熱療與腰椎牽拉對下背軟組織僵硬程度與關節活動度之影響效果

Effects of Thermal Agents and Lumbar Stretch Exercise on Lower Back Soft Tissue Stiffness and Range of Motion

陳嘉弘(Chia-Hong Chen) ； 徐其昭(Chi-Chao Hsu)

《物理治療》 43卷4期 (2018/12) Pp. 258-265

https://doi.org/10.6215/FJPT.201812_43(4).0003

摘要

背景與目的：熱療雖有降低肌肉痙攣、增加組織延展性等效益，但臨床證據並不明確，本研究探討三種不同的熱療及腰椎牽拉對下背軟組織僵硬程度與關節活動度之影響效果。方法：31位健康受試者，均接受熱敷袋、紅外線、短波、腰椎牽拉和無介入等5種方式的介入，抽籤決定順序，每項介入中間至少隔一天，受試者均採俯臥姿，介入時間20分鐘，介入前後皆測第四與第五節腰椎接合處兩側同高的脊柱旁肌軟組織僵硬程度，以及腰椎前彎Schober測試。結果：只有腰椎牽拉可以有效的降低下背軟組織僵硬程度(p = 0.001)，其餘的熱療均無達統計上顯著差異。比較5種不同介入方式的效益結果顯示，僅腰椎牽拉和紅外線治療器介入(p = 0.028)，以及腰椎牽拉和無介入(p = 0.007)達顯著差異。在改良式Schober測試方面，無論各組治療前後或各組間的比較均無差異。結論：熱療介入並無改變下背軟組織僵硬程度，而腰椎牽拉雖無法增加腰椎活動度，但仍有助於腰椎軟組織的僵硬程度下降。

關鍵字

熱療 ； 腰椎牽拉 ； 軟組織僵硬程度 ； Schober測試

並列摘要

Background and Purpose: The concept of decreasing muscle spasm, increasing tissue elasticity and decreasing joint stiffness by thermal agents are commonly accepted. But very few clinical studies proved it. Therefore, the purpose of this study is to investigate the effects of three different kinds of thermal agents (including hot pack, infrared and shortwave) and lumbar stretch exercise on lower back soft tissue stiffness, and range of motion. Methods: Thirty-one healthy subjects were recruited in our study (average age = 29.6 ± 8.3 years old). Every subject received five kinds of interventions, including hot pack, infrared, shortwave, lumbar stretch exercise and rest (on intervention). The sequence of interventions was decided by draw lots. The resting interval between any two interventions was more than 24 hours. The position of interventions is prone. All interventions lasted 20 minutes. The measurements before and after interventions were modified Schober test and soft tissue stiffness measurement of paraspinal muscles between L4 and L5 with myotometer to compare the differences between pretest and posttest. Results: Lumbar stretch exercise made lower back soft tissue stiffness decreased effectively (p = 0.001). There is no statistically significant difference between pretest and posttest of all thermal agents' interventions. There are significant differences between lumbar stretch exercise and infrared (p = 0.028) and between lumbar stretch exercise and rest (p = 0.007). There is no statistical significant difference between interventions and between pretest and posttest. For modified Schober test, there is no statistical difference between all compares. Conclusion and Clinical Relevance: Thermal agents do not interfere with lower back soft tissue stiffness. The mobility of lumbar spine is not increased after lumbar stretch exercise, but the stretch exercise helps to decrease lower back soft tissue stiffness. We hope that lumbar stretch exercise could be used in treating lower back problems in the future.

並列關鍵字

Thermal agents ； Stretch exercise ； Stiffness ； Schober test