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系統識別號 U0026-3108201611171200
論文名稱(中文) 胸椎鬆動術對於腰椎退化性滑脫之慢性下背痛患者在肌肉活性、腰部受力及疼痛感覺立即性影響
論文名稱(英文) Immediate Effect of Thoracic Mobilization on Lumbar Spine Muscle Activity, Joint Force and Pain Sensation on Lumbar Degenerated Spondylolisthesis of Chronic Low Back Pain Patients
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 104
學期 2
出版年 105
研究生(中文) 蔡旻錡
研究生(英文) Min-Chi Tsai
學號 T66031016
學位類別 碩士
語文別 英文
論文頁數 121頁
口試委員 指導教授-林呈鳳
口試委員-陳文玲
口試委員-徐碧真
口試委員-林政立
口試委員-鄭智修
中文關鍵字 胸椎鬆動術  軟組織放鬆  慢性下背痛  肌電訊號  關節受力 
英文關鍵字 thoracic mobilization  soft tissue release  chronic LBP  myoelectric activity  joint reaction force 
學科別分類
中文摘要 背景與目的:慢性下背痛的疼痛機轉已經被認為是受到許多因素的影響,所以治療時不應只單純針對疼痛減緩去做解決,而應該更完整地考慮致病因素。慢性下背痛患者常會伴隨著較低關節活動度的胸椎而導致有過多的腰部脊椎動作。此外,較差關節活動度的胸椎可能會讓豎脊肌動作時有較大的力臂而使得動作時肌肉活化程度上升,進而讓腰部肌肉緊繃、增加關節受力和疼痛感覺,因此胸椎關節的活動度對於慢性下背痛患者而言非常的重要。所以本篇研究的目的是想要了解胸椎關節鬆動術對於慢性下背疼痛患者在豎脊肌活性、腰部關節受力和疼痛感覺的影響;此外,也想和臨床上最常見的軟組織放鬆做組間比較。方法:共28位經醫師診斷為退化性滑脫且疼痛超過六個月以上參與本實驗,採隨機分配方式分入胸椎鬆動組與軟組織放鬆組,受測者會在治療前後進行關節角度測量、肌肉力量測試、胸椎活動度測試、腰部穩定度測試、組織硬度、疼痛閾值以及進行搬動0公斤與5公斤重的物品去探討搬運時身體軀幹肌肉與腰部關節受力的狀況,並且會用量表在治療前與治療48小時後去看患者的治療延續性效果。重複雙因子變異數分析會用來測量組間與組內差異,顯著差異水準訂在小於0.05。結果:在量表、軀幹伸直肌群力量、關節活動度、組織硬度在兩個治療組前後都有明顯改善,疼痛閾值除了在左邊L1外側量測點沒有前後顯著差異外,其他量測點治療後都能明顯改善疼痛閾值。在肌電訊號部分,腰部豎脊肌經過胸椎鬆動術後和軟組織放鬆相比,在0公斤身體回正時期及5公斤軀幹彎曲與身體回正時期都有明顯降低;關節受力在兩組間沒有顯著差異,但在0公斤右邊髖關節、第五腰椎與第一薦椎關節(L5S1)、第一腰椎與第二腰椎關節(L1L3)最低點及5公斤左邊髖關節、右邊髖關節、第五腰椎與第一薦椎關節(L5S1)、第四腰椎與第五腰椎關節(L3L5)、第一腰椎與第二腰椎關節(L1L3)最低點都有明顯上升。結論:胸椎鬆動術及軟組織放鬆都能有效改善疼痛感覺、增加關節角度、軀幹伸直肌群力量、組織硬度及疼痛閾值,但胸椎鬆動術跟軟組織放鬆相比,在0公斤搬運時較能降低軀幹的肌電訊號以及減緩關節受力增加的速度。因此,本實驗結果建議胸椎鬆動術應該被納入退化性腰部滑脫患者的治療介入模式。
英文摘要 Background: It is widely accepted that pain mechanism of chronic LBP involves multiple factors. Therefore, intervention should not only focus on pain relief but also consider causative factors more comprehensively. Chronic low back pain patients commonly have excessive lumbar spine movements that may be compensated by limited motion of thoracic spine. The tight thoracic spine may lead to greater lever arm for the erector spine muscles. Further, greater erector spinae muscles activity may cause tight extensor muscles, increased lumbar spine joint force and pain sensation in lumbar region. Therefore, thoracic mobility is a very important factor for the chronic low back pain patients. Thus, the purpose of this study is first to determine the effect of thoracic mobilization intervention on erector spine muscles activity, lumbar spine joint force and pain sensation in chronic low back pain patients. The second purpose is to compare the clinical effect on pain, electromyography and joint force between thoracic mobilization and soft tissue release group.
Methods: Twenty-eight participants diagnosed with lumbar degenerated spondylolisthesis and pain over six months patients participated in this study and were randomly divided into thoracic mobilization group (3M11F, n=14) and soft tissue release group (3M11F, n=14). Participants received range of motion test, muscle strength test, thoracic spine mobility test, lumbar instability test, tissue hardness, pressure pain threshold, and then lifted objects with 0 kg and 5 kg before and after the intervention to measure their electromyography activity level and joint force. The questionnaires were measured in the first day and 48 hours after. Repeated two way ANOVA statistical analyses were performed to compare the groups and time effect. The significant level was set at p<0.05.
