腓腸肌緊縮對行走時的肌肉拉緊程度及踝和膝關節動作的影響

The Effect of Gastrocnemius Tightness on the Tensile Level of Muscle, the Ankle and the Knee Movement During Walking

吳錫昆(Shyi-Kuen Wu) ； 羅世忠(Shu-Zon Lou) ； 陳翰裕(Han-Yu Chen) ； 陳志鳴(Chih-Ming Chen) ； 李瑋君(Wei-Chun Lee) ； 游家源(Jia-Yuan You)

《物理治療》 44卷2期 (2019/06) Pp. 53-61

https://doi.org/10.6215/FJPT.201906_44(2).0002

摘要

背景與目的：腓腸肌緊縮會影響踝或膝關節的活動度，本研究目的在探討腓腸肌緊縮對行走時腓腸肌拉緊程度、踝和膝關節動作的影響。方法：實驗包含腓腸肌緊縮組、輕度緊縮組和腓腸肌柔軟度正常的控制組，各組依腓腸肌柔軟度測試結果篩選分別徵召10位受試者。步態試驗是以動作分析系統測量與計算出行走的時空參數、踝關節和膝關節的角度。腓腸肌長度是利用踝和膝關節角度輸入數學模式推算。腓腸肌拉緊程度為行走中腓腸肌長度除以腓腸肌柔軟度測試的長度。結果：行走中在第二峰值腓腸肌長度（腓腸肌最長）時，3組間的腓腸肌拉緊程度有顯著差異（p ＜ 0.001）。緊縮組的腓腸肌拉緊程度最大，輕度緊縮組次之，正常控制組最小。在第二峰值腓腸肌長度時的踝關節角度在3組間無顯著差異，但膝關節角度在3組間有顯著差異（p = 0.002）。緊縮組和輕度緊縮組的膝關節較正常控制組彎曲。結論：在行走中腓腸肌最長時期，緊縮腓腸肌的拉緊程度已超過柔軟度測試的情況，患者以增加膝彎曲的不正常動作代償肌肉的延展受限而維持踝關節正常動作。

關鍵字

腓腸肌 ； 肌肉緊縮 ； 步態分析 ； 運動學

並列摘要

Background and Purpose: Gastrocnemius tightness can affect the ankle or the knee joint movement. Therefore, the purpose of the study is to investigate the effect of the gastrocnemius tightness on the tensile level of muscle, the ankle and the knee movement in gait. Methods: The gastrocnemius flexibility test was used to screen the participants. Ten volunteers with tight gastrocnemius (tight group), 10 volunteers with mildly tight gastrocnemius (mildly tight group), and 10 healthy volunteers with normal gastrocnemius flexibility (control group) were recruiting in the study. A motion analysis system was used in the gait analysis. The spatiotemporal parameters, joint angles in the ankle and the knee joints were computed and analyzed. The gastrocnemius length was calculated by the mathematic model with input the joint angles in the ankle and the knee joints. The gastrocnemius tensile level was using the gastrocnemius length during gait dived by the length in the gastrocnemius flexibility test. Results: At the time of second peak gastrocnemius length (maximal gastrocnemius length) during walking, significant differences were found in the gastrocnemius tensile level among the three groups (p ＜ 0.001). The tight group had the higher gastrocnemius tensile level than the mildly tight group, and the both tight and mildly tight groups had higher gastrocnemius tensile level than the control group. There was no significant difference for the dorsiflexion angle among the three groups at the time of second peak gastrocnemius length during gait. However, the group significantly affected the knee joint angle at the time of second peak gastrocnemius length during gait (p = 0.002). Compared with the control group, a greater knee flexion was found in the tight group and mildly tight group. Conclusions: At the time of maximal gastrocnemius length in gait, the tensile level of tight gastrocnemius exceeds the condition in the gastrocnemius flexibility test. Participants with tight gastrocnemius increase the knee flexion to compensate the limitation of gastrocnemius tensile level and to maintain the normal movement in the ankle joint.

並列關鍵字

Gastrocnemius ； Muscle tightness ； Gait analysis ； Kinematics