中老年人肌肉骨骼疼痛及動作功能之相關探討

Musculoskeletal Pain and Motor Dysfunction in the Elderly Adults

王淑芬(Shwu-Fen Wang) ； 吳瑞屏(Jui-Ping Wu)

《物理治療》 31卷4期 (2006/08) Pp. 261-266

摘要

我國已邁入高齡社會，以規律運動健身者之人數比例仍偏低。其原因之一在於對疼痛及運動的認識不足。本篇文獻回顧著重於中老年人運動時之疼痛現象及心理、認知、社會等因素對疼痛的影響。嘗試回答下列兩個常問的問題：中老年人是否比較容易出現肌肉骨骼系統疼痛？有肌肉骨骼系統疼痛的中老年人，其疼痛本身對動作功能的影響有哪些？中老年人有較高的比例出現肌肉骨骼系統疼痛，部分原因是對抗重力的肌肉及軟組織隨著組織退化而功能消退，反應協調能力下降。肌肉骨骼系統之疼痛會造成肌肉張力增加、動作控制異常、改變脊椎深淺層肌收縮方式之現象。慢性疼痛所發生的周圍及中樞敏感生理現象及對動作後產生疼痛的恐懼排斥也會造成心理認知的障礙。中老年人運動時宜以循序漸進的方式，注意運動前的暖身及緩和，進行低衝擊性運動，並考慮對運動及疼痛之認知。針對預防腰酸背痛而言，建議對過度用力肌群進行放鬆及伸展，增加軀幹對抗重力肌群的肌力與耐力，及訓練深層肌群反應協調能力。此外，配合生理回饋的運動以增加動作控制的能力，也是建議的運動項目。運用這些原則於我國的中老年族群之運動成效，仍須進一步的實證。

關鍵字

老年人 ； 運動 ； 疼痛 ； 適應

並列摘要

The percentage of our elderly population that maintained regular exercise is relatively low. One of the psycho-socio-physical factors that prevent the elderly to maintain exercise are the lack of understanding of pain phenomenon during activities. This review aimed to answer two frequently asked questions: Do the elderly have more musculoskeletal pain? How does the musculo-skeletal pain influence the motor system of the elderly? Some of the reasons that higher percentage of the elderly suffered with musculoskeletal pain are related to the changes of extensibility of connective tissue, muscle power, and muscle reaction time. These changes might lead to the development of abnormal posture and the consequent wear-and-tear phenomenon. Musculoskeletal pain itself could result in increased reflex, muscle tone, motor control impairment of superficial or deep muscles. Exercise principles for the elderly include gradually exposure, warm-up and cool-down, low impact and low resistance exercise. To prevent the development of abnormal posture, stretching and relaxing exercises and strengthening of the extensor and deep group of the trunk are recommended. This exercise principle was proposed based on theoretical inference from the mechanism of pain and movement dysfunction, thus needed to be further tested with clinical trials.

並列關鍵字

Elderly ； Exercise ； Pain ； Adaptation