Results: The questionnaires, trunk extensor muscle strength, ROM, tissue hardness were improved after the intervention both in thoracic mobilization group and soft tissue release groups (p<.05). The pressure pain threshold in each measure points were almost increased after the intervention (p<.05), except the right L1 lateral measure point. The electromyography of lumbar part of erector spinae in thoracic mobilization group decreased significantly in 0kg ascending phase (F=5.523, p=0.024) and 5kg descending and ascending phase (F=4.434, p= 0.041; F=4.574, p=0.038) compared with soft tissue release group. The joint force were not significantly different in these two groups but increased significantly after the intervention in lowest position of 0kg right hip (F=4.502, p=0.040), L5S1 (F=4.390, p=0.042), L1L3 (F=4.445, p=0.041) and 5kg left hip (F=5.302, p=0.026), right hip (F=6.276, p=0.016), L5S1 (F=6.227, p=0.017), L3L5 (F=5.760, p=0.021), L1L3 (F=5.752, p=0.021).
Conclusion: Thoracic mobilization and soft tissue release both can improve the pain condition, increase range of motion, trunk extensor muscle strength, tissue hardness and pressure pain threshold. However, the thoracic mobilization had better effect to decrease the electromyography activity and to slow down the rising rate of joint force during the functional movement comparing to the soft tissue release in non-weight lifting. Therefore, thoracic mobilization should be integrated into the common rehabilitation program for degenerated lumbar spondylolisthesis patients.
論文目次 Abstract II
中文摘要 IV
致謝(Acknowledgement) VI
Table of Content: VII
List of Table XI
List of Figures XII
List of equation XVII
Chapter 1 Introduction 1
1.1 Background 1
1.2 Research purpose 4
1.3 Hypotheses 5
Chapter 2 Literature review 6
2.1 Epidemiology and risk factors of low back pain with lumbar degenerated mild spondylolisthesis 6
2.2 The pain mechanisms of low back pain 8
2.3 Joint force of the lumbar spine 8
2.4 Electromyography activity of the trunk muscles 9
2.5 The clinical presentation of the chronic low back pain patients 10
2.6 The current clinical management and introduction the preferred type of physical therapy in clinical 11
2.7 A new idea of treatment method for chronic low back pain patients 12
2.8 The effect of tight thoracic spine mobility and compensatory muscles on chronic low back pain patients 13
2.9 Manual therapy in thoracic spine have immediately effect to increase thoracic mobility 17
Chapter 3 Methods 19
3.1 Participant 19
3.2 Instrumentation 20
3.2.1 Maker placement 20
3.2.2 Electromyography arrangement 21
3.3 Experimental procedure 22
3.3.1 Questionnaire 25
3.3.2 Physical examination 25
3.3.2.1 Range of motion 25
3.3.2.2 Muscle strength 26
3.3.2.3 Thoracic spine mobility 26
3.3.2.4 Trunk instability test (prone instability test) 27
3.3.2.5 Slump test 27
3.3.2.6 Back erector spine muscle tissue hardness and pressure pain threshold 28
3.3.2.7 Lifting protocol 28
3.3.3 Thoracic mobilization intervention group 30
3.3.4 Soft tissue release intervention group 32
3.4 Data reduction 32
3.4.1 Parameters 32
3.4.1.1 Kinematic parameters 33
3.4.1.2 Kinetic measures 33
3.4.1.3 EMG measures 35
3.4.2 Event definition 35
3.4.2.1 Time moment definition 35
3.4.2.2 Phase definition 35
3.5 Statistical Analysis 36
Chapter 4 Result 37
4.1 Demographics 37
4.2 Questionnaires 39
4.3 Muscle strength and range of motion 44
4.4 Tissue hardness 49
4.5 Pressure pain threshold 57
4.6 Electromyography 65
4.6.1 0 kg condition on the electromyography 65
4.6.2 5 kg condition on the electromyography 71
4.7 Joint force 77
4.7.1 0 kg condition in joint force 77
4.7.2 5 kg condition in joint force 82
Chapter 5 Discussion 87
5.1 Demographics 87
5.2 Visual analog scale, Oswestry Disability Index, Fear Avoidance Belief Questionnaire 87
5.3 Trunk extensor muscle strength 89
5.4 Trunk range of motion 90
5.5 Tissue hardness in lumbar region 91
5.6 Pressure pain threshold in lumbar region 92
5.7 The integral EMG during trunk descending phase and ascending phase 94
5.7.1 0 kg condition 94
5.7.2 5 kg condition 95
5.8 The increased joint force at lowest, recovery, and maximal rotation position 199
5.9 Limitation 103
5.10 Future applications 104
Chapter 6 Conclusion 105
Reference: 107
Appendixes: 116
Appendix 1 Oswestry Disability Index 116
Appendix 2 Fear Avoidance Belief Questionnaire 118
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