功能性踝關節不穩定影響平衡測試中踝關節肌肉活化的表現

Functional Ankle Instability Influences Ankle Muscle Activation during Balance Tasks

蔡博琳(Po-Lin Tsai) ； 陳文英(Wen-Yin Chen) ； 施怡芬(Yi-Fen Shih)

《物理治療》 42卷2期 (2017/06) Pp. 80-87

https://doi.org/10.6215/FJPT.PTS20170642024

摘要

背景與目的：功能性踝關節不穩定（functional ankle instability, FAI）為常見之腳踝扭傷後遺症，患部關節機械性敏感性降低可能造成此類患者的神經肌肉控制受影響。過去對於踝關節不穩定患者的功能性活動表現如跳躍與站姿轉換等研究中，發現患者具有異常的足部肌肉活化情形，然而各研究結果並不一致。另外，過去研究多在患者穿著鞋子的情況下測試，對於光腳時的足部肌肉表現情形則少有探討。因此本篇研究的目的為，探討穿鞋與否是否影響FAI患者與健康者神經肌肉表現的異同。研究方法：研究招收功能性踝關節不穩定患者（FAI組）與一般健康者（控制組）各9名，分別在穿鞋及沒有穿鞋狀況下測量其雙至單腳站立（double-to-single-leg stance test, DST）與單腳落地（single-leg landing test, SLT）兩個任務中的比目魚肌與腓骨長肌表面肌電圖。統計分析使用多變項變異數比較兩組間表面肌電圖參數的差異，並以T檢定進行事後分析。結果：與控制組相比，患者在跳躍落地時，腓骨長肌在反應性肌肉活性變項上有組別的差異（group main effect, p=.015）；事後分析顯示，FAI患者顯現較低的比目魚肌和腓骨長肌活性（p=.013; p=.028）。兩組受試者在光腳與穿鞋狀況的肌肉反應則無顯著差異。結論與臨床意義：功能性踝關節不穩定顯著影響病患腓骨長肌與比目魚肌的活化程度與時序。臨床介入時應警惕此類個案的神經肌肉表現差異以提供適當的復健治療。

關鍵字

功能性踝關節不穩定 ； 肌肉活化 ； 表面肌電圖

並列摘要

Background and purpose: Functional ankle instability (FAI) is a common residual symptom after lateral ankle sprain injuries. The reduced mechanical sensitivity of the injured joint might have an effect on the neuromuscular control in these individuals. Previous researchers identified alterations in muscle activation during functional tasks; however, the results were inconsistent. Furthermore, most studies performed the measurement under shod condition. Not much was known about the influence of barefoot or shod condition. Therefore, the purposes of the study were to investigate the effect of wearing shoes or not on the muscle activation in subjects with and without FAI. Methods: We recruited 18 subjects, nine with FAI (FAI group) and the other nine without FAI (control group). Each subject performed the double-to-single-leg stance test (DST) and the single-leg landing test (SLT) under two conditions: barefoot and shod. The electromyographis (EMG) data of soleus and peroneal longus were measured during the tests. We used multivariate analysis of variance to compare the between-group and the within-group EMG data. Results: The results showed a significant group effect for the peroneus longus reactive muscle activation during SLT (p = .015). The post-hoc t-test indicated lower activation level of the soleus and peroneal longus in the FAI group (p = .013; p = .028) during the SLT. No significant difference was identified for barefoot or shod conditions. Conclusion and clinical relevance: FAI had a significant influence on muscle activation pattern which should be taken into consideration when managing individuals with FAI.

並列關鍵字

Functional ankle instability ； Muscle activation ； Surface electromyography