主動動態伸展對腓腸肌肌肉肌腱複合體緊繃者之肌肉長度變化

腓腸肌肌肉肌腱複合體（GAS-MTU）緊繃者常見於運動愛好者，造成腳踝背屈角度受限，嚴重會引起其他部位問題。傳統處理方式為靜態伸展，但靜態伸展後，雖可增加踝背屈角度，但會降低其運動表現。近代研究指出採用動態伸展能增進肌肉柔軟度，且可強化運動表現。然而這些研究皆為間接量測，未有研究探討動態伸展對組織長度的影響，故本研究旨在探討使用全景式超音波影像量測GAS-MTU之肌肉段、筋膜段、肌腱段等三區段之長度，以了解腓腸肌緊繃者的緊繃區段位置，並藉由主動動態伸展是否能影響腓腸肌緊繃者之GAS-MTU的各區段長度變化，進一步分析GAS-MTU之各段組織特性與主動動態伸展是否能提供不同之動作表現。為確保影像品質，實驗前先檢測本研究全景式超音波影像操作者之測試者內信度。本研究為便利取樣、隨機控制、測量者、影像數據擷取者雙盲、前後測的實驗設計。在測試者內信度的研究中，檢視本研究全景式超音波影像操作者執行GAS-MTU的各區段長度量測時之測試者信度，徵召12名健康成人，受試者接受間隔一小時的兩次GAS-MTU長度之全景式超音波影像量測，量測者為本研究操作者。使用組內相關係數、量測標準誤以及最小偵測改變值來檢測同一量測者於同日之測試者內信度。主研究共分二部分：第一部分收集腓腸肌緊繃者23名與非緊繃者10名，使用全景式超音波影像量測GAS-MTU之各區段長度，以共變異數分析比較緊繃者與非緊繃者之各區段長度差異。第二部分將緊繃者23名隨機分配於伸展組（16名）與控制組（7名），伸展組進行主動動態伸展而控制組為靜態坐姿休息，使用全景式超音波影像量測GAS-MTU之各區段長度。並以電子量角器量測最大踝背屈角度，以跳躍高度測量板量測蹲跳測試的高度。使用重複量測變異數分析來比較二組介入前、後各區段長度、最大踝背屈角度與跳躍高度之差異。所有數據皆以SPSS統計套裝軟體第25版進行分析，顯著水準訂在 = 0.05，檢定力訂在0.8。本研究先導之GAS-MTU之各區段的測試者內信度研究，發現本研究全景式超音波影像操作者之二次量測的ICC值皆 > 0.998（95%CI: 0.993 ~ 1.000），SEM介於1.29-2.19 mm之間，MDC則在2.53-6.06 mm之間，故為優異之量測信度，其擷取之影像品質優異。第一部分主研究發現緊繃者與非緊繃者之GAS-MTU各區段長度經小腿長校正之共變數統計分析之後皆無顯著差異。第二部分主研究發現緊繃者於主動動態伸展介入前、後在各區段長度進行共變異數分析後發現，其肌肉段（p=0.034）與全長（p=0.003）有顯著差異，而踝背屈角度僅有在介入前、後之顯著差異（p<0.001），其他區段之組織長度、跳躍高度（p=0.061）於兩組間皆無顯著差異。本研究結果顯示GAS-MTU緊繃者的緊繃發生部位尚不明確，但緊繃者於主動動態伸展後，雖能增加踝背屈角度，但伸展的效應發生在GAS-MTU的肌肉段，對於緊繃的筋膜段在伸展前後未能呈現變化。但因施測方式不同、受試者族群差異、受試者人數亦會影響此結論，故未來需要增加個案數將使後續研究繼續探討。

關鍵字

腓腸肌；肌肉肌腱複合體；主動動態伸展；柔軟度；超音波影像；跳躍表現

並列摘要

Tightness of the gastrocnemius muscle-tendon unit (GAS-MTU) occurs frequently in individuals who engage sports activities. It results in restriction of ankle dorsiflexion angle and may affect other joints in the severe situations. It is well-known that static stretch to the GAS-MTU may improve ankle dorsiflexion, but recent studies showed that static stretch before competition may affect their sport performance. Some researchers proposed dynamic stretch to substitute static stretch due to similar effect on muscle flexibility improvement but better sport performance. However, most of those studies measured the effect of dynamic stretch by functional improvement or ankle dorsiflexion angle only. No studies has been conducted to measure the change of tissue length after active dynamic stretch. Therefore, the purposes of this research were 1) to compare lengths of the muscle, fascia and tendon portions of the GAS-MTU using panoramic ultrasonography between people with and without a tight GAS-MTU; 2) to investigate the effect of active dynamic stretch on length of each portions of the GAS-MTU, maximum ankle dorsiflexion angle and squat-jump angle among individuals with tight GAS-MTU. To ensure the image quality, a reliability study of panoramic ultrasonographic measurements was conducted to investigate the intra-rater reliability of the operator who is the examiner of this research. This research is a convenience sampling design, randomized allocation, and pre-post study design. The pilot intra-rater reliability study recruited 12 participants who participating sport activities at least 5 hours weekly. All participants received twice length measurements of the GAS-MTU using panoramic ultrasonography within a 1-hour interval. All images were taken by the same examiner who is also the same operator in the main study. The reliability indices included intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC). The first part of the main study recruited total 33 participants, including 23 individuals with tight GAS-MTU and another 10 without tight GAS-MTU. Lengths of 3 different portions of the GAS-MTU was measured using panoramic ultrasonography and compared the mean differences between 2 groups using analyses of covariance (ANCOVA). The second part of this research recruited 23 participants with a tight GAS-MTU and randomly assigned into 2 intervention groups: stretch and control groups. The stretch group executed active dynamic stretch for 6 min by performing a heel drop and heel raise alternatively to stretch the GAS-MTU of both legs while the control group just quiet sitting for the same time. All participants received a total of 2 measurement before and after intervention, including panoramic ultrasonographic measurements, maximum ankle dorsiflexion angle and squat jump height. An analysis of variance (ANOVA) with repeated measures was employed for statistical analyses. All analyses were processed using SPSS v.25. The significant  level and power were set at  = 0.05 and 1- = 0.8, respectively. Results of the intra-rater reliability suggested that the panoramic ultrasonography operator in this research has an excellent intra-rater reliability on the same day with ICC > 0.998 (95%CI: 0.993 ~ 1.000), and SEM between the range of 0.41 ~ 0.69 mm, and MDC between the range of 1.13 ~ 1.92 mm. Results of the first part study showed no any significant diffeneces between the three portions of muscle, fascia and tendon, and also total length after adjusted by low leg length (all p > 0.05). For the second part study, however, only muscle portion had significant change after active dynamic stretch (F = 5.121, p = 0.034). Although degree of ankle dorsiflexion without trend to improve between group (F=.596, p=.449), there is a trend to increase in both group after intervention (F=28.190, p<0.001), and no trend in the jump height variable between both groups (F=3.917, p=0.061). The research findings revealed that tightness of the GAS-MTU occurred at which portion is still unknown, but only the muscle portion showed marginal elongation after active dynamic stretch. Active dynamic stretch did not affect the length of the fascia portion. We may fix the testing condition, target on part of participants or increase population to know detail of GAS-MTU tightness and effect of active dynamic stretch in the future study.

並列關鍵字

gastrocnemius muscle ； muscle-tendon unit ； active dynamic stretch ； flexibility ； ultrasonography ； jump performance

參考文獻

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國際替代計量

主動動態伸展對腓腸肌肌肉肌腱複合體緊繃者之肌肉長度變化

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