於髂腰肌緊縮流行率頗高的運動族群來說格外重要。臨床上在面對髂腰肌緊縮的背痛運動員時,其訓練計畫之設計需於進行例行性核心穩定訓練前即施予髂腰肌緊縮相關的治療,才能有效改善腰椎失穩等相關臨床症狀,並提昇進運動表現。
英文摘要 Background: Lumbar segmental instability and iliopsoas tightness are recognized as contributing factors to identifiable subgroups of individuals among the heterogeneous LBP conditions. The lumbar segmental instability might be caused by the iliopsoas tightness that aggravated lumbar lordosis, indirectly resulting in low back pain, decreased muscle strength or flexibility around pelvic region, and over activities of lumbar muscles during lumbar flexion. In addition, high prevalence of iliopsoas tightness and back pain has been reported in football players. However, direct link between iliopsoas tightness and lumbar instability is still lacking. In addition, no studies have investigated the effects of core stability training in football players with iliopsoas related back pain, especially focusing on the improvement of sports performance. Purpose: This study aimed to investigate the effects of the core stabilization exercise (CSE) on sports performance in football players with or without iliopsoas tightness. The effect of additional myo-facial release techniques was also examined. Methods: Twenty-two high school football players were divided into 4 different groups, 7 with instability and iliopsoas tightness (LI-IT), 4 with iliopsoas tightness (nonLI-IT) and 4 with instability (LI-nonIT) with chronic low back pain, and 7 non-symptomatic controls, were recruited based on physical assessments and clinical tests in the beginning. All subjects participated in CSE training for 10 weeks. Subjects with iliopsoas muscle tightness (IT) were then arranged to take 4 additional weeks of myofascial release (MR) treatments and regular football training after completing post-CSE assessment. Meanwhile, subjects without iliopsoas muscle tightness (non-IT) and the 7 control subjects only took regular football training. A series of physical assessments focusing on the assessment of pain status, the flexibility and strength tests for trunk and hip muscles , muscle activation patterns for back extensors during prone hip extension and standing lumbar flexion movements, and sports performances were arranged at different stage points, including the initial assessments (Initial),the assessments two months (the control phase) prior to CSE (pre-CSE ), the assessments post CSE (post-CSE), and the 4th assessments after completing MR treatments(post-MR). Results: No significant differences were found between the first two assessments before and after the control phase for all sub-groups. After completing 10 weeks CSE training, significant improvements were only found in the LI-nonIT group, including the proportion of lumbar instability, pain intensity, paravertebral muscle activities at full lumbar flexion and the reversed phase, the flexibility of hip rotators and the strength of hip and trunk flexors and extensors, and sports performances. (p<0.05). However, after completing the MR treatment, the groups with IT also exhibited significant improvement in the proportion of lumbar instability, pain intensity, paravertebral muscle activities at full lumbar flexion and the reversed phase, the flexibility of hip rotators and the strength of hip and trunk flexors and extensors, and sports performances. (p<0.05). Conclusion: This study has confirmed the effect of CSE training for the football players with LI but without iliopsoas tightness. However, significant improvements were not found in subjects with iliopsoas tightness until completing additional MR treatment. The results have suggested a priority of treating iliopsoas tightness before CSE training is conducted for the young athletes with iliopsoas related back pain. These results might clearly imply the importance of iliopsoas associated with active system of lumbar stability in the treating young athletes with lower crossed syndrome. In conclusion, this study was the first research to provide evidence for supporting the effects of CSE training and MR treatment on iliopsoas for athletes with iliopsoas related back pain in reducing pain, improving lumbar stability, and especially promoting sports performances. Iliopsoas release treatment should be used as a routine maneuver prior to core stability training in treating young athletes that have non-specific backache accompanied with iliopsoas tightness or lumbar segmental instability.
Keyword: instability, iliopsoas tightness, core stability training, low back pain
論文目次 中文摘要 ...... I
English abstract...... III
Acknowledge....... V
Contents....... VI
Table Contents ..... X
Figure Contents....... XI
Chapter 1. Literature review ..... 1
1.1 Introduction...... 1
1.2 Iliopsoas tightness and posture of lumbar pelvic region2
1.3 Lumbar segmental instability (LSI).... 4
1.3.1 Clinical test of Instability.... 4
1.3.1.1 Passive intervertebral motion test.. 5
1.3.1.2 The prone instability test.... 6
1.3.1.3 Passive Lumbar Extension.... 6
1.4 Lumbar segmental stability exercise... 7
1.4.1 Stage 1. Local Segmental Control.... 7
1.4.2 Stage 2. Closed Chain Segmental Control... 8
1.4.3 Stage 3. Open Chain Segmental Control... 8
1.5 Motivation...... 9
1.6 Purpose....... 9
1.7 Hypothesis...... 9
Chapter 2. Methods..... 10
2.1 Subjects............... 10
2.1.1 Inclusion criteria............ 10
2.1.2 Exclusion criteria ............ 10
2.2 Instruments.............. 12
2.2.1 Ultrasound-based motion analysis system......... 12
2.2.2Maximum isometric trunk muscle strength........ 12
2.2.3 Hand-held dynamometer............ 12
2.2.4 A digital Inclinometer........... 12
2.2.5 Inclinometer.............. 13
2.2.6 Stop watch and strap............ 13
2.3 Settings.............. 13
2.4 Experimental procedures........... 14
2.5 Measurements.............. 15
2.5.1 Demographic data............. 15
2.5.2 Pain condition............. 15
2.5.3 Physical Examination........... 15
2.5.4 Functional performance tests.......... 18
2.6 Core Stabilization exercise............ 20
2.6.1 Stage 1: Local Segmental Control.......... 20
2.6.2 Stage 2: Closed Chain Segmental Control ........ 21
2.6.3 Stage 3: Open Chain Segmental Control ......... 22
2.7 Manual therapy.............. 23
2.8 Data Processing............. 25
2.9 Statistics analysis............. 26
Chapter 3. Results.............. 27
3.1 Basic data.............. 27
3.2 The changes in the control phase before initiating core stabilization exercise .. 28
3.3 Proportion of Lumbar Instability........... 28
3.4 Flexibility of Iliopsoas............. 30
3.5 The intensity of Low Back Pain and VAS of Trigger Points..... 31
3.6 Flexibility............... 34
3.6.1 Flexibility of Hamstring and Rectus Femoris........ 34
3.6.2 ROM of Hip joint Rotators.......... 36
3.7 Muscle Strength............. 38
3.7.1 Hip Flexor and Extensor........... 38
3.7.2 Hip Abductors and Adductors.......... 39
3.7.3 Strength measurements of Trunk muscles........ 40
3.7.4 Trunk Muscle Strength ratio of Flexor/Extensor (F/E)...... 41
3.8 Maximum Range of Lumbar Spine Motion........ 43
3.9 Average EMG intensity............. 45
3.9.1 Full Flexion phase............ 45
3.9.2 Flexion Relaxation Phenomenon (FRP)......... 47
3.9.2 Reversed phase............. 48
3.10 Performance tests............ 51
Chapter 4. Discussions.............. 52
4.1 The comparisons of baseline data before training....... 52
4.2 Intensity of Low Back Pain........... 54
4.3 Lumbar Stability &Iliopsoas Tightness......... 55
4.4 VAS of Trigger Points............ 57
4.5 Flexibility............... 58
4.5.1 Flexibility of Iliopsoas............ 58
4.5.2 Flexibility of Hamstring and Rectus Femoris........ 59
4.6 Muscle Strength............. 60
4.6.1 Hip muscles.............. 60
4.6.2 Trunk Muscles............ 61
4.7 Maximum Range of Lumbar Spine Motion........ 62
4.8 Average EMG intensity............ 63
4.8.1 Full flexion phase............. 63
4.8.2 Flexion and Reversed phase........... 65
4.9 Performance tests.............. 66
Chapter 5. Conclusions............. 67
5.1 Clinical implications............. 67
5.2 Limitations.............. 68
References............... 69
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