Effectiveness of Joint Mobilization in Addition to Neuromuscular Training on Dynamic Carpal Instability in Athletes with Repetitive Loading on Upper Extremities

關節鬆動術加上神經肌肉訓練對於因反覆承重導致的運動員動態手腕關節不穩定之額外療效

張家豪(Chia-Hao Chang) ； 王子娟(Tzyy-Jiuan Wang) ； 曾國維(Kuo-Wei Tseng) ； 陳文英(Wen-Yin Chen)

《物理治療》 42卷4期 (2017/12) Pp. 327-328

https://doi.org/10.6215/FJPT.2017.74.O06

摘要

Background and Purpose: Dynamic carpal instability is common among athletes, especially in those who repetitively bear weight on their hands. This impairment usually results from ligament laxity and intercarpal positional faults. Yet, there has no established guidelines regarding its clinical management. Neuromuscular training has been recommended for the treatment of joint instabilities and joint mobilization for positional faults in a joint. The aim of this study was to investigate the additional effects of joint mobilization as compared to neuromuscular training for athletes with dynamic carpal instability. Methods: This was a prospective and randomized control trial. Thirty-two student athletes with carpal instability were recruited and randomly allocated into a neuromuscular rehabilitation group (the NMR group) or a combined treatment group with joint mobilization and neuromuscular rehabilitation (the NMR+M group). Both groups received neuromuscular exercise training for their wrist problems, but only subjects in the NMR+M group received carpal mobilization. Wrist active range of motion, pain-free maximal grip strength and pain-free weight-bearing capacity were evaluated before, immediate after the first treatment session, and after the 6-week intervention. Patient specific functional scale (PSFS) was assessed before and after the 6-week intervention, while the global rating of change scores (GROC) was evaluated only after the 6-week intervention. Results: Joint mobilization combined with neuromuscular rehabilitation did demonstrate additional effect on pain intensity (p ＜ 0.001) and weight bearing capacity on the hand (p ＜ 0.001). Similar results were revealed in the participant rated outcomes. The scores of PSFS and GROC were significantly higher in the NMR+M group than those in the NMR group (PSFS: p ＜ 0.006; GROC: p ＜ 0.001). Conclusion: A 6-week neuromuscular rehabilitation combined with joint mobilization was effective on pain intensity and pain-free weight bearing capacity, and these objectively measured functional enhancements did translate to participant-perceived improvements. Clinical Relevance: Neuromuscular training combined with joint mobilization is an effective strategy to treat dynamic carpal instability in athletes with repetitive loading on the upper extremities and allow them to proceed with regular training without delay, and the similarity of the content of neuromuscular rehabilitation could enhance their field performance